New Research Shows Home Care Cooperative Can Improve Patient Care
Home care cooperatives – agencies co-owned and managed by home care workers – have key factors that appear to significantly improve the quality of care for patients, according to a new study co-authored by Senior Associate Dean for Outreach and Sponsored Research Ariel Avgar, Ph.D. ’08, and Dr. Madeline Sterling, A&S ’08, associate professor of medicine at Weill Cornell Medicine and director of ILR’s Initiative on Home Care Work.
The study, “The cooperative difference: perceived drivers of higher care quality at home care cooperatives,” published June 27 in the journal Health Affairs Scholar, found four drivers of improved care quality at cooperatives, all centered on empowering workers as stakeholders. They included: 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.
The study's lead author is Dr. Geoffrey Gusoff, an assistant professor of family medicine at the David Geffen School of Medicine at UCLA. Co-authors include Miguel Cuevas and Dr. Catherine Sarkisian of UCLA, and Gery Ryan of Kaiser Permanente.
Gusoff is an affiliate of the Initiative on Home Care Work, and the study was partially funded by a Center for Applied Research on Work (CAROW) pilot grant.
“This research is a great example of cutting-edge research informing practitioners and policymakers about innovations designed to improve home care work and, by extension, outcomes for patients,” said Avgar, ILR’s David M. Cohen ’73 Professor of Labor Relations and director of CAROW. “It is another great example of the importance of having the Initiative on Home Care Work.”
According to Gusoff 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.
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,” Gusoff said.
In previous research, the same 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. They 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.
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).
Portions of this story courtesy of Enrique Rivero of the UCLA Health media relations team.