Home care cooperatives may be the key to alleviating the shortage of paid caregivers for older Americans, a new study suggests.
The research, to be published in the peer-reviewed journal JAMA Network Open, found that participants in cooperatives experienced more respect, control, job support, and compensation than their counterparts in traditional care services. These factors may explain how cooperatives have achieved half the turnover rates of traditional agencies, which are plagued with high turnover and employee dissatisfaction.
Millions of older adults will lack the support they need to safely age at home unless new strategies are developed and policies are changed to retain and recruit caregivers, said Dr. Geoffrey Gusoff , assistant professor of family medicine at the David Geffen School of Medicine at UCLA and the study's lead author.
"Homecare cooperatives represent an innovative approach to addressing the caregiver crisis to improve caregiver job quality and retention," Gusoff said. "Other home care businesses can learn from cooperatives' practices to improve caregiver jobs and ultimately retain and recruit more caregivers to meet the growing demand."
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 that 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 compared their experiences at cooperatives with their prior employment at traditional services, the inclusion of only English speaking home care workers in the study, and potential role that other factors, such as agency size, may play in workers' perceptions of the cooperatives.
More work is needed to further identify the qualities influencing home care workers' job satisfaction, Gusoff said.
"The next step is to test the factors identified in the study through a national caregiver survey to better quantify the role of each factor in caregiver retention, satisfaction, and care quality," he said.
Study co-authors are Miguel Cuevas and Dr. Catherine Sarkisian of UCLA, Dr. Madeline Sterling of Weill Cornell Medicine, Ariel Avgar of Cornell University, and Gery Ryan of Kaiser Permanente.
This study was funded by Career Development Awards from the National Institute on Aging (K01AG088782, 1K24AG047899-07), the National Heart Lung and Blood Institute (K23HL150160), the National Institutes of Health (TL1TR001883, UL1TR001881), 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 (DDCF 2022053).
