A major challenge in rural America is making affordable home health care services available for the elderly who either can’t afford to move out of their houses or who have no interest in leaving their homes. The situation is complicated by the fact that many rural elders have inadequate retirement benefits and lack adequate private health insurance. Even if they could afford a nursing home, in some areas there are so few nursing homes that the elderly may have no choice but to stay in their homes if they want to stay in the community. Instead, they rely on rural aging services networks that haven’t always been able to meet the population’s needs for in-home health nursing, homemaker and chore services, respite programs, adult day care, adult foster care and hospice care.
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. See http://www.cdf.coop/challenges-confronting-the-direct-care-workforce/.
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 and three rural home care cooperatives: Cooperative Care in Wisconsin, Circle of Life in Washington State, and Paradise Home Care in Hawaii.