# The cooperative difference: perceived drivers of higher care quality at home care cooperatives

## TL;DR

Home care cooperatives may improve care quality by giving workers more input, motivation, and training, according to interviews with care workers.

## Contribution

Identifies four specific drivers of improved care quality in home care cooperatives through qualitative interviews.

## Key findings

- Increased HCW input into patient care decisions is a key driver of improved care quality.
- Co-ownership motivates HCWs to provide better care.
- Cooperatives preferentially select mission-driven, high-performing HCWs and provide hands-on training.

## Abstract

The quality of care provided by home care workers (HCWs), on whom millions of Americans rely, is undermined by practices, structures, and policies that marginalize this workforce. Home care cooperatives—agencies co-owned and controlled by HCWs—represent a promising model for reducing HCW marginalization and improving care, but the specific ways in which the cooperative model may facilitate higher care quality are not well understood.

We conducted 32 semistructured interviews with HCWs and other staff across 5 home care cooperatives to identify perceived drivers of improved care quality at cooperatives.

Respondents identified 4 main drivers of improved care quality at cooperatives: (1) increased HCW input into patient care decisions; (2) additional motivation derived from being co-owners; (3) preferential selection of high-performing, mission-driven HCWs; and (4) access to high-quality, hands-on training.

Increasing the prevalence of these perceived quality drivers through the expansion of home care cooperatives, the adoption of cooperatives’ practices by traditional agencies, and the implementation of industry-wide policies that facilitate them may significantly improve care quality across the home care sector. However, additional research is needed to determine the role each perceived driver plays in home care quality.

Home care workers’ input into patient care, motivation as co-owners, selection of other invested caregivers, and access to hands-on training may be important drivers of higher care quality at home care cooperatives. Participants’ responses suggest potential agency-level practices and structures as well as industry-wide policies that may facilitate each driver to improve care quality across the home care sector.