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Worker ownership and empowerment in the home healthcare industry

[The need for in-home care is growing rapidly. While the field of in-home care is known for low wages, cooperatives provide an alternative. Recently WIP’s Matt Crichton talked with Nora Edge, founder and past executive director of Capital Homecare cooperative, and CHC current executive director Paulette La Douceur.]

MC: How did you get into the in-homecare field?

Paulette: I was raised in a large, multi-generational family. I’ve been a caregiver since I started babysitting when I was 12. It’s a skill that is minimized in our culture, and often we minimize ourselves as domestic workers. Coming to Capital Healthcare was one of the most empowering experiences of my adult life.

Nora: I started out taking care of our grandfather in high school, through the end of his life. I knew about the Northwest Cooperative Development Center. I got into the field after I was invited by someone here to come and learn about cooperative homecare. I eventually started the coop we are discussing today.

MC: What is the demand for in-home care workers?

Nora: Right now, we are in the “silver tsunami” of the baby boomers. Over 10,000 people are turning 65 every day. Ironically, as the number of seniors who need care goes up, the number of people trained in that industry is going down. The need for caregivers is intense. The 2016 census by the NW Cooperative Development Center found that for every caregiver available, there are 16 people who were not going to receive care in their lifetime, regardless of need.

At the same time, the caregiver workforce is one of the most exploited in the country. Most homecare agencies make a very nice profit while paying their caregivers the lowest possible wage. The hours are incredibly difficult, inconsistent, and very person-centered. It requires a great deal of skill to do this work. The average homecaregiver is aged 39 to 75, but 40% of these are between 65 and 75. 60% of homecare workers are immigrants. A similar percentage are women and speak English as a second language.

MC: How long has Capital Home-care Coop been around?

Paulette: CHC is five years old. New York has one of the oldest home-care coops. It was started in the Bronx in 1983 and has over 2000 members who make the highest caregiver wage in New York State. In Washington State we have five care coops. The oldest, Circle of Life in Bellingham, has been around about 15 years. We’re one of the newer ones.

MC: How is the coop in-home care model different from the regular model?

Paulette: What sets the cooperative model apart is the notion of worker ownership and empowerment. Our workers are invested in this business and have the opportunity to make their voices heard, their needs addressed, and to learn skills that come through business ownership. In most agencies, workers have no place at the table.

Members of our board of directors are appointed by the workers. This governing body creates all of our policies. Each worker who wants to engage in our processes can become a part of the on-going story of who we are, what we create and implement together.

MC: Many WIP readers are familiar with the Olympia Food coop. Is this coop organized in the same way?

Nora: In the coop world, there are different types of coops. A grocery coop is a consumer coop with customers as members. Typically, they are the ones making the decisions. In a worker cooperative, like ours, the workers own the business. Both types have a board of directors, but one has a board made up of customers/consumers, and the other has workers as board members. What’s similar is one member, one vote.

How profits are distributed is up to the workforce. Membership has control over the rates and wages that are set, and the overall goals of the business. That makes it much easier to support workers in this industry. In Washington, on average we pay our caregivers $2 more an hour than standard competitors. Our caregivers voted for that. They have a lot more control.

MC: How does the cooperative model address issues of burn-out?

Paulette: Instead of having top-down management scheduling people without offering them any say, we try to be like matchmakers. We set people up for success by connecting well with clients. We want our workers to set boundaries for themselves, to take on what is manageable. Some clients need 24-hour care. How do we break that down, and make that manageable? Some clients only need a few hours a week.

It’s not necessarily a 9-5 job. Some folks really enjoy working evenings, preparing a meal for an elder and making sure they get their medications before they go to bed. We have others that are early birds and like to greet the day and help people get their day started.

MC: How did you function during the pandemic?

Nora: When Covid happened, we had weekly meetings for about four months to review our Covid policies. If a caregiver felt like some things were left out, we worked until it was right. We brought policy changes to the board on a regular basis. Anytime a caregiver raised a concern, we would try to create an allowance for that.

MC: Is the cooperative model of in-home care sustainable?

Nora: The standard profit margin for home care is 35-45%! Some people think that business owners don’t have much money and can’t raise wages. That is just not true. The cooperative model is completely sustainable. The big “crisis” with the caregiver shortage is that corporate organizations have to raise wages and think about benefits because workers are cardholders now.

Our caregiver coops have survived and thrived. People want good, quality care. They want their money to go back into the community and they want to employ people from the community. The coop model is solving a lot of problems that the corporate model has helped to create.

MC: How do you navigate traditional state agencies, doctors, hospitals, etc.?

Nora: Capital Homecare is licensed with the Department of Health as an in-home services agency. We follow the RCW and the WAC, just like any agency. Sometimes we partner with assisted living or memory care facilities. Sometimes we coordinate with hospital social workers, receiving somebody getting discharged; figuring out the timing. But unfortunately our work is not treated on a social or monetary level as part of the healthcare system. We are healthcare workers but seen and treated as “chore workers”—glorified babysitters.

MC: What’s the connection between this coop model and high quality care?

Paulette: Happy caregivers do a better job. People who feel valued and taken care of are going to enjoy what they are doing. We attract folks who want to engage in cooperative development, to learn about it and do what we can to dismantle capitalism. This is a commitment. A life way, not a hobby. We are serious about it.

Nora: What the cooperative model offers is a place for caregivers to bloom in skill building. It offers support so they can do their job and provide care at a higher level. The clients get to receive this immediately. No one enters the caregiving workforce for the money. It’s not an easy job. Oftentimes they took care of a family member or neighbor, or had some random job and found they had a unique skill. It requires a rainbow of abilities to be successful.

MC: How do you maintain high quality care?

Paulette: We do evaluations and assessments often. For new folks, we provide shadowing and training and introductions. A huge part of homecare, and what makes someone really good at their job, is honoring the client’s preferences. It’s about coming in and asking the client, “can you show me how you make your bed, or load your dishwasher?” If you don’t do that, you have frustrated people, who feel like it’s invasive and not a help in their life.

MC: How do you know the coop model is working?

Paulette: Happy clients. Happy workers. When people feel valued and respected in their home and their job, that’s the measure of success. We build trust and authentic relationships with people. This is very different from the business world. Profit growth, member engagement, quality of care; those are the most important things at Capital Homecare.

Nora: We encourage skill development, even if it leads to a caregiver moving on. One of our caregivers started developing bylaws,working with our consultants, became board president, then went to law school and is now a public defender. Another caregiver was at Evergreen College in graphic design and volunteered to make videos. She developed an awesome portfolio while working at CHC, and went on to get a graphic design job. When people are engaged and growing because of skills learned at CHC, that’s success.

MC: What are you most proud of about your organization?

Paulette: That we help people stay in their homes to live out their final days. That family members come to us and say, “you brought meaning to my father’s life at the end of his time.”

Nora: I am really proud of how CHC treats its workers, especially as a young business. We’ve had an average of 33% wage growth almost annually since we opened. During Covid-19, we distributed a huge chunk of our Paycheck Protection loan to our workers. We put so much effort into protecting our workers. I think CHC really lives up to the moniker of “coop,” we really are about the people.

MC: What is the biggest challenge for your coop currently?

Paulette: We have a lot of competition. That sets us apart from other coops in Washington that are situated in less densely populated areas where they’re the only gig in town. Then there are a lot of massive entities where management is not connected to the client or the workers. I see that changing over time. I want to foster the growth of this coop by providing exceptional care. It’s not babysitting and it’s not housecleaning.

What suggestions do you have for workers interested in starting a coop like yours?

Nora: My big advice would be do it. If you’re in the care industry and someone asks if you want to open a business, you think they’re making fun of you. In a capitalist system, low income workers are taught they cannot do it. But you can! One huge benefit of coops is that coops support coops. While we have a lot of competitors, we also have a lot of allies. People all over the world will throw you copies of their bylaws, policies and best practices because we all want to see each other succeed.

Is there anything else you would like WIP readers to know?

We are hiring, and we are seeking new clients. Come and join us!

Resources: Capital Homecare cooperative–
Northwest cooperative Development Center–

Matt Crichton is interested in social justice issues and teaches math.

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