Research identifies four main drivers of improved care quality at home care cooperatives

New research on home care cooperatives – agencies co-owned and managed by home care workers – has identified key factors that appear to significantly improve the quality of care for patients.

The researchers identified four main drivers of improved care quality at cooperatives, all centered on empowering workers as stakeholders: incorporation of worker input into care planning; a boost in motivation derived from being co-owners; selective hiring of high-performing workers; and access to high-quality, hands-on training.

This study identifies specific factors that may improve the quality of home care, a relatively understudied area but one that has major consequences for care recipients and the broader health care system. The care-enhancing practices identified by participants represent testable interventions that have the potential to significantly improve care quality across the home care sector."

Dr. Geoffrey Gusoff, assistant professor of family medicine at the David Geffen School of Medicine at UCLA and study's lead author

The study will be published in the peer-reviewed journal Health Affairs Scholar.

Millions of older Americans rely on home care provided by paid caregivers. But those traditional services are plagued by high turnover, limited training and difficulty communicating with other team members, Gusoff said.

"Quality home care is essential for improving the quality of life of care recipients and reducing unnecessary medical costs, but our current system, which often treats home care workers as low-skilled and easily replaceable, undermines home care quality," he said.

Cooperatives can represent a new approach toward providing quality home care. "Expanding the home care cooperative model and the adoption of cooperatives' practices by traditional agencies could contribute to significantly improved home care quality, benefiting both care recipients and the broader healthcare system," he said.

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 workers that deliver these services, leading to a more collaborative experience and sense of ownership for the participants.

In previous research, the team focused on how cooperatives can reduce employee turnover through practices such as better compensation, a sense of community, and control. For this study, the researchers examined which cooperative practices appear to improve the quality of care.

The researchers conducted 32 semi-structured interviews with home care workers and other staff at five cooperatives to identify drivers of care quality.

The researchers acknowledged several limitations of the study, including a lack of input from care recipients and non-English speaking workers, who may provide additional insight into care quality drivers. They also noted the possibility of selection or recall bias in participant responses and that additional research is needed to test the true impacts of the perceived drivers of care quality identified.

The next step in the research is to conduct quantitative studies to assess how the identified factors impact safety, patient experience and health outcomes, Gusoff said.

Additional study 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 Bernard J. Tyson School of Medicine.

The study was funded by the National Institute on Aging (K01AG088782, 1K24AG047899-07), University of California, Los Angeles Clinical and Translational Science Institute (TL1TR001883, UL1TR001881), the Cornell University Center for Applied Research on Work, the Rutgers University Institute for the Study of Employee Ownership and Profit Sharing, the National Heart Lung and Blood Institute (K23HL150160) and the Doris Duke Charitable Foundation (DDCF 2022053).