This paper is an attempt to chronicle and evaluate the struggle to innovate, to understand and to produce a sustainable response to the pressing problems of the care and protection of an aging population. In that struggle, quite distinct world views of the lived experience of the older person and their families and carers, the pressures and challenges of practitioners, on managers and planners and on the politicians who strive to improve the experience of life of their constituents and the desire of technicians to design and build something useful and interesting come together not in a rational orchestration of interests but in the agonistics of real life. The reality of the distinction between what we have called North-South, hierarchical. and East-West, peer and partnership behaviours and attitudes, between Gregory Bateson’s distinctions of first order and second order processes and deutero versus acquisitive learning together with the need to support and nurture sense making and co-production are very apparent in the experience of the project. The challenges of maintaining an appropriate balance have been significant and are ongoing. We have tried to describe, and provide some detailed evidence for, a style of intervention which we have claimed takes a step further than what is usually conceived of as participative design. This is not based on a reallocation of rights and capabilities between architect/designers and client/users in what are still linear or iterative but two sided design processes. Such reallocations still leave the definition of the objectives and the contexts of development as preconditions of design and assume that the architectural language and conceptual framework are available to the participants in which the problem and the solution can be articulated. In circumstances where these assumptions cannot be safely made, there is a need for an intervention which has the purpose of addressing this lack. In our classification of development processes, this necessarily implies the creation of what we have called East-West occasions which are furnished with material, exhibits and provocations around which the participants can engage with each other in sense making and the co-construction of a shared language.