Cooperative Home Care Associates (CHCA) is a
In 1985, federal Medicare policy began encouraging hospitals to increase their service-capacity by arranging for the full convalescence of patients in their own homes. New York City’s home care system was poorly prepared to offer quality care for this substantial influx of new patients. I was primarily considering many with illnesses not previously managed at home. Simultaneously, most home health aides assigned to provide services for these clients received poor quality jobs, characterized by low wages, few benefits, part-time hours, as well as inadequate training and support.
CHCA’s two co-founders believed that improving the quality of jobs offered to home health aides was a critical strategy to provide clients with quality home care services. Therefore, they established CHCA in 1985 to create a home health care company that was a model dedicated to achieving three critical goals:
- Providing quality and reliable home health services for elders and individuals living with physical disabilities;
- Providing home care workers with the highest possible salaries and benefits, while sustaining a profitable worker-owned company; and
- Offering home care workers new career advancement, educational, and asset-building opportunities.
- The hourly wage earned by CHCA’s home health aides currently averages $9.97—among the industry’s highest in New York City.
- CHCA offers a comprehensive benefits package for home health aides, including an individual health insurance policy with a modest $5 per week cost contribution, 401(k) accounts, life insurance, and paid sick and vacation time—also unique within the industry.
- Annual turnover among CHCA’s home health aides averages between 20 and 25 percent, compared with an estimated 60 percent among these positions in New York City.
CHCA’s employees are invited to purchase an ownership stake in the cooperative, which offers the following additional benefits: 1) annual dividends, based on the company’s profits; 2) free income tax preparation services; and 3) the right to participate in elections for 8 of 13 positions on the Board of Directors.
- CHCA’s four-week home health aide training program uses adult-centered learning techniques to empower participants—and help them learn critical thinking, problem-solving, and team-building skills.
- CHCA encourages home care workers to pursue available administrative staff positions, especially as: associate instructors, clinical field assistants, coordinators, peer mentors, receptionists, and bookkeepers.
In 2007, the New York City Human Resources Administration awarded CHCA a significant contract to provide 400 Bronx residents with home care services—and awarded CHCA a second such contract in 2010, to provide 400 Brooklyn residents with home care services.
Factors in CHCA’s Success:
In addition to providing home health aides with quality jobs, CHCA attributes its success to several key factors:
- Training: CHCA provides individuals with twice the hours of training required by federal and state regulations to earn their home health aide certification—and additional opportunities for improving their skills.
- Management: CHCA’s managers are highly skilled professionals who effectively balance client needs, employee empowerment and the company’s financial stability.
- Organizational Culture: An organizational culture of mutual respect and support has been engendered among employees at all levels of the company, to create an authentic workplace community.
- Worker-Ownership: CHCA’s reinforces the balance between a supportive and accountable culture with a worker-ownership structure based on the democratic principle of “one person, one vote.”
The world’s largest union local, 1199SEIU, represents more than 300,000 health care workers in New York State, Maryland, Massachusetts, and the District of Columbia. In 2003 they organized CHCA’s home care workers as part of a broader effort to unionize all home health aides working in New York City.
Our home care workers have access to a Member Assistance Fund as 1199SEIU. It offers bereavement counseling as well as support in resolving alcohol or substance abuse addictions, landlord/tenant disputes, or parenting challenges. CHCA also contributes to 1199SEIU’s Education Fund to provide our home care workers with tuition-free assess to a range of continuing education classes. They include English-as-a-Second Language Course, General Equivalency Diploma, computer skills, and nursing courses offered by the City University of New York.
Replication of CHCA’s Model:
CHCA’s achievements have also inspired the creation of new home care agencies, structured as worker-cooperatives, in Philadelphia, Wisconsin, and California. PHI—an affiliated non-profit organization created by the leaders of CHCA in 1993—have also disseminated CHCA’s innovative compensation and workforce development practices to crucial other stakeholder groups within the nation’s long-term care sector, including: consumer organizations, unions, government agencies, training providers and “high road” healthcare employers who recognize the critical linkage between job quality for direct-care workers and quality long-term care services for their clients.
Cooperative structure Cooperative Home Care Associates (CHCA) has been a worker-owned cooperative since 1985.
CHCA schedules all home health aides and administrative staff members to attend a three-hour workshop about purchasing an ownership stake in the cooperative after three months of employment. It begins with a brief overview of such businesses. To become a worker-owner, employees authorize deductions totaling $50 from their paycheck during a two-to-five week period, as a down-payment toward a $1,000 equity stake in the business. CHCA then provides employees with a no-interest loan of $950, which they repay through small weekly payroll deductions of $3.65. Through this process, CHCA provides employees with all the rights, privileges, and responsibilities of worker-ownership after contributing only $50—including 1) dividends, based on our annual profits; 2) free income tax preparation services; and 3) one vote in elections for 8 of 13 members on CHCA’s Board of Directors. Typically, worker-owners accumulate $1,000 in equity after five years of employment with CHCA.