Getting Creative–And Cooperative–to Meet Rural Home Health Needs

In the late 1990s in tiny Wautoma, Wisconsin, two recipe boxes sat in the Waushara County human services office and dictated how residents in need of home care accessed that support. One box’s stack of index cards held the names and information of home care workers. The other held cards with information on local residents needing care. County staff did their best to make matches, but the work was hard to coordinate, and jobs for caregivers were precarious and offered no insurance or other benefits.

In home care, both clients and caregivers can face significant challenges, which can be particularly acute in rural areas. On the worker side, the US Bureau of Labor Statistics projected employment as a home care worker or personal care aide to grow by 21 percent between 2023 and 2033, compared to 4 percent for overall employment. However, despite the urgent need, pay for caregivers tends to be very low. Nationally, home care workers earn around $16 an hour. And pay aside, in 2022, the US Surgeon General issued an advisory on burnout among health care workers. In the accompanying report, both home care workers and rural health care workers were highlighted as groups that had experienced particularly challenging environments both before and during the COVID-19 pandemic.

As for those needing care, a 2023 report from the Commonwealth Foundation points out that rural seniors who want to age in place–to continue to stay in their homes with appropriate support–may face particular struggles accessing professional in-home care. This could require them to instead move to a skilled care facility or to depend on informal caregiving from family. Home care is hard and often undervalued work, but it is essential for individuals needing these services .

But Waushara County leaders wanted to find a better way. In 1999, while residents were still match-making with recipe boxes, the head of the county human services division, Lucy Rowley, happened to run across a report about Cooperative Home Care Associates in the south Bronx, a worker-owned home care cooperative, and decided to explore whether this innovative strategy could work well in their county. Intrigued by the concept of a cooperative, she and other county leaders met with the local community action agency and with Margaret Bau, who had recently joined USDA Rural Development as a cooperative developer and who kindly shared her experiences with me for this piece. That conversation led to the development of Cooperative Care, serving residents of Waushara County–and now four others–since 2001. Worker cooperatives, unlike conventional businesses, are jointly owned by members. Expenses and profits are shared, and decision-making for the business is collaborative.

Worker cooperatives for home care are no silver bullet, but they do offer some clear benefits. For example, recent statistics from the ICA Group, a nonprofit operating as a worker cooperative providing development and strategic support to other cooperatives, show that home care workers in cooperatives earn $2.37 more per hour on average than peers working in noncooperative counterparts in the same states where home care cooperatives operate. And at Cooperative Care, members/owners are paid for serving on most committees and on the cooperative board, as well as for time spent mentoring peers, providing earnings and leadership development opportunities on top of their hours spent caring for clients. Not only that, annual turnover for home care workers nationally with conventional employers is a staggering 78 percent. However, turnover is less than half that at 30 percent for home care workers in cooperatives. In fact, Margaret mentions that Cooperative Care is now seeing second generation members/workers, the children of care workers who initially formed the cooperative over 20 years ago.

While not (yet) commonplace, this business model may present rural community leaders and caregivers a way to meet local home care needs and encourage higher quality caregiving jobs at the same time. If you’re curious about whether a cooperative home care model could serve your community well, Margaret offers a few good places to start:

• First, look into USDA resources. USDA Rural Development offers a library of publications related to cooperatives. Two grant opportunities, the Socially Disadvantaged Groups Grant and the Rural Cooperative Development Grant Program may be of interest. You can reach out to your state USDA office to get more information for information and resources on exploring the cooperative model.
• The ICA Group also provides a great library of resources on starting and sustaining cooperatives, with some tools created specifically for home care cooperatives. Margaret says making a cooperative work in isolation isn’t easy and that the ICA Group’s work to support collaboration among home care cooperatives has been a huge benefit.
• The Cooperative Development Foundation provides an array of publications and guides on key issues for cooperatives, such as financing and governance strategies. CDF also operates the Home Care Cooperative Initiative to support peer learning, including an annual home care cooperative conference.

As more communities seek solutions to home care access and better working conditions for caregivers, the cooperative model may provide just the creative solution they need.