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.

What services have been available have been fraught with problems and questions about the consistency and quality of care. A major problem has been the stability of the workforce. Low wages, worker isolation, lack of benefits and lack of opportunities for career advancement all contribute to exceptionally high turnover rates.

Home care cooperatives could be a solution. There are several basic approaches that have received the most attention: creation of a worker-owned business; conversion from a private agency to a cooperative; or even a hybrid in which ownership is shared by clients and workers. Some of these approaches are currently being tested in a variety of rural settings across the country through the USDA Home Health Care Cooperative grant program.