Worker Co-op Reinvents An Industry

Home care co-op builds esteem, families, and business in the Bronx

One of the articles in Good Medicine (IC#39)
Originally published in Fall 1994 on page 48
Copyright (c)1994, 1997 by Context Institute

Sally Ramirez, age 42, spent 22 years on public assistance. Four years ago, she became a home health aid for Cooperative Home Care Associates in the South Bronx.

It’s been the most wonderful thing that ever happened to me and my four kids," she says. "I’ve learned how to form my own independence, how to do my own things. My kids are proud of me. It’s changed my life completely.

The South Bronx in New York City is not a place you would expect to find a story about entrepreneurial success, worker empowerment, and high quality home care for the frail elderly – but then, this story is unusual in many ways.

It began in 1985. Medicare cutbacks were forcing thousands of people to return home early from the hospital. The traditional home care agencies in New York City were not prepared for either the increase in clients or their complex care needs.

At the same time, the Community Service Society of New York, a long-time social service organization, was trying to find ways to create "good jobs" for low-income people – jobs specifically defined as providing adequate wages and benefits, decent working conditions, employment stability, and opportunities for advancement. Their first enterprise, a small start-up carpentry cooperative, failed after 18 months. They decided to try again and began researching the home care market. This time, their efforts paid off.

Today, Cooperative Home Care Associates of the South Bronx, headquartered in one of the poorest sections of New York City, employs 300 home care workers, primarily African-American and Latina women. More than 80 percent of the workers were on public assistance when they began. With annual sales of $5 million, the company has earned a profit for the last six years and is expanding by 40 new jobs each year. It is now one of the largest home care companies in the Bronx.

CHCA’s financial success tells only part of the story. Of even greater importance is the model of excellence and innovation it has created.

The co-op was established on the premise that high quality service and high quality jobs are directly related. If workers own a piece of the business, the founders reasoned, they become empowered, strengthening their ties to both job and clients. Good training, job stability, and adequate pay and benefits further strengthen these ties, resulting in reliability and good care. Today, nine years later, the proof of these simple ideas can be counted among CHCA’s many achievements.


CHCA is set up as a worker-owned cooperative, with more than 200 employees owning voting stock and serving on board and management committees. Not only are employees able to help shape the business and their jobs, but they have earned bonuses from the company’s profits each year.

I was elected to be on the board a month and a half ago," says Sally, "and I got 70 percent of the vote! It’s a beautiful thing to be on the board. You learn about the company, how they’re handling business. I feel like I’m somebody important – like the president!

CHCA wages, currently averaging $7 perhour, are among the highest in the industry, ranging far above the $3.75 per hour industry average paid when the co-op began in 1985. Benefits are among the best in the industry, and include health insurance, paid vacation, and sick leave.

Home care is essentially a part-time industry because clients often need assistance only a few hours a day. The work is isolating because services are provided in the home, away from supervisors and co-workers. To address these problems, the co-op provides many of their aides with guaranteed 30-hour work weeks. It has also created an organizational culture of mutual repect and support at all levels of the company. As a result, while turnover rates for home care agency staff nationwide range from 50 to 60 percent a year, CHCA has a low 15 to 20 percent turnover record.

I used to be bad-tempered," Sally says. "If somebody talked to me and I didn’t feel like answering, I wouldn’t. I didn’t care. Now when I go into the office, I feel like it’s my home. Everybody knows me. Everybody says, ‘Hi!’


Workers are carefully chosen – only one in five applicants is hired. Selection is based on maturity, patience, and diligence, rather than formal work experience. Once hired, CHCA provides dual-language entry-level training that is learner-centered, and emphasizes critical-thinking, problem-solving skills, and cooperative team building. For what are typically dead-end jobs, career ladders are now provided through on-site adult education, and supervisory and teaching responsibilities.

I’m trying to become an assistant instructor," Sally reports. "I would love to inspire others to pass the exam and show them that it’s not just public assistance, that they don’t have to lean back and wait for their checks or depend on their husbands to give them a little money. You can do it on your own if you really want it.

The co-op’s accomplishments have won the company national recognition. In 1992, it was one of five winners of the national Business Enterprise Trust award for "courage, integrity and social vision in business." In the same year, it was one of three national finalists for Inc. magazine’s Socially Responsible Entrepreneur of the Year award.

But the true test is customer satisfaction. Several of its major contractors have named CHCA the highest quality provider on the basis of reliability, competence and low incidence of patient complaints. It has also been featured for "best practice" in all three of the industry’s trade journals. Having achieved the status of a "yardstick corporation," CHCA is now recognized by government regulators, union officials, hospital administrators and patient organizations as a trusted model of excellent home care management.

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