Direct care services that have been available have been fraught with problems brought on by a high-turnover workforce that is inconsistent in its delivery of care. Low wages, worker isolation, lack of peer support, lack of benefits and lack of opportunities for career advancement all contribute to exceptionally high turnover rates in the direct care workforce. Today’s direct care workers also are more likely than other workers to live in poverty, to lack health insurance and to rely on food stamps.

In spite of this bleak profile of the direct care workforce, the U.S. Census Bureau reports that, between 2006 and 2016, direct care work will be one of the fastest-growing occupations in the nation, with the demand for personal and home care aides expected to grow by approximately 50 percent. Aging “baby boomers,” along with adults that are living longer, account for much of the increased demand for services. The new health care reform law reinforces that demand with its stated preference for home- and community -based services that acknowledges the need for a bigger and better long-term care workforce and it includes incentives for workforce recruitment and training programs. The challenge is to make direct care jobs an attractive alternative and to build stability and quality care into the direct care workforce. Much of that can be achieved through effective recruitment and training, but consideration should also be given to a more innovative model for the direct care business itself: a work-owned business.

Home Care Cooperatives – An Innovative Solution

In a field that has been, historically, plagued with low wages, inconsistent quality of care and an unstable workforce, the home care cooperative provides a stark contrast.  What sets home care cooperatives apart from other providers of home care is their focus on the workers — their training, their compensation, their peer relationships, their relationships with their clients, and their role in the governance of the business. The home care cooperative provides a dependable, mutually supportive and stable workforce to meet the home care needs of its clients and it empowers its caregivers (mostly lower-income women) by giving them a voice in how their business is run. It is a business model in which the employees are involved in ownership and management of the business, participating in control of the business on a democratic basis of “one person, one vote.” Rather than being independent contractors providing home care services in an isolated setting, members of a home care cooperative have a peer group, a role in decision making, opportunities for training and professional interaction with fellow members, a benefits package, workers compensation coverage, patronage refunds and a living wage.

Home care cooperatives all share a common governance structure, but there are several basic approaches that have received the most attention: creation of a new worker-owned business; conversion from a private agency to a cooperative; or even a hybrid in which ownership is shared by clients and workers. Our neighbors to the North in Canada have much more experience with this hybrid model of cooperative home care than the United States. Since 1997, 30 of these cooperatives have been organized in Quebec province that are known as a multi-stakeholder (or “solidarity” co-op) in which the member-owners of the cooperative are care providers, care recipients, and external interests such as advocacy groups or area hospitals. In the United States there are several well-established urban home care cooperatives, but the rural worker-owned model has only been tested in recent years through a US Department of Agriculture pilot program that established several home care cooperatives in Hawaii and Washington State. That USDA pilot program was designed to replicate the successful launch in 2001 of the first rural worker-owned home care cooperative, Cooperative Care in Wautoma, Wisconsin.