According to a new study, home care cooperatives could offer a vital solution to the ongoing shortage of paid caregivers for older adults. The research reveals that caregivers working within cooperative models experience greater respect, autonomy, workplace support, and compensation than those employed by traditional home care agencies. These enhanced conditions help explain why cooperatives have achieved turnover rates approximately half that of conventional providers, many of which struggle with persistent employee dissatisfaction and high staff attrition.
Without significant innovation and policy reform, millions of older adults across the United States may find themselves without the necessary support to continue living safely in their own homes, warned Dr Geoffrey Gusoff, an assistant professor of family medicine at the David Geffen School of Medicine at UCLA and the lead author of the study. As the demand for elderly care continues to surge with an ageing population, the need for sustainable, practical solutions to recruit and retain qualified caregivers has never been more urgent. Dr Gusoff emphasised that home care cooperatives offer an innovative and promising pathway to improving both the quality of caregiver jobs and the stability of the caregiving workforce. “Home care cooperatives represent an innovative approach to addressing the caregiver crisis to improve caregiver job quality and retention,” he stated. “Other home care businesses can learn from cooperatives’ practices to enhance caregiver jobs and ultimately retain and recruit more workers to meet the growing demand.”
In practice, home care cooperatives deliver the same essential services as traditional home care agencies, including assistance with activities of daily living such as bathing, medication management, and meal preparation. However, the key difference lies in the structure of ownership and management. Unlike traditional agencies, the caregivers own and operate cooperatives, fostering a stronger sense of collaboration, shared purpose, and mutual accountability. This structure empowers caregivers to have a direct say in the decision-making processes that affect their daily work, contributing to higher job satisfaction and a more profound commitment to their profession.
The team interviewed 23 home care workers and nine staff members across five cooperatives to conduct their research. Most participants had previously worked in traditional paid caregiving roles, offering them a unique perspective on the comparative advantages of the cooperative model. The interviews highlighted four major factors contributing to the superior job quality and lower turnover observed within cooperatives. First, caregivers enjoyed higher levels of input and control, particularly in three crucial areas: managing patient care, scheduling their work shifts, and shaping broader agency policies. Second, a palpable sense of community and teamwork emerged, primarily driven by the cooperative ownership structure and the mutual support among staff and workers. Third, a culture of respect for caregivers was pervasive, with many workers reporting that they felt genuinely valued for the first time in their careers. Finally, better compensation — not only in wages but also in benefits such as health insurance and opportunities for profit-sharing — played a central role in encouraging workers to stay within the cooperative system.
While the findings are compelling, the researchers did acknowledge certain limitations in their study. The possibility of recall or selection bias must be considered, as participants were asked to reflect on and compare their past experiences in traditional agencies with their current roles in cooperatives. Additionally, the study sample included only English-speaking home care workers, potentially overlooking the experiences of a significant portion of the caregiving workforce. Furthermore, other factors not directly explored — such as the agency’s size or regional differences — may also influence perceptions of job satisfaction and retention within cooperatives.
Dr Gusoff and his team highlighted the need for further research to deepen understanding of the factors influencing caregiver satisfaction and retention. “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 explained. Such a survey would help illuminate the broader applicability of the cooperative model across different contexts. It could inform policymakers and industry leaders seeking to strengthen the caregiving workforce in the years ahead.
Ultimately, the study’s findings suggest that home care cooperatives could serve as a blueprint for transforming the caregiving profession into one characterised by respect, empowerment, and economic security. Adopting some cooperative practices — such as giving workers a meaningful voice in decisions, fostering strong workplace communities, and ensuring fair compensation — even traditional agencies might improve the quality of their jobs. In doing so, they could help avert a looming crisis that threatens the well-being of millions of elderly Americans who wish to age with dignity and support in their own homes.
More information: Geoffrey Gusoff et al, Perceived Contributors to Job Quality and Retention at Home Care Cooperatives, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2025.4457
Journal information: JAMA Network Open Provided by University of California – Los Angeles Health Sciences
