Like home care agencies across the country, New York Cooperative Home Care Associates faced a major challenge: How can high quality caregivers be hired and retained?
Since 1985, the agency has been a nationwide model of what experts nationwide believe is a burgeoning domestic worker crisis. Today, the company employs more than 2,000 of the first 12 employees in home health. And, unlike the vast majority of home care facilities, the company is owned by the employees: employees have the option to buy into the company.
Employees have comprehensive health insurance and grants for study programs and career advancement. The cooperative puts new workers on a four-week training program, a rarity among home care facilities and funded by a combination of state and federal grants and philanthropic grants.
The cooperative guarantees experienced helpers at least 30 hours of work at a cost of USD 15 per hour and benefits including a pension worth an additional USD 4 per hour. The result: a loyal workforce with an annual wear rate of 18 to 24 percent, well below the industry standard of 82 percent.
“Building support is at the core of attracting and retaining workers,” said Adria Powell, president and CEO of Cooperative Home Care Associates. “We need to create a quality job so that workers can build quality care.”
However, the cooperative remains far more the exception than the rule as agencies that rely heavily on Medicaid funding struggle to keep workers in jobs that typically pay $ 12-15 an hour.
In an industry with around 2.4 million employees, there are only 11 home care cooperatives in the country. They employ 2,600 workers, just 0.1 percent of the country’s home care workers.
Instead, agencies in Michigan rely on raise, bonuses, and internship programs to help stem the shortage and attract new workers to the field.
“We all are getting older. Investing in these workers means investing in our own future, ”said Stacey Dudewicz, Region VII Coordinator on Aging in Bay City.
“We need people in this field to do this job.”
“Helping people is what I do”
In New York City, the cooperative helps seniors like Kathryn Goldman (89), who lives alone in an apartment on the third floor not far from Central Park.
The home health worker Valerie McBride-Johnson comes six hours on shift six days a week to help with bathing, cooking, cleaning and transporting to doctor’s appointments. She also gives Goldman tips when she’s at a loss on her computer. Your help has helped Goldman stay in the apartment she has lived in since 1972.
On Monday, McBride-Johnson braved more than a meter of snow to work in Goldman’s apartment when a blizzard blanketed the city.
“I definitely find them remarkable,” Goldman said of McBride-Johnson. “It’s not easy when life changes as you get older. It’s really important to find someone like her. “
McBride-Johnson has been a home carer for nearly 30 years and has been with the cooperative for the past 13 years. She said she offers assistance in handling difficult customers.
“If there is a situation where a client does not want to take their medication or go to the doctor or not eat, I can speak to my coordinator or the nurses. You are very helpful. “
The cooperative also provides career advancement paths that prepare Ramona Santos to become a nurse. Hired from the Dominican Republic three months after arriving in New York in 2017, she spoke virtually no English.
After a year as a domestic worker, she is now conducting orientation courses in Spanish for new workers while working in home care on weekends and plans to take college courses in nursing this spring.
“From the first day I said, ‘This is my place. ‘They make me feel like I can achieve all of my goals,’ said Santos, 23.
“Helping people is what I want to do.”
But the cooperative is unique because it was well financed from the start. The agency’s CEO, Powell, said he had heard of the Community Service Society of New York, a not-for-profit nonprofit organization dedicated to fighting poverty.
This type of money is not available to many home care agencies, the PHI trading group noted.
“Overall, these numbers show the inherent difficulty in creating and scaling home care co-operatives,” stated PHI.
“But they also offer leadership opportunities for companies that want to meet these challenges through collaboration and innovation.”
In Michigan, the shortage of direct caregivers is being addressed through other initiatives.
In a 10-county region in the central Lower Peninsula, the Region VII Area Agency on Aging uses cash rewards to encourage home care workers to stay at work.
The agency offered direct care agencies the opportunity to apply for bonus grants of $ 1,000 per employee and up to five employees in fiscal 2018. Eighty direct nurses from 18 agencies received rewards that were given to those who had been on the job for at least a year and had a good job record.
A year later almost all of the workers were still on duty. The agency offered 71 cash rewards of $ 1,000 in fiscal 2019 with similar results.
“It’s recognition for all of the hard work they do. I had the opportunity to deliver checks to some of the workers who received them, ”said Dudewicz.
“They sighed and said, ‘Thank you. It’s nice that someone thinks I’ve done a job. ‘”
In rural southwest Michigan, the Region IV Area Agency on Aging launched a fund in 2019 to assist home care workers with emergencies ranging from car repairs to childcare costs.
With many home care workers living in households at or near the poverty line, overcoming these financial hurdles can be key to their long-term employment, proponents say.
“We recognize that this is an underpaid and undervalued workforce,” said Christine Vanlandingham, the agency’s chief operating officer.
“There are some obstacles that are low-hanging fruit for us, but enormous obstacles for the workforce. Maybe they have a dead battery and can’t go to work. Or they can’t pay for their auto insurance. Much revolves around transportation, especially in rural Michigan.
“Often there are emergencies in childcare. It could be cell phone minutes – it really is as unique as the individual. “
In its last fiscal year, according to Vanlandingham, the agency invested $ 682,000 in additional support for home care workers, which included not only emergency costs, but also personal protective equipment and additional hazard payments for workers who were in direct contact with COVID-19 customers.
“As a society we have to value this work. We have to make it sustainable so that they can do it for a lifetime, ”Vanlandingham said.
At Grand Ledge High School outside of Lansing, a handful of students received an introduction to the world of home care through a course started in Fall 2019 that covers everything from CPR to the basics of aging to appropriate techniques to give a client while showering or help get out of a tub.
Michigan State University gerontologist Clare Luz, who was instrumental in setting up the program, sees it as a potential model for building a larger base of future home care workers.
“Yes, we have to increase wages and education, but I preach all the time that I don’t think any of this will work if we don’t engage in cultural change and don’t just value older people and people with disabilities, but also the people who take care of them. “
Planning for the pilot program was funded by a $ 100,000 grant from the Michigan Health Endowment Fund, a Lansing-based health foundation taught by nurses who specialize in geriatrics.
Luz said it was interrupted by the Michigan school closings in March, preventing students from completing the final stage of the course, which was to shadow home care workers as they work.
If COVID-19 is under control by then, Luz hopes to be able to restart the program in the fall.
“We are very confident that this will continue,” she said.
This story was produced by the New York & Michigan Solutions Journalism Collaborative, a partnership of news organizations and universities devoted to rigorous and persuasive reporting on successful responses to social problems. The group is supported by the Solution journalism network.
The first series of the collaboration, Invisible Army: Caregivers on the Front Lines, focuses on possible solutions to challenges faced by caregivers of older adults.