Like last week, I’ve been thinking this week about how people take care of each other in hostile situations. I want to share some notes about Cooperative Home Care Associates (CHCA), a worker co-op that allows workers, mostly women of color, to take care of themselves and their clients, despite the tough situation created by the health care system.
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Home health care is a tough business
Helping people who are aging, ill, or disabled is challenging skilled work. It’s also work that is in high demand with not nearly enough caregivers to meet the sharply increasing need.
Despite the need, home health care jobs are poorly paid with few benefits, inconsistent hours, little training, and few paths for advancement. More than half of home healthcare workers need public assistance just make ends meet. It’s a bad deal, especially for such important work.
There are various causes. A root cause is that care and caregivers are also not highly valued in US society. Which means that there is not enough public investment in home care. The situation is exacerbated by the fact most of this work is done by women of color and immigrants, whose work is chronically undervalued.
It’s a bad situation.
Here’s an article about the problems in the home health care system:
An article on the challenges faced by caregivers: Porter, Eduardo. “Home Health Care: Shouldn’t It Be Work Worth Doing?” The New York Times, August 29, 2017, sec. Business.
Some more stats on home caregivers: Paraprofessional Health Care Institute, “U.S. Home Care Workers: Key Facts”, 2016.
Cooperative Care
Cooperative Home Care Associates (CHCA) offers a much better situation for caregivers. Founded in 1985 in the Bronx, the organization’s goal from the beginning was to create opportunities for borough’s poor Black and Latinx women. Today it’s grown to 2,000 workers and serves clients across the NYC area.
Jobs with CHCA are a lot better than the national averages: Pay and benefits are much better. They have guaranteed minimum hours, extensive training, opportunities for advancement, a great deal of control over their work. CHCA also offers other perks, like financial literacy classes, tax prep help, and interest-free short term loans.
CHCA manages this because it is a worker co-op. It’s actually the largest worker co-op in the US. This means that the caregivers fully own and control the company. No outside investors get profits and no external board of directors sets the direction of the company. Instead, the workers themselves decide what to do with surplus income and each member has equal voting power to choose the board and make governance decisions. As a result, workers are able to invest in themselves and the company can call on the expertise and leadership of every member.
The structure seems to make a big difference. Lots of companies talk about valuing employees and many ask for suggestions from workers, but these gestures only ever go so far. CHCA shows what is possible when the workers are the whole show.
Here are some links to learn more about CHCA:
An overview of CHCA: Community Wealth, “Cooperative Home Care Associates,” July 5, 2012.
A book based on interviews with CHCA members: Glasser, Ruth, and Jeremy Brecher. “We Are The Roots: The Organizational Culture of a Home Care Cooperative,” 2002.
Just the beginning
CHCA is the largest and most established worker-owned health care co-op in the US, but it is part of a growing movement. Here are some links to the larger picture:
An article arguing for the importance of home care cooperatives: Reed Ingalls, “Home Care Cooperatives and the Future of Work,” Resilience, March 12, 2018.
Some podcasts about worker co-ops in health care: UW Center for Cooperatives. “Homecare Cooperative Podcasts.” Accessed June 13, 2022.
A report on the potential of co-ops to change the home care landscape: Cooperative Development Foundation, “The Cooperative Solution to the Caregiver Crisis: A National Strategy Analysis” 2017.
Some links to co-ops in other areas of health care: UW Center for Cooperatives, “Healthcare”
Co-ops are an important and growing part of healthcare across the world. Although the health care systems vary greatly and each fails in distinctive ways, co-ops seem to be able to answer the problems in each case. There’s a lot more to learn about these variations.
A report on the worldwide role of co-ops in healthcare: International Health Cooperative Organization, “Cooperative Health Report 2018.”
I’d love to hear from you. What’s your vision for a living world? What projects and ideas are you excited about? What topics do you want to see here? What am I missing? Let me know in the comments.
