Researchers reveal how home care cooperatives are a promising solution to high employee turnover and improve worker satisfaction
Could home care cooperatives provide a solution to reducing home care worker turnover? A recent UCLA-led research study investigates why these worker-owned cooperatives achieve lower employee turnover and higher job quality/satisfaction compared to traditional home health agencies.
The qualitative study, published in JAMA Open, interviewed 23 health care workers and 9 staff members employed by cooperatives. From these interviews, researchers were able to identify four primary factors that contribute to overall satisfaction and higher employee retention in home care cooperatives:
- More say in how they care for patients, manage their schedules, and shape workplace policies;
- better teamwork and overall support from colleagues;
- greater appreciation and recognition from their organizations; and
- better overall compensation, including wages, benefits and opportunities to share in organizational success.
Home care cooperatives are distinguished from traditional home care companies by their ownership structure. Unlike traditional home care services, they are owned and operated by the workers themselves.
The lead author of the study is Geoffrey Gusoff, MD, MBA, MTS, assistant professor of family medicine in the UCLA David Geffen School of Medicine, and also a former CTSI TL1 Postdoc Fellow. “I did the bulk of this research as a TL1 Fellow through CTSI,” said Gusoff. “The CTSI K Bootcamp led by Drs. Wong and Duru also helped me develop my K application which became the follow up study based on the results of this study.”
In a follow-up study published in Health Affairs Scholar, Gusoff and his research team expand on their initial JAMA Open findings to uncover the specific practices and approaches that may be driving the improvements in the quality of care that have been seen in previous studies of home care cooperatives.
Utilizing a similar qualitative approach consisting of 32 semi-structured interviews, the study team found 4 major contributing factors that may ultimately improve the quality of care in cooperatives:
- Giving healthcare workers more say in patient care choices;
- boosting motivation through shared ownership;
- choosing dedicated, high-quality staff; and
- providing high-quality practical training.
From these two studies, Gusoff has partnered with ICA Group, a national organization dedicated to promoting cooperative worker ownership and VividLife, a statewide initiative across California, to develop "The 7 Cs of the Cooperative Difference,” which summarizes his findings and carefully lays out the myriad factors that contribute to home care worker retention and home care quality.
This important research comes at a time in which the demand for home healthcare services is surging across the country, primarily driven by a rapidly aging population. Meanwhile, the home health care workforce is facing a critical shortage that has been further exacerbated by high turnover rates. According to Gusoff, home care cooperatives have the potential to address these ongoing national concerns, while also serving as a helpful business model to others: “Other home care businesses can learn from cooperatives' practices to improve caregiver jobs and ultimately retain and recruit more caregivers to meet the growing demand,” said Gusoff.
In March 2025, Dr, Gusoff had the opportunity to share his research and fundings at the 9th Annual National Home Care Cooperative Conference which took place in Dulles, Virginia. The three-day conference was held from March 11-14, and featured the theme “Cooperative Ownership” United in Purpose.” That month he also presented to the Cooperative Home Care Associates (CHCA), the largest home care cooperative in the country, located in the Bronx, New York.
In regard to what’s next on his agenda, Dr. Gusoff is excited to build on his research. He plans to develop a survey study to further test and validate his earlier findings by identifying which specific factors are most strongly correlated with worker retention and improve quality of care. “Our goal is to survey 1000 home care workers, 500 at cooperatives and 500 at traditional agencies, to better understand the impacts of the cooperative model and also to help cooperatives and other agencies to improve their retention and care quality.” He also plans to explore the patient perspective of the home care cooperative model: “We would likely use a similar process as we have with our workforce research: starting with interviews to identify potential differentiating factors related to cooperatives and then adapting or developing a survey tool to assess the prevalence of these factors more broadly.”
Photo caption: Nurse takes man's blood pressure
Photo source: UCLA Health