Cooperative Home Care Associates

Headquartered in the heart of the South Bronx, Cooperative Home Care Associates (CHCA) is a worker-owned home health care agency that currently employs more than 550 African-American and Latina women—75% of whom had previously been dependent on public assistance. 

CHCA was founded in 1985, when federal Medicare policy was forcing thousands of patients out of their hospital beds and back into their homes. New York's home care system was poorly prepared for this sudden increase in patients, many with illnesses far more serious than those previously managed at home. At the same time, the home health aides expected to care for these clients were being offered extremely poor jobs with little training, low wages, no benefits and temporary work.

In response, CHCA was conceived on the premises that home health care clients would receive a higher quality of care only if home health care workers were offered higher quality jobs. CHCA was thus formed as a model home health care enterprise with three explicit goals:

• To create high quality paraprofessional jobs for low-income women;
• To empower those women with greater skills and self-confidence; and
• To improve the quality of practice in the home health care industry.

In fifteen years, CHCA has achieved all three goals:

High Quality Job Creation:

• Over 550 quality jobs have been created for low-income African-American and Latina women—a highly successful welfare-to-work model.
• CHCA wages average $8/hour—among the industry’s highest, particularly in New York.
• CHCA benefits include individual health insurance, paid vacation and sick time--also among the best in the industry.
• Worker turnover is less than 20% a year, compared to an industry average of 40-60%.

Empowerment:

• Over 80% of CHCA's employees share in the cooperative's ownership and elect from among themselves the majority of people on the Board of Directors.
• CHCA's learner-centered home health aide training is an empowering experience, emphasizing critical thinking, problem solving and cooperative team building.
• CHCA is creating a job ladder within the company. Several aides have become licensed practical nurses, assistant instructors, or job counselors. A new initiative will allow many workers to be promoted as "specialized aides".

Home Health Care Practice:

• CHCA has achieved the status of a "yardstick corporation"--a company valued by government regulators, union officials, health care administrators and consumer organizations as a trusted model of excellent home care services.
• CHCA has led the development of a new "quality care through quality jobs" school of thought--the basis of a United Hospital Fund of New York report entitled, "Better Jobs, Better Care: Building the Home Care Work Force."
• CHCA‘s creation of quality paraprofessional jobs has also led to the cooperative's consistent citation by its major contractors as their highest quality provider, with an excellent record of reliability, competence, high patient satisfaction and low incidence of patient complaints.
• Quality frontline jobs have also been central to CHCA's successful business strategy, with current annual sales of $9.8 million and profitability for the last nine years. CHCA's worker-owners typically earn annual dividends of $200-$400 as their share of the company's profits.

Other Key Factors in CHCA's Success:

In addition to the provision of quality jobs to its home health aides, CHCA attributes its success to a number of other key factors:

• Screening: Potential workers are chosen carefully from those applying to its entry-level training program. Only one out of every four applicants is hired.
• Training: CHCA aides receive double the entry-level training of most home care workers and enjoy continuing opportunities for skill upgrading.
• Management: CHCA's managers are highly skilled professionals who effectively balance client needs, employee empowerment and company financial stability.
• Organizational Culture: An organizational culture of mutual respect and support has been engendered among employees at all levels of the company—creating a true “community.”
• Worker-Ownership: This supportive culture is reinforced by a worker-ownership structure based on the democratic principle of "one person, one vote."

National Replication of the CHCA Model:

CHCA's achievements in the South Bronx inspired the formation of a national Cooperative Healthcare Network—developed by the Paraprofessional Healthcare Institute (CHCA’s non-profit affiliate)—comprised of worker-owned home care cooperatives, innovative paraprofessional workforce development programs, and state-based advocacy efforts across seven states. 

CHCA’s expertise likewise informs the technical assistance offered by PHI to consumer organizations, unions, government agencies, training providers and “high road” healthcare employers who recognize the link between job quality for paraprofessionals and care quality for their clients.