Perceived Contributors to Job Quality and Retention at Home Care Cooperatives.

Abstract

Importance: To safely age at home, millions of older adults rely on the services of home care workers (HCWs), a workforce marked by poor working conditions, high turnover, and critical worker shortages. Home care cooperatives-businesses co-owned and controlled by HCWs-have demonstrated significantly lower turnover and higher job quality than traditional home care businesses, but the factors associated with these outcomes have not been investigated.

Objective: To identify potential factors associated with higher job quality and lower turnover at home care cooperatives.

Design, setting, and participants: In this qualitative study, semistructured interviews were conducted in English from November 2023 to June 2024. To be eligible for the study, participants had to be 18 years old or older, speak English, and currently be employed by a home care cooperative. Interviews were conducted remotely over Zoom with individual HCWs and staff from home care cooperatives from across the US. Data were analyzed from May to July 2024.

Exposure: Employment at a home care cooperative.

Main outcomes and measures: Interviews were audio recorded and transcribed. A thematic analysis approach was used to code interviews and identify major themes and subthemes, informed by a conceptual model of direct care worker job outcomes.

Results: A total of 23 HCWs and 9 staff members (14 participants aged 20-39 years [44%]; 8 [25%] African American, 4 [13%] Latinx, and 17 [53%] non-Latinx White) from 5 home care cooperatives participated in the study. Participants identified 4 key aspects of the cooperative work environment they perceived to be contributing to higher job quality and lower turnover compared with traditional agencies: (1) greater workplace control regarding patient care, case assignments, and organizational policies; (2) stronger community support and camaraderie; (3) a deeper culture of respect in which HCWs felt more valued; and (4) higher overall compensation in the form of wages, benefits, or profit sharing.

Conclusions and relevance: In this qualitative study of HCWs and staff at home care cooperatives, participants perceived cooperatives' relatively high levels of HCW control, community, respect, and compensation to be important contributors to HCWs' retention in the field. The participatory structure and practices of home care cooperatives in these areas may represent novel approaches for home care agencies to reduce HCW turnover and improve job quality to address critical workforce shortages.