Health Care Cooperatives Could Hold Key to Easing Elderly Caregiver Shortage

Home care cooperatives may be the key to alleviating the shortage of paid caregivers for older Americans, according to a new study co-authored by Senior Associate Dean for Outreach and Sponsored Research Ariel Avgar, Ph.D. ’08, and Dr. Madeline Sterling, A&S ’08, associate professor of medicine at Weill Cornell Medicine and director of ILR’s Initiative on Home Care Work.

The research, Perceived Contributors to Job Quality and Retention at Home Care Cooperatives, published April 7 in the peer-reviewed journal JAMA Network Open, found that workers in cooperatives experienced more respect, control, job support and compensation than their counterparts in traditional care services. These factors may explain how cooperatives have half the turnover rates of traditional agencies, which are plagued with high turnover and employee dissatisfaction.

The study's lead author is Dr. Geoffrey Gusoff, an assistant professor of family medicine at the David Geffen School of Medicine at UCLA. Co-authors include Miguel Cuevas and Dr. Catherine Sarkisian of UCLA, and Gery Ryan of Kaiser Permanente.

Gusoff is an affiliate of the Initiative on Home Care Work, and the study was partially funded by a Center for Applied Research on Work (CAROW) pilot grant.

“A study like this really illustrates the importance of having the Initiative on Home Care Work,” said Avgar, ILR’s David M. Cohen ’73 Professor of Labor Relations and director of CAROW. “lt helps us to connect scholars across Cornell, and across the nation, who are studying home care in very different settings and allows them to work together in a really impactful way.

“At the ILR School, we tend to study home care work in unionized settings, and this study by Dr. Gusoff allows us to focus on a different institutional configuration, namely cooperatives, to better understand home care work and its contribution to patient care.”

Home care cooperatives provide the same daily living assistance to the elderly such as bathing, medication management and meal preparation, as do traditional home care services. Unlike traditional home care services, cooperatives are owned and operated by the home care workers who deliver these services, leading to a more collaborative experience and sense of ownership for the participants.

The researchers interviewed 23 home care workers and nine staff members from five cooperatives, most of whom had previously worked in traditional paid caregiving settings. The home care workers at the cooperatives identified four factors that contributed to better job quality and lower turnover compared with traditional care services:

• High levels of input and control in three areas: patient care, scheduling and agency policies
• A sense of community, camaraderie and teamwork stemming in part from their ownership and the support they received from staff and other home care workers on their teams
• A culture of respect for home care workers, leading to a perception that they are valued
• Better overall compensation that included wages, benefits (particularly health insurance) and/or profit sharing, which play a crucial role in employee retention.

Some study limitations include the possibility of recall or selection bias when participants compare their experiences at cooperatives with their prior employment at traditional services, the inclusion of only English-speaking home care workers in the study, and the potential role that other factors, such as agency size, may play in workers’ perceptions of the cooperatives.

This study was funded by Career Development Awards from the National Institute on Aging, the National Heart Lung and Blood Institute, the National Institutes of Health, the Cornell University Industrial and Labor Relations Center for Applied Research on Work, and a Clinical Scientist Development Award from the Doris Duke Charitable Foundation.

Portions of this story courtesy of Enrique Rivero of the UCLA Health media relations team.