June 30, 2025 • 39 mins
Health care is one of our nation’s largest industries and employers. Though worker-owned cooperatives have a fairly significant presence in this industry, largely through home care, only about 2% of ESOPs are in healthcare. But these dynamics may also change as more clinics, private practices, and direct-care companies look to employee ownership to strengthen their performance, create better jobs, and retain their independence. Some advocates also argue that employee ownership may also be able to support better patient and client outcomes. In this conversation from the 2025 Employee Ownership Ideas Forum, panelists examine the current state of employee ownership in healthcare and how the model might help strengthen the industry.
For additional resources, visit our website: https://www.aspeninstitute.org/videos/industry-spotlight-healthcare/
Or subscribe to our podcast and listen on the go: https://creators.spotify.com/pod/profile/aspeneop/
For other session videos, visit the Aspen Institute Economic Opportunities Program on YouTube: https://www.youtube.com/@aspeneop
The 2025 Employee Ownership Ideas Forum took place on April 9-10, 2025, virtually and in Washington DC. The Forum is proudly co-hosted by the Aspen Institute Economic Opportunities Program and the Institute for the Study of Employee Ownership and Profit Sharing at Rutgers University.
This year’s theme, “From Workers to Owners,” highlights how the experience of ownership changes the reality of work for workers. The forum highlights companies in a range of business sectors and explores how employee ownership fits their business strategy and approach to business leadership. We also discuss the particular role employee ownership can play in supporting business success, and we consider the role institutional investors can play in improving capital access for employee ownership conversions and expansions.
For more information about the Employee Ownership Ideas Forum, including our speakers, agenda, and additional resources, visit our website: https://www.aspeninstitute.org/events/employee-ownership-ideas-forum-2025/
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:04):
I'm Adria Scharf. I'm part of the leadership team
at the Rutgers Institute for theStudy of Employee Ownership and
Profit Sharing, and I am delighted to have the
opportunity to moderate this important discussion focused on
the role of employee ownership, worker ownership models,
specifically in the health sector, health sector, in the
(00:27):
care providing sectors. This sector has been a
particular interest of mine in my own, in my own research.
And I'm excited to be joined today by Terrell Cannon and
Katrina Kozda, Terry Leahy, and we'll introduce them in more
detail in just a minute. But just wanted to frame out
(00:48):
just in a few words, sort of howI think about the importance of
this question. And, you know, I would say that
the way we structure ownership in the health sector really,
really matters. And I think some previous
speakers today, including AudriaPowell, have really kind of set
(01:08):
the stage for this conversation,laying out a number of themes
related to the fact that we as asociety insufficiently care for
the people, the human beings whowe asked to provide care to
ourselves and to our loved ones,And the crisis in care work and
the importance of democratic High Road shared ownership
models that share dignity with frontline workers.
(01:31):
Other speakers have also talked about the rapid growth in this
sector, the health sector care work is one of the fastest
growing kind of segments in terms of jobs.
It's also, as Lauren just kind of alluded to, with Forgotten
Cities. You know, as we've seen the
decline of the manufacturing sector in many communities in
the Rust Belt, increasingly the health systems, the health
(01:53):
providers are the economic driver of the community and
central to just establishing theeconomic foundation for entire
localities. But a third reason that the
structure of ownership and health matters to me is
something really obvious. But then I think we just take
for granted and forget sometimesas Americans, those of us who
(02:13):
are Americans, which is just thefact that in the United States
the provision of health servicesand the provision of care
services are commercialized and privatized to a much greater
degree than in many other parts of the world.
So here in the United States, werely on for profit businesses to
(02:35):
provide many of the foundationalhealth care needs to meet our
healthcare needs as a community.And yet the predominant models
of ownership in the sector are often outside investor owned
models or structures of ownership that limit ownership
to just one or two a small number of individuals within the
business and employee ownership models are relatively rare.
(02:57):
I think that within the kind of the healthcare pie chart, sorry,
within the ESOP pie chart, amongall Esops, Esops in healthcare
and social assistance represent just 2% of all Esops overall,
which is relatively small. But their examples are very
(03:17):
important. And we'll hear, we'll hear from
Terry in just a minute about thecompany he leads in the universe
of worker cooperatives. We heard earlier from Audria
Powell and yesterday from JC about CHCA, which as we know is
the largest worker cooperative in the country, one of the most
robust and resilient and important models around.
(03:40):
And I think it really stands outas an example and kind of a
motivator for so many. And we'll hear more today about
other models and some new innovations in the home care
cooperative space. So with that, I would love to
introduce our panelists. We have with us Terry Leahy, who
is CEO of the ESOP company, My Path, Katrina Kozda, Vice
(04:04):
President of Home Care Innovations, the ICA Group and
Cherelle Cannon, Director of Training and Workforce
Development, Home Care Associates of Philadelphia.
And we will start by just inviting each of you to share a
little bit about yourself and your employee ownership journey,
a little bit about your own, your own companies.
(04:26):
So Terrell, let's start with you.
Would you tell us about yourselfand the history and the work of
Home Care Associates? Hi everyone, thank you again
Rutgers asking for inviting me to the Space 8.
I will not get this Adria. Adria But I am Terrell Cannon.
I am a employee owner of Home Care Associates of Philadelphia.
(04:51):
I came into this to to this space in 1993, coming from a
traditional workplace where I was not valued, respected or
even appreciated for the work that I did in providing care to
the members of my community. When I got to Home Care
(05:12):
Associates, it was very different and coming into a
space where my ideas, my voice and I was offered to make the
decisions and sit at the table with what I thought in a
traditional workplace where the elites to sit at the table with
the elites to make the decisionsfor the company.
And what I found at working at Home Care Associates is that I
(05:34):
am the elite. So, and yes, snap, snap, snap.
So with with that and being in this space, I've grown from
starting out as a young woman onpublic welfare clocking and
clocking out to now a business owner making decisions to expand
(05:56):
my organization with my other colleagues and working
collectively with other co-ops like Cooperative Home Care
Associates of New York who has provided us with the foundation
to be here 30 years later. So.
Katrina, let's stick with home care cooperatives.
And could you share a little bitabout your work at ICA Group?
(06:21):
Yeah, sure. So I've been working with the
ICA Group for a little over 8 years now.
We launched ICA, has been involved in the home care
cooperative space since the founding of Cooperative Home
Care Associates in 1985. But we launched a formal program
in 2018 and for a number of years I was heading up that
(06:42):
program and now have now shiftedover to focusing on our scaled
initiatives both nationally and state based.
But yeah, ICA sort of has its hands in all aspects of home
care. Cooperatives live and breathe it
both to my benefit and to my detriment, because I can't
(07:04):
imagine working with a more amazing group of humans, really.
It's an incredible, incredible space to work in individuals
like Trail. And also, it is a very, very
hard industry and there are so many challenges and barriers
that we're having to work through.
But yeah, you know, I see as work really kind of touches the
(07:27):
whole space from startup to, youknow, strategic consulting and
supporting existing cooperativesin their continued growth and
stability. And as I said, now really
looking at how do we grow and scale the sector and really
through that, the point of that is more employee ownership in
the space, more control and ultimately to transform the
(07:50):
industry and the way that it operates.
Thank you, Terry. Tell us about my path.
Sure. And and thanks again to Rutgers
and the Institute for including myself and our company in this
list of illustrious ESOP companies that I've heard about
over the last two days. And I guess my path is that
Unicorn. We are a traditional ESOP, but
(08:13):
we're in a social services, Human Services space and our
company was founded 40 years ago.
We had our 40th anniversary lastfall and our founder bought the
assets of the company out of bankruptcy when he was 30 years
old. Now we have kids in their 30s
who are still on their parents cell phone plan.
So the idea of thinking of one of them going out and taking the
(08:37):
risk that Jim did is quite something.
And Jim is ACPA, so he's a moneyguy, but he had worked in
programs for people with disabilities as a teenager and
he had a passion for growing those programs, opening new
programs. And that balance between mission
and margin remains in the company to this day.
So Fast forward, he, at the timethat he bought the assets of the
(09:00):
company, we had a residential program for children with
significant disabilities and eight group homes for adults.
And those two service lines became kind of the double Helix
of our DNA as an organization. So we replicated over the years,
grew organically. And today we have 8 operating
companies, each with a differentfocus, different regulators.
(09:22):
But the common unifying strategyis that we focus on very high
needs individuals and we try andprovide a continuum of care from
childhood until end of life. So that means, for example, we
have clinics for toddlers with autism, we have day schools for
children with significant disabilities, We have community
(09:45):
living settings for people with disabilities.
So a whole range of services. We now have about 2000 owners
and we're in 41 communities in Wisconsin and Indiana and about
159 program locations. In our case, a program location
could be anything from a large residential campus for children
(10:06):
to a single person setting in the middle of nowhere in
Wisconsin. Staff 24/7.
So if you think about Aesop's and Aesop culture, that becomes
part of the equation as to how do you communicate with that
group. Just a few financial metrics
because it's not about the money, but it's kind of about
the money with this audience. So we are at about 170 million
(10:30):
in revenue run rate and 12 to 13% of that is EBITDA.
Our ESOP started in 2002 is a 30or I'm sorry, 2000, yes, 2002 is
a 30%. In 2016, we became 100% ESOP.
Our share price has had a 12% compounded annual growth rate
(10:51):
over that time. So we do have caregivers who
have 6 figure retirement accounts, which is amazing and
something to be thankful for. That's what.
That's my intro. Thank you.
We were talking, a few of us were talking earlier about kind
of worker cooperatives in Esop'sand how they're both, we both
kind of fold them together underthis banner of employee
(11:12):
ownership or worker ownership and and in some ways how
different they are structurally.And so just back to Cherry 1st
and then we'll turn to co-ops. I don't know if you could share
just a little bit more about what ownership means to a
worker, a care worker. It might path both in terms of
sort of what you do to reinforcethe culture and make people feel
(11:34):
like owners. And then you mentioned the
fight, just the financial benefit, but what does it really
look like from the perspective of any slot participant to be an
owner? And maybe what I could do is
we've taken some of the the general themes of the conference
about what it means to be an employee owner and then give you
some specific examples of how weapply that at my path.
So communication, we've talked alot about the need for
(11:55):
continuous communication, continuous education.
In our case, because we have a large number of employees, we do
have turnover, so we always havenew people coming in.
We created a series of animated videos that explain employee
ownership and there are 10 of them.
They're 45, four to 5 minutes each.
(12:16):
You can watch them on your phone.
And then when you complete that series, because we can track
that, our owners are given a certified employee owner or CEO
designation and they get a papercertificate and they're very
proud of them. They post them on their cubicles
or in their homes, wherever theyhappen to be.
So you know, one example on communication on the area of
(12:40):
voice, having a voice in the workplace, one of our one of
their recent initiatives becauseit came from our owners is in
our field traditionally one of the sort of problematic
situations is clients with disabilities sometimes direct
racial slurs to our owners. And I think the traditional view
(13:02):
in our industry was that, well, they don't know what they're
doing, they're not accountable. You need to just get over it.
And what I've learned is that can be traumatic in two ways,
both from the initial experienceand then from the fact that the
experience is dismissed by supervisors, by managers.
So our owners came up with a a training on those situations,
(13:25):
how to handle them. They call it Owner Dignity
Project. So that didn't come from me.
And that's been very powerful toindicate to our people that yes,
we are listening. We are concerned about your,
you're feeling valued and feeling included.
And I, I didn't mention the composition of our workforce.
We're about 45% non white, about75% women.
(13:50):
So we are working hard on the certification that Lauren talked
about. We're not number one, but we
hope we can be #2 thanks to Leslie and for her assistance
and the assistance of her team on that.
So that's an example. Thank you.
And Mr. Mystery solved, Terrell Terry just shared a little bit
about what ownership feels like looks like at this my path ESOP
(14:14):
company. Curious, could you just tell us
from the ground up kind of what is it?
What is what is ownership like? What does it mean for a worker,
owner, cooperative member in your space?
And the home care space at Home Care Associates ownership is me.
And I say that because from the moment you come into the doors
(14:36):
of Home Care Associates, you areintroduced to other Co-op.
When new employees come in, they're actually interviewed by
owners, employee owners. So they have a part in who's
actually coming into the organization from the beginning
and they also are a part of the training that gets to new
(14:57):
workers. They are a part of the in our
organization, we have committees, we have a policy
Action Group, we have a safety committee, we even have a
happiness committee, which is great.
We have a mentor program and allof those committees are ran by
the employee owners. The employee owners run those
(15:20):
committees bring it back to the larger of the employee owners.
Our owners are the board members.
Our board is set up of 12, sevenbeing the employee owners.
We have a Finance Committee that's set up of majority of the
employee owners. So in our organization the
employees really run the business.
(15:41):
We are, we have ACEO at our organization and it is good to
know that like JC mentioned yesterday, there's an open door
policy because all of us are owners.
So we own the building, we own the offices, we can come in and
you know, have meetings or look at finances and strategically
(16:03):
plan new programs and things together.
So in our organization we are the elites, we really run the
business and we the CEO comes inand she brings in her you goals
for the company or throughout the year, but that all has to be
approved by the employee owners.So in a sense we are her boss.
(16:26):
So in our organization, the decrement, the democratic
decision makings that we make, the governance that we follow
really gives the workers the field, well, not just the field.
We are the owners and, and, and having that they provide more
quality of service when they're going to the consumers.
(16:48):
Our consumers we provide serviceto are more involved in the work
that we do because they're receiving the quality of care
from a owner and not just an employee of the organization.
Thank. You so much powerful, Katrina.
Well, I know first of all, I know that with Audria and JC and
(17:10):
Charelle, we've heard from voices from some of the more
robust examples of home care cooperatives nationally.
I know you and ICA Group have have done an important job of
kind of documenting the entire home care cooperative sector.
And I wondered if you could paint a little bit of a picture
for us of the home care sector nationally and then share a
little bit about some of the newinnovations in scale through
(17:32):
secondary cooperatives you've been involved in.
Yeah, sure. I would love to.
So I'm really excited because wejust had a new cooperative that
was incorporated just last week.And so we have officially hit a
goal that we had set a couple ofyears ago of 25 worker owned
home care cooperatives by 2025. So, yeah, very excited about
(17:54):
that. And we've set ourselves a goal
of 50 by 2030. So we are really working towards
a big push for scale at this moment and I think we're really
well poised to do that. So the 25 cooperatives that
exist now are located in 10 different states in Puerto Rico
and we have a couple of states that have strong consolidations
of home care cooperative activities.
(18:16):
So Washington State just welcomed at six that that was
the one that launched last week,Mariposa.
So they have 6 home care cooperatives in Washington.
There are five in Minnesota and there's a scaled state based
initiative there. There is a state based scale
initiative in California that the ICA group is really involved
(18:36):
in, as well as a number of otherorganizations, Democracy at Work
Institute, National Domestic Worker Alliance, Filipino Worker
Center and the California Domestic Worker Coalition.
So that project is called Vivid Life.
And we're working on a rapid replication model for home care
cooperatives across the state there and we'll be launching 4
(18:57):
new cooperatives as part of thatproject in just a couple of
months. So we're really about that, but
there is at least another dozen home care cooperative projects
that are actively underway in about as many states across the
country now. So there's just a lot of
activity in this space. When I started now just a little
over 8 years ago, I think there were seven.
(19:20):
So this is a really exciting moment for us.
And especially coming out of COVID, there's just been so much
interest in and, and activity inworker ownership in the home
care space because the caregivers were not treated well
during that time. They weren't treated well before
and they're certainly not being treated well now.
But it really just, I think the combination of knowledge about
(19:45):
the model growing and just dissatisfaction growing with the
conditions, you know, has reallyled to a lot of activity.
But in terms of the 25 that exists now, you know, they're,
they're all women LED. Many are.
Led by owners of color and immigrants.
(20:06):
And they are primarily small businesses.
So, you know, I was happy there was some conversation in the
last panel about like true smallbusinesses.
And that is the vast majority ofbusinesses in the country.
But and that's very much the case in home care.
So, you know, over 80% of businesses in the home care
space, you know, have 50 or fewer employees.
(20:27):
And so home care cooperatives are, you know, very much in that
space, though we do have some larger outliers including CHCA.
And and that's certainly a goal that we have for the sector is,
you know, not only growing the number, but also growing the
size of home care cooperative sothat they can be more resilient.
So that gives you a little bit of a sense of what the home care
(20:49):
cooperative space looks like now.
And ICA is really involved in, in kind of a number of different
initiatives, you know, where we have now for years been really
focused on supporting the existing home care cooperatives
that are in operation, making them stronger, making them more
(21:09):
resilient, you know, really getting to that growth, that
growth path and growth mindset. Home care is an incredibly
difficult business, very, very slim margins.
And then also, yeah, growing startups and now really looking
at scaled initiatives. So I mentioned that there's this
project in California that's a rapid replication model, will
(21:29):
actually be replicating under a common brand with common
systems, policies, etc, with a shared secondary cooperative
back office. So that's a new model that we'll
be testing out and we're really,really excited about that.
And, and really what we'll be testing is, you know, our
hypothesis about how to address some of the challenges that we
(21:52):
see that are replicated across the country.
So we have been, you know, benchmarking the sector now for
seven years and we, you know, have documented all of the ways
that home care cooperatives are outperforming the, you know, the
broader industry, but also the persistent challenges that we're
seeing year after year state, you know, state to state, etc.
(22:13):
So that's one. And then the second just really,
you know, my, my love is the development of Elevate
Cooperative, which is a new national secondary cooperative
for the home care cooperative sector specifically.
And Elevate Cooperative will actually launch a membership, a
(22:34):
formal membership program this fall.
But we have for a number of years now actually been piloting
a variety of different initiatives.
We have a national online peer networking and exchange platform
where cooperatives can share information and connect
etcetera. That's something we launched
last fall and a number of other programs.
(22:55):
But really the, the idea is that, you know, it's very
difficult for home care cooperatives to compete, you
know, and, and there's a number of challenges that I can get
into around that. But what we have as our
competitive advantage is this desire to cooperate.
(23:16):
And so really leaning into and formalizing cooperation among
cooperatives and pooling our resources to be able to better
compete with the traditional home care space S there's a lot
more I could say there, but I'llstop there for now and we can
talk more about that as we go along.
Thank you. That's an important innovation,
(23:38):
a question for a question reallyfor any of you.
In my own, in some of my own research on employee owned
businesses in the health sector,I found some really suggestive
but still anecdotal evidence that when you embed workers and
better support systems and you actually give them an ownership
stake that that can translate into improved care for patients
(24:04):
or clients. I was just curious, Terrell,
Terry, Katrina, any examples youcan think of or is is that in
your experience, is that true? And any examples you can think
of of how ownership could potentially translate into
improved care that? I have I have several examples
of that as I before I started home care, I was a certified
(24:26):
nursing assistant working in thenursing home and one of the
things and I was just the personthere at that time because I'm
fully engulfed in Co-op at this point.
But while there, I was told thatI could not go into the rooms
and hold conversations with the residents longer than 5 minutes.
(24:49):
When you go into the room, you denounce yourself.
Go in there what you're in therefor and don't spend long times
in there talking to the residents.
That's what they do at the community room, but not in their
rooms. I talk a lot.
I like the crack jokes and dancefor people.
So I found that that was hard for me because I could not
(25:14):
connect with my consumers when Igot to home Care associates.
First, I must say in the Co-op world, we are a collective.
A lot of my initial trainings tobe the director I am today I got
for free from cooperative Home care Associates because they
were the largest Co-op in our model was built from theirs.
(25:38):
They shared all of their knowledge with us, trained the
workers to be where we are todayand further and continue to do
that. So when I got to Home Care
Associates, the first thing thatstruck me is when I came in,
they said my name and I didn't know these people.
And then they gave me a hug and they gave me food and it was
really nice. But when I got to my consumers
(26:01):
homes and I'm, you know, and they're doing my work and I
found myself conversing with my consumers and I got appreciated
for doing so. And I was like, wow, you know,
and they said what's real, you got a really good rapport with
the consumers. I want to send you over to this
one and maybe you can talk with her and help.
So now I'm being asked to go in and talk with people where,
(26:25):
where I came from, you can't talk with them more than 5
minutes. So when you are given some
ownership in the work that you do, you tend to put more quality
in the work that you do and is supported to do so because it's
the it's quality jobs, quality care.
So in my the quality of my job, it allowed, it pushed me to want
(26:49):
to give more quality of care because it was expected.
If I could follow up on that, Soif you look at the data produced
by NCO or Rutgers or the other groups about financial
outperformance by Esops and employee ownership, that's great
data. I would love to have similar
(27:10):
data in the healthcare space. I don't think we do yet.
In our case, we're in that subset or that niche of
healthcare where quality has notreally yet been totally defined
in a standard or uniform way. We have accreditations, so we
achieve accreditation in different areas, but that's kind
of a baseline. So and that's actually been a
topic in our pure networking group under the auspices of NCO.
(27:34):
We have a small group of healthcare companies that get
together and it'd be great to have that data so you can
produce that. Thank God.
Yeah, I'll add as well. I think this is such a tricky
one. It's something that we're very
aware of that we need more data on the client side.
(27:55):
You know, I think in particular to be taken more seriously
though, we have tons of anecdotal evidence from clients
who express how different the care is from cooperatives.
And what we do also have is dataon the caregiver side.
So Audrey, I touched on this earlier.
So home care cooperatives have an annual turnover, caregiver
(28:16):
turnover rate of only 30% versusthe broader industry, which is
79%. And that relationship and that
consistency that's created by a caregiver that is showing up day
after day is building rapport with clients, knows their needs,
their wants, their specific, youknow, ways of of wanting support
(28:39):
because it is quite a client centered service, you know, that
that produces a higher quality experience.
And so, so that's a key factor is the turnover rate.
And the turnover rate directly relates to caregiver tenure.
You know, all of the cooperatives have examples of,
(29:01):
you know, numerous caregivers, caregivers who have been
employed with them for years, decades, etcetera.
And the other that we do know isthat client tenure is longer.
So that is a piece of data that we have that client tenure at
Home Care Cooperatives is more than double the industry
average. And so we do all of our
benchmarking. We compare against what's now
(29:22):
Activated Insights, which is a great report that looks at the
the broader industry. So I think we have a lot of data
indicators, but it would be great to get more on the client
side and it's something that we're certainly thinking a lot
about. I think the challenge is that
the way that, you know, it's typically looked at is re
(29:44):
hospitalizations and things likethat.
And that's such a tricky data point because actually going to
the hospital could be an indicator of better care.
And so I don't think the industry as a whole has figured
this out. It's kind of a challenge that
everybody is dealing with cooperative or not.
And so we're not unique in that way, but you know, we're trying
(30:06):
trying to figure that out so that we can can have more proof
on the client side of kind of the cooperative difference to
the client experience we. Definitely need better measures.
Let's see, I guess one more question and then we'll we'll
turn it over to some some Q&A. You know, we've talked about how
this home care, residential careare quite low margin sectors and
(30:31):
in part it's an economic space that's very much constrained by
policy and like Medicare, Medicaid reimbursement rates and
such. So just curious as we're talking
about quality of jobs and also quality of care, if you, any of
you have thoughts on sort of policy solutions, regulatory
solutions that could help kind of undergird this higher job
(30:53):
quality, higher care approach, shared ownership approach like
what policy solutions, regulatory solutions would be
helpful? Well, that's a big one.
In our case, we have last count 230 different government funding
sources and that's a lot of policy to keep track of.
But I would say one of the themes that we run into frankly
(31:13):
is over regulation. No offense to Hillary, but there
are situations and we see this more at the state level where
we're involved, but you might have situations with poor
quality providers, incidents occur and then the immediate
reaction is to regulate like, oh, what this means.
It just, we just need more rules.
That's totally disconnected fromfunding and those two sides do
(31:37):
not talk to each other. So, yeah, I mean dealing with
that. And then the other is more
support for technology. And we are not really adopters
of technology, but when we look at the workforce situation,
demographic trends, we have to come up with technological
solutions to take away the tasksthat divert from client care.
(32:00):
And I think there are a lot of opportunities, opportunities to
do that. And again, regulators do not
necessarily see that are not familiar with systems that are
available today. So those were a couple things I
would mention. I would add to if there is a way
to make it feasible for worker home care co-ops that have the
(32:28):
same access to funds as non traditional agencies without
that personal guarantee, becausethe guarantee is already here.
It's proven we are the workforce, we, we are the owners
to make that easier for us to gain to put that back into the
workers, you know, whether it bein money and training and and
(32:52):
those things. If there was some way to have
that policy a little more clear for home care co-ops, it would
would take a little weight off of us because we are always
innovative because the workers have ideas and getting over
those struggles and being able to persevere like we did through
(33:14):
COVID by leaning on each other. But if we were able to get those
funds, it would have been a lot more easier.
Access to capital at the earlierdiscussion about.
Yeah, OK, thank you. Katrina, any additional?
Yeah. I mean, well, the the big and
obvious one is we need more public investment in home care,
(33:35):
you know, through Medicaid, Medicare, we'll see if and when
that happens. But sort of in, in the absence
of that or in the meantime, right, we can't sort of sit back
and wait for that. We need to be finding other ways
to get creative and get more investment into the field and
into the job. So I think you know what would
(33:56):
be great would be preferential contracting for employee owned
companies or home care companiesthat are investing in job
quality. Not all home home care agencies
are created equal, absolutely not.
And those that are investing in training and ongoing education.
So that's a big one. I do think workforce development
(34:17):
came up on one of the other panels and there, there are no
national standards for, for homecare.
So in some states you can quite literally get employed and just
walk into a home and start caring for someone and that's
crazy. And other states have very low
barriers and others much higher.So there's no standards and
(34:40):
there's not enough investment intraining in general.
So I would say that's another area and workforce development
might be one of the the places to do that investment.
The personal guarantees is another, and this is a little
bit different than the policy question, but I'm going to steal
the space here for a little soapbox, which is also that we
(35:01):
even find actually from foundations and funders, there's
often a lot of pushback and investing in home care because
home care jobs are considered bad jobs.
And so there's this thought, well, no, we don't want to
invest in home care. We want to be moving people from
home care into other jobs that are that are high, higher
paying, but then that sort of glosses over the fact that home
(35:23):
care is a huge need, that it's one of the fastest growing
professions in the country. And so if we just don't invest
in that, then we're we are making a, you know, a statement
really that that we are OK with having, you know, a whole
population of workers that are just going to be low wage and
(35:44):
not invested in. So I think that there's there's
a policy changes that are neededbig time, but also we need to
change our thinking in general around how we're investing in
this workforce and, and how important it is and sort of at
all the different levels. Thank.
You for that, friends? We have time for just a question
(36:06):
or two. Any questions, Terrell?
Yes. Oh, I'm sorry.
Yeah. Hi, thank you.
And I'm actually with a healthcare provider in
California. So I would love to learn more
about your Co-op and and you know how you guys are working
together with other co-ops and you know, would invite you to
(36:29):
really have that quality data. I mean, you know, that's our
driver is, you know, being able to provide high quality,
affordable healthcare. And while we don't provide, you
know, home care to our members, you know as an insurer we pay
for it. And so we would like to see
that. And I'm an advocate in our
organization for preferential treatment for whom are
(36:50):
cooperatively owned or employee owned home care providers
because of the quality element, the job quality and how that
promotes upstream health. So I'd love to connect
afterwards. Wonderful.
Thank you. Any other questions?
(37:13):
Questions. Got one more Hillary?
Actually not a question, but a comment.
It is just so inspiring to hear.Thank you for laying out those
numbers. Katrina 7 home care co-ops eight
years ago, 25 today. We'll double that in the next 10
(37:33):
years. So just congratulations and
thank you. It's remarkable to see the
infrastructure you've built through cooperation among
cooperatives through the excellent support of the, you
know, technical assistance providers like the ICA Group and
DAUI and we need this in home care and wonderful to hear about
your ESOP as well. So just thank you for the work
(37:54):
and. Keep it up.
Thank you. Thank you, Hilary.
Last question, Sir. Thank you for the interesting
presentation. Now instead of asking, I'm I'm
glad you came to a question as to whether or not employee
(38:17):
ownership would improve servicesbecause in DC where I have some
experience of receiving home health care.
So it's not a very good even though they are all licensed and
the licensing process is also a little corrupt.
Given that, I would like to ask Terry, how did you solve your
(38:37):
racial slur problem? Just kidding.
Well. I don't know if we solved it,
but we we've taken some steps totry and address it.
I'll put it that way. Because it has to be somebody
very crazy to use a racial slur or somebody who has been
oppressed to such a point that they've gone.
Well, the reality is some of ourchildren or adults that come to
(39:00):
us, to our programs, this is what they've heard all their
lives. This is their families.
So it's not a quick fix. I'll add some good news, which
is there's a home care cooperative in development in
DC, so hopefully coming coming. Soon, friends, thank you.
(39:21):
Tremendous thank you to the panel round of applause.
I'm Adria Scharf. I'm part of the leadership team
at the Rutgers Institute for theStudy of Employee Ownership and
Profit Sharing, and I am delighted to have the
opportunity to moderate this important discussion focused on
the role of employee ownership, worker ownership models,
specifically in the health sector, health sector, in the
(00:27):
care providing sectors. This sector has been a
particular interest of mine in my own, in my own research.
And I'm excited to be joined today by Terrell Cannon and
Katrina Kozda, Terry Leahy, and we'll introduce them in more
detail in just a minute. But just wanted to frame out
(00:48):
just in a few words, sort of howI think about the importance of
this question. And, you know, I would say that
the way we structure ownership in the health sector really,
really matters. And I think some previous
speakers today, including AudriaPowell, have really kind of set
(01:08):
the stage for this conversation,laying out a number of themes
related to the fact that we as asociety insufficiently care for
the people, the human beings whowe asked to provide care to
ourselves and to our loved ones,And the crisis in care work and
the importance of democratic High Road shared ownership
models that share dignity with frontline workers.
(01:31):
Other speakers have also talked about the rapid growth in this
sector, the health sector care work is one of the fastest
growing kind of segments in terms of jobs.
It's also, as Lauren just kind of alluded to, with Forgotten
Cities. You know, as we've seen the
decline of the manufacturing sector in many communities in
the Rust Belt, increasingly the health systems, the health
(01:53):
providers are the economic driver of the community and
central to just establishing theeconomic foundation for entire
localities. But a third reason that the
structure of ownership and health matters to me is
something really obvious. But then I think we just take
for granted and forget sometimesas Americans, those of us who
(02:13):
are Americans, which is just thefact that in the United States
the provision of health servicesand the provision of care
services are commercialized and privatized to a much greater
degree than in many other parts of the world.
So here in the United States, werely on for profit businesses to
(02:35):
provide many of the foundationalhealth care needs to meet our
healthcare needs as a community.And yet the predominant models
of ownership in the sector are often outside investor owned
models or structures of ownership that limit ownership
to just one or two a small number of individuals within the
business and employee ownership models are relatively rare.
(02:57):
I think that within the kind of the healthcare pie chart, sorry,
within the ESOP pie chart, amongall Esops, Esops in healthcare
and social assistance represent just 2% of all Esops overall,
which is relatively small. But their examples are very
(03:17):
important. And we'll hear, we'll hear from
Terry in just a minute about thecompany he leads in the universe
of worker cooperatives. We heard earlier from Audria
Powell and yesterday from JC about CHCA, which as we know is
the largest worker cooperative in the country, one of the most
robust and resilient and important models around.
(03:40):
And I think it really stands outas an example and kind of a
motivator for so many. And we'll hear more today about
other models and some new innovations in the home care
cooperative space. So with that, I would love to
introduce our panelists. We have with us Terry Leahy, who
is CEO of the ESOP company, My Path, Katrina Kozda, Vice
(04:04):
President of Home Care Innovations, the ICA Group and
Cherelle Cannon, Director of Training and Workforce
Development, Home Care Associates of Philadelphia.
And we will start by just inviting each of you to share a
little bit about yourself and your employee ownership journey,
a little bit about your own, your own companies.
(04:26):
So Terrell, let's start with you.
Would you tell us about yourselfand the history and the work of
Home Care Associates? Hi everyone, thank you again
Rutgers asking for inviting me to the Space 8.
I will not get this Adria. Adria But I am Terrell Cannon.
I am a employee owner of Home Care Associates of Philadelphia.
(04:51):
I came into this to to this space in 1993, coming from a
traditional workplace where I was not valued, respected or
even appreciated for the work that I did in providing care to
the members of my community. When I got to Home Care
(05:12):
Associates, it was very different and coming into a
space where my ideas, my voice and I was offered to make the
decisions and sit at the table with what I thought in a
traditional workplace where the elites to sit at the table with
the elites to make the decisionsfor the company.
And what I found at working at Home Care Associates is that I
(05:34):
am the elite. So, and yes, snap, snap, snap.
So with with that and being in this space, I've grown from
starting out as a young woman onpublic welfare clocking and
clocking out to now a business owner making decisions to expand
(05:56):
my organization with my other colleagues and working
collectively with other co-ops like Cooperative Home Care
Associates of New York who has provided us with the foundation
to be here 30 years later. So.
Katrina, let's stick with home care cooperatives.
And could you share a little bitabout your work at ICA Group?
(06:21):
Yeah, sure. So I've been working with the
ICA Group for a little over 8 years now.
We launched ICA, has been involved in the home care
cooperative space since the founding of Cooperative Home
Care Associates in 1985. But we launched a formal program
in 2018 and for a number of years I was heading up that
(06:42):
program and now have now shiftedover to focusing on our scaled
initiatives both nationally and state based.
But yeah, ICA sort of has its hands in all aspects of home
care. Cooperatives live and breathe it
both to my benefit and to my detriment, because I can't
(07:04):
imagine working with a more amazing group of humans, really.
It's an incredible, incredible space to work in individuals
like Trail. And also, it is a very, very
hard industry and there are so many challenges and barriers
that we're having to work through.
But yeah, you know, I see as work really kind of touches the
(07:27):
whole space from startup to, youknow, strategic consulting and
supporting existing cooperativesin their continued growth and
stability. And as I said, now really
looking at how do we grow and scale the sector and really
through that, the point of that is more employee ownership in
the space, more control and ultimately to transform the
(07:50):
industry and the way that it operates.
Thank you, Terry. Tell us about my path.
Sure. And and thanks again to Rutgers
and the Institute for including myself and our company in this
list of illustrious ESOP companies that I've heard about
over the last two days. And I guess my path is that
Unicorn. We are a traditional ESOP, but
(08:13):
we're in a social services, Human Services space and our
company was founded 40 years ago.
We had our 40th anniversary lastfall and our founder bought the
assets of the company out of bankruptcy when he was 30 years
old. Now we have kids in their 30s
who are still on their parents cell phone plan.
So the idea of thinking of one of them going out and taking the
(08:37):
risk that Jim did is quite something.
And Jim is ACPA, so he's a moneyguy, but he had worked in
programs for people with disabilities as a teenager and
he had a passion for growing those programs, opening new
programs. And that balance between mission
and margin remains in the company to this day.
So Fast forward, he, at the timethat he bought the assets of the
(09:00):
company, we had a residential program for children with
significant disabilities and eight group homes for adults.
And those two service lines became kind of the double Helix
of our DNA as an organization. So we replicated over the years,
grew organically. And today we have 8 operating
companies, each with a differentfocus, different regulators.
(09:22):
But the common unifying strategyis that we focus on very high
needs individuals and we try andprovide a continuum of care from
childhood until end of life. So that means, for example, we
have clinics for toddlers with autism, we have day schools for
children with significant disabilities, We have community
(09:45):
living settings for people with disabilities.
So a whole range of services. We now have about 2000 owners
and we're in 41 communities in Wisconsin and Indiana and about
159 program locations. In our case, a program location
could be anything from a large residential campus for children
(10:06):
to a single person setting in the middle of nowhere in
Wisconsin. Staff 24/7.
So if you think about Aesop's and Aesop culture, that becomes
part of the equation as to how do you communicate with that
group. Just a few financial metrics
because it's not about the money, but it's kind of about
the money with this audience. So we are at about 170 million
(10:30):
in revenue run rate and 12 to 13% of that is EBITDA.
Our ESOP started in 2002 is a 30or I'm sorry, 2000, yes, 2002 is
a 30%. In 2016, we became 100% ESOP.
Our share price has had a 12% compounded annual growth rate
(10:51):
over that time. So we do have caregivers who
have 6 figure retirement accounts, which is amazing and
something to be thankful for. That's what.
That's my intro. Thank you.
We were talking, a few of us were talking earlier about kind
of worker cooperatives in Esop'sand how they're both, we both
kind of fold them together underthis banner of employee
(11:12):
ownership or worker ownership and and in some ways how
different they are structurally.And so just back to Cherry 1st
and then we'll turn to co-ops. I don't know if you could share
just a little bit more about what ownership means to a
worker, a care worker. It might path both in terms of
sort of what you do to reinforcethe culture and make people feel
(11:34):
like owners. And then you mentioned the
fight, just the financial benefit, but what does it really
look like from the perspective of any slot participant to be an
owner? And maybe what I could do is
we've taken some of the the general themes of the conference
about what it means to be an employee owner and then give you
some specific examples of how weapply that at my path.
So communication, we've talked alot about the need for
(11:55):
continuous communication, continuous education.
In our case, because we have a large number of employees, we do
have turnover, so we always havenew people coming in.
We created a series of animated videos that explain employee
ownership and there are 10 of them.
They're 45, four to 5 minutes each.
(12:16):
You can watch them on your phone.
And then when you complete that series, because we can track
that, our owners are given a certified employee owner or CEO
designation and they get a papercertificate and they're very
proud of them. They post them on their cubicles
or in their homes, wherever theyhappen to be.
So you know, one example on communication on the area of
(12:40):
voice, having a voice in the workplace, one of our one of
their recent initiatives becauseit came from our owners is in
our field traditionally one of the sort of problematic
situations is clients with disabilities sometimes direct
racial slurs to our owners. And I think the traditional view
(13:02):
in our industry was that, well, they don't know what they're
doing, they're not accountable. You need to just get over it.
And what I've learned is that can be traumatic in two ways,
both from the initial experienceand then from the fact that the
experience is dismissed by supervisors, by managers.
So our owners came up with a a training on those situations,
(13:25):
how to handle them. They call it Owner Dignity
Project. So that didn't come from me.
And that's been very powerful toindicate to our people that yes,
we are listening. We are concerned about your,
you're feeling valued and feeling included.
And I, I didn't mention the composition of our workforce.
We're about 45% non white, about75% women.
(13:50):
So we are working hard on the certification that Lauren talked
about. We're not number one, but we
hope we can be #2 thanks to Leslie and for her assistance
and the assistance of her team on that.
So that's an example. Thank you.
And Mr. Mystery solved, Terrell Terry just shared a little bit
about what ownership feels like looks like at this my path ESOP
(14:14):
company. Curious, could you just tell us
from the ground up kind of what is it?
What is what is ownership like? What does it mean for a worker,
owner, cooperative member in your space?
And the home care space at Home Care Associates ownership is me.
And I say that because from the moment you come into the doors
(14:36):
of Home Care Associates, you areintroduced to other Co-op.
When new employees come in, they're actually interviewed by
owners, employee owners. So they have a part in who's
actually coming into the organization from the beginning
and they also are a part of the training that gets to new
(14:57):
workers. They are a part of the in our
organization, we have committees, we have a policy
Action Group, we have a safety committee, we even have a
happiness committee, which is great.
We have a mentor program and allof those committees are ran by
the employee owners. The employee owners run those
(15:20):
committees bring it back to the larger of the employee owners.
Our owners are the board members.
Our board is set up of 12, sevenbeing the employee owners.
We have a Finance Committee that's set up of majority of the
employee owners. So in our organization the
employees really run the business.
(15:41):
We are, we have ACEO at our organization and it is good to
know that like JC mentioned yesterday, there's an open door
policy because all of us are owners.
So we own the building, we own the offices, we can come in and
you know, have meetings or look at finances and strategically
(16:03):
plan new programs and things together.
So in our organization we are the elites, we really run the
business and we the CEO comes inand she brings in her you goals
for the company or throughout the year, but that all has to be
approved by the employee owners.So in a sense we are her boss.
(16:26):
So in our organization, the decrement, the democratic
decision makings that we make, the governance that we follow
really gives the workers the field, well, not just the field.
We are the owners and, and, and having that they provide more
quality of service when they're going to the consumers.
(16:48):
Our consumers we provide serviceto are more involved in the work
that we do because they're receiving the quality of care
from a owner and not just an employee of the organization.
Thank. You so much powerful, Katrina.
Well, I know first of all, I know that with Audria and JC and
(17:10):
Charelle, we've heard from voices from some of the more
robust examples of home care cooperatives nationally.
I know you and ICA Group have have done an important job of
kind of documenting the entire home care cooperative sector.
And I wondered if you could paint a little bit of a picture
for us of the home care sector nationally and then share a
little bit about some of the newinnovations in scale through
(17:32):
secondary cooperatives you've been involved in.
Yeah, sure. I would love to.
So I'm really excited because wejust had a new cooperative that
was incorporated just last week.And so we have officially hit a
goal that we had set a couple ofyears ago of 25 worker owned
home care cooperatives by 2025. So, yeah, very excited about
(17:54):
that. And we've set ourselves a goal
of 50 by 2030. So we are really working towards
a big push for scale at this moment and I think we're really
well poised to do that. So the 25 cooperatives that
exist now are located in 10 different states in Puerto Rico
and we have a couple of states that have strong consolidations
of home care cooperative activities.
(18:16):
So Washington State just welcomed at six that that was
the one that launched last week,Mariposa.
So they have 6 home care cooperatives in Washington.
There are five in Minnesota and there's a scaled state based
initiative there. There is a state based scale
initiative in California that the ICA group is really involved
(18:36):
in, as well as a number of otherorganizations, Democracy at Work
Institute, National Domestic Worker Alliance, Filipino Worker
Center and the California Domestic Worker Coalition.
So that project is called Vivid Life.
And we're working on a rapid replication model for home care
cooperatives across the state there and we'll be launching 4
(18:57):
new cooperatives as part of thatproject in just a couple of
months. So we're really about that, but
there is at least another dozen home care cooperative projects
that are actively underway in about as many states across the
country now. So there's just a lot of
activity in this space. When I started now just a little
over 8 years ago, I think there were seven.
(19:20):
So this is a really exciting moment for us.
And especially coming out of COVID, there's just been so much
interest in and, and activity inworker ownership in the home
care space because the caregivers were not treated well
during that time. They weren't treated well before
and they're certainly not being treated well now.
But it really just, I think the combination of knowledge about
(19:45):
the model growing and just dissatisfaction growing with the
conditions, you know, has reallyled to a lot of activity.
But in terms of the 25 that exists now, you know, they're,
they're all women LED. Many are.
Led by owners of color and immigrants.
(20:06):
And they are primarily small businesses.
So, you know, I was happy there was some conversation in the
last panel about like true smallbusinesses.
And that is the vast majority ofbusinesses in the country.
But and that's very much the case in home care.
So, you know, over 80% of businesses in the home care
space, you know, have 50 or fewer employees.
(20:27):
And so home care cooperatives are, you know, very much in that
space, though we do have some larger outliers including CHCA.
And and that's certainly a goal that we have for the sector is,
you know, not only growing the number, but also growing the
size of home care cooperative sothat they can be more resilient.
So that gives you a little bit of a sense of what the home care
(20:49):
cooperative space looks like now.
And ICA is really involved in, in kind of a number of different
initiatives, you know, where we have now for years been really
focused on supporting the existing home care cooperatives
that are in operation, making them stronger, making them more
(21:09):
resilient, you know, really getting to that growth, that
growth path and growth mindset. Home care is an incredibly
difficult business, very, very slim margins.
And then also, yeah, growing startups and now really looking
at scaled initiatives. So I mentioned that there's this
project in California that's a rapid replication model, will
(21:29):
actually be replicating under a common brand with common
systems, policies, etc, with a shared secondary cooperative
back office. So that's a new model that we'll
be testing out and we're really,really excited about that.
And, and really what we'll be testing is, you know, our
hypothesis about how to address some of the challenges that we
(21:52):
see that are replicated across the country.
So we have been, you know, benchmarking the sector now for
seven years and we, you know, have documented all of the ways
that home care cooperatives are outperforming the, you know, the
broader industry, but also the persistent challenges that we're
seeing year after year state, you know, state to state, etc.
(22:13):
So that's one. And then the second just really,
you know, my, my love is the development of Elevate
Cooperative, which is a new national secondary cooperative
for the home care cooperative sector specifically.
And Elevate Cooperative will actually launch a membership, a
(22:34):
formal membership program this fall.
But we have for a number of years now actually been piloting
a variety of different initiatives.
We have a national online peer networking and exchange platform
where cooperatives can share information and connect
etcetera. That's something we launched
last fall and a number of other programs.
(22:55):
But really the, the idea is that, you know, it's very
difficult for home care cooperatives to compete, you
know, and, and there's a number of challenges that I can get
into around that. But what we have as our
competitive advantage is this desire to cooperate.
(23:16):
And so really leaning into and formalizing cooperation among
cooperatives and pooling our resources to be able to better
compete with the traditional home care space S there's a lot
more I could say there, but I'llstop there for now and we can
talk more about that as we go along.
Thank you. That's an important innovation,
(23:38):
a question for a question reallyfor any of you.
In my own, in some of my own research on employee owned
businesses in the health sector,I found some really suggestive
but still anecdotal evidence that when you embed workers and
better support systems and you actually give them an ownership
stake that that can translate into improved care for patients
(24:04):
or clients. I was just curious, Terrell,
Terry, Katrina, any examples youcan think of or is is that in
your experience, is that true? And any examples you can think
of of how ownership could potentially translate into
improved care that? I have I have several examples
of that as I before I started home care, I was a certified
(24:26):
nursing assistant working in thenursing home and one of the
things and I was just the personthere at that time because I'm
fully engulfed in Co-op at this point.
But while there, I was told thatI could not go into the rooms
and hold conversations with the residents longer than 5 minutes.
(24:49):
When you go into the room, you denounce yourself.
Go in there what you're in therefor and don't spend long times
in there talking to the residents.
That's what they do at the community room, but not in their
rooms. I talk a lot.
I like the crack jokes and dancefor people.
So I found that that was hard for me because I could not
(25:14):
connect with my consumers when Igot to home Care associates.
First, I must say in the Co-op world, we are a collective.
A lot of my initial trainings tobe the director I am today I got
for free from cooperative Home care Associates because they
were the largest Co-op in our model was built from theirs.
(25:38):
They shared all of their knowledge with us, trained the
workers to be where we are todayand further and continue to do
that. So when I got to Home Care
Associates, the first thing thatstruck me is when I came in,
they said my name and I didn't know these people.
And then they gave me a hug and they gave me food and it was
really nice. But when I got to my consumers
(26:01):
homes and I'm, you know, and they're doing my work and I
found myself conversing with my consumers and I got appreciated
for doing so. And I was like, wow, you know,
and they said what's real, you got a really good rapport with
the consumers. I want to send you over to this
one and maybe you can talk with her and help.
So now I'm being asked to go in and talk with people where,
(26:25):
where I came from, you can't talk with them more than 5
minutes. So when you are given some
ownership in the work that you do, you tend to put more quality
in the work that you do and is supported to do so because it's
the it's quality jobs, quality care.
So in my the quality of my job, it allowed, it pushed me to want
(26:49):
to give more quality of care because it was expected.
If I could follow up on that, Soif you look at the data produced
by NCO or Rutgers or the other groups about financial
outperformance by Esops and employee ownership, that's great
data. I would love to have similar
(27:10):
data in the healthcare space. I don't think we do yet.
In our case, we're in that subset or that niche of
healthcare where quality has notreally yet been totally defined
in a standard or uniform way. We have accreditations, so we
achieve accreditation in different areas, but that's kind
of a baseline. So and that's actually been a
topic in our pure networking group under the auspices of NCO.
(27:34):
We have a small group of healthcare companies that get
together and it'd be great to have that data so you can
produce that. Thank God.
Yeah, I'll add as well. I think this is such a tricky
one. It's something that we're very
aware of that we need more data on the client side.
(27:55):
You know, I think in particular to be taken more seriously
though, we have tons of anecdotal evidence from clients
who express how different the care is from cooperatives.
And what we do also have is dataon the caregiver side.
So Audrey, I touched on this earlier.
So home care cooperatives have an annual turnover, caregiver
(28:16):
turnover rate of only 30% versusthe broader industry, which is
79%. And that relationship and that
consistency that's created by a caregiver that is showing up day
after day is building rapport with clients, knows their needs,
their wants, their specific, youknow, ways of of wanting support
(28:39):
because it is quite a client centered service, you know, that
that produces a higher quality experience.
And so, so that's a key factor is the turnover rate.
And the turnover rate directly relates to caregiver tenure.
You know, all of the cooperatives have examples of,
(29:01):
you know, numerous caregivers, caregivers who have been
employed with them for years, decades, etcetera.
And the other that we do know isthat client tenure is longer.
So that is a piece of data that we have that client tenure at
Home Care Cooperatives is more than double the industry
average. And so we do all of our
benchmarking. We compare against what's now
(29:22):
Activated Insights, which is a great report that looks at the
the broader industry. So I think we have a lot of data
indicators, but it would be great to get more on the client
side and it's something that we're certainly thinking a lot
about. I think the challenge is that
the way that, you know, it's typically looked at is re
(29:44):
hospitalizations and things likethat.
And that's such a tricky data point because actually going to
the hospital could be an indicator of better care.
And so I don't think the industry as a whole has figured
this out. It's kind of a challenge that
everybody is dealing with cooperative or not.
And so we're not unique in that way, but you know, we're trying
(30:06):
trying to figure that out so that we can can have more proof
on the client side of kind of the cooperative difference to
the client experience we. Definitely need better measures.
Let's see, I guess one more question and then we'll we'll
turn it over to some some Q&A. You know, we've talked about how
this home care, residential careare quite low margin sectors and
(30:31):
in part it's an economic space that's very much constrained by
policy and like Medicare, Medicaid reimbursement rates and
such. So just curious as we're talking
about quality of jobs and also quality of care, if you, any of
you have thoughts on sort of policy solutions, regulatory
solutions that could help kind of undergird this higher job
(30:53):
quality, higher care approach, shared ownership approach like
what policy solutions, regulatory solutions would be
helpful? Well, that's a big one.
In our case, we have last count 230 different government funding
sources and that's a lot of policy to keep track of.
But I would say one of the themes that we run into frankly
(31:13):
is over regulation. No offense to Hillary, but there
are situations and we see this more at the state level where
we're involved, but you might have situations with poor
quality providers, incidents occur and then the immediate
reaction is to regulate like, oh, what this means.
It just, we just need more rules.
That's totally disconnected fromfunding and those two sides do
(31:37):
not talk to each other. So, yeah, I mean dealing with
that. And then the other is more
support for technology. And we are not really adopters
of technology, but when we look at the workforce situation,
demographic trends, we have to come up with technological
solutions to take away the tasksthat divert from client care.
(32:00):
And I think there are a lot of opportunities, opportunities to
do that. And again, regulators do not
necessarily see that are not familiar with systems that are
available today. So those were a couple things I
would mention. I would add to if there is a way
to make it feasible for worker home care co-ops that have the
(32:28):
same access to funds as non traditional agencies without
that personal guarantee, becausethe guarantee is already here.
It's proven we are the workforce, we, we are the owners
to make that easier for us to gain to put that back into the
workers, you know, whether it bein money and training and and
(32:52):
those things. If there was some way to have
that policy a little more clear for home care co-ops, it would
would take a little weight off of us because we are always
innovative because the workers have ideas and getting over
those struggles and being able to persevere like we did through
(33:14):
COVID by leaning on each other. But if we were able to get those
funds, it would have been a lot more easier.
Access to capital at the earlierdiscussion about.
Yeah, OK, thank you. Katrina, any additional?
Yeah. I mean, well, the the big and
obvious one is we need more public investment in home care,
(33:35):
you know, through Medicaid, Medicare, we'll see if and when
that happens. But sort of in, in the absence
of that or in the meantime, right, we can't sort of sit back
and wait for that. We need to be finding other ways
to get creative and get more investment into the field and
into the job. So I think you know what would
(33:56):
be great would be preferential contracting for employee owned
companies or home care companiesthat are investing in job
quality. Not all home home care agencies
are created equal, absolutely not.
And those that are investing in training and ongoing education.
So that's a big one. I do think workforce development
(34:17):
came up on one of the other panels and there, there are no
national standards for, for homecare.
So in some states you can quite literally get employed and just
walk into a home and start caring for someone and that's
crazy. And other states have very low
barriers and others much higher.So there's no standards and
(34:40):
there's not enough investment intraining in general.
So I would say that's another area and workforce development
might be one of the the places to do that investment.
The personal guarantees is another, and this is a little
bit different than the policy question, but I'm going to steal
the space here for a little soapbox, which is also that we
(35:01):
even find actually from foundations and funders, there's
often a lot of pushback and investing in home care because
home care jobs are considered bad jobs.
And so there's this thought, well, no, we don't want to
invest in home care. We want to be moving people from
home care into other jobs that are that are high, higher
paying, but then that sort of glosses over the fact that home
(35:23):
care is a huge need, that it's one of the fastest growing
professions in the country. And so if we just don't invest
in that, then we're we are making a, you know, a statement
really that that we are OK with having, you know, a whole
population of workers that are just going to be low wage and
(35:44):
not invested in. So I think that there's there's
a policy changes that are neededbig time, but also we need to
change our thinking in general around how we're investing in
this workforce and, and how important it is and sort of at
all the different levels. Thank.
You for that, friends? We have time for just a question
(36:06):
or two. Any questions, Terrell?
Yes. Oh, I'm sorry.
Yeah. Hi, thank you.
And I'm actually with a healthcare provider in
California. So I would love to learn more
about your Co-op and and you know how you guys are working
together with other co-ops and you know, would invite you to
(36:29):
really have that quality data. I mean, you know, that's our
driver is, you know, being able to provide high quality,
affordable healthcare. And while we don't provide, you
know, home care to our members, you know as an insurer we pay
for it. And so we would like to see
that. And I'm an advocate in our
organization for preferential treatment for whom are
(36:50):
cooperatively owned or employee owned home care providers
because of the quality element, the job quality and how that
promotes upstream health. So I'd love to connect
afterwards. Wonderful.
Thank you. Any other questions?
(37:13):
Questions. Got one more Hillary?
Actually not a question, but a comment.
It is just so inspiring to hear.Thank you for laying out those
numbers. Katrina 7 home care co-ops eight
years ago, 25 today. We'll double that in the next 10
(37:33):
years. So just congratulations and
thank you. It's remarkable to see the
infrastructure you've built through cooperation among
cooperatives through the excellent support of the, you
know, technical assistance providers like the ICA Group and
DAUI and we need this in home care and wonderful to hear about
your ESOP as well. So just thank you for the work
(37:54):
and. Keep it up.
Thank you. Thank you, Hilary.
Last question, Sir. Thank you for the interesting
presentation. Now instead of asking, I'm I'm
glad you came to a question as to whether or not employee
(38:17):
ownership would improve servicesbecause in DC where I have some
experience of receiving home health care.
So it's not a very good even though they are all licensed and
the licensing process is also a little corrupt.
Given that, I would like to ask Terry, how did you solve your
(38:37):
racial slur problem? Just kidding.
Well. I don't know if we solved it,
but we we've taken some steps totry and address it.
I'll put it that way. Because it has to be somebody
very crazy to use a racial slur or somebody who has been
oppressed to such a point that they've gone.
Well, the reality is some of ourchildren or adults that come to
(39:00):
us, to our programs, this is what they've heard all their
lives. This is their families.
So it's not a quick fix. I'll add some good news, which
is there's a home care cooperative in development in
DC, so hopefully coming coming. Soon, friends, thank you.
(39:21):
Tremendous thank you to the panel round of applause.
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