Centering marginalized care: Home care cooperatives and system change.

Home care workers (HCWs), who provide paid in-home support for daily activities, are at the center of the care received by millions of Americans. However, HCWs are profoundly marginalized professionally and economically within our political-economic system, which devalues care work, public goods, and the labor of women, immigrants, and workers of color. This systemic marginalization has contributed to the impoverishment of millions of HCWs and massive workforce shortages, which prevent millions of Americans from accessing the consistent care they need. Home care cooperatives-businesses co-owned and controlled by HCWs-represent an alternative approach that places HCWs at the center. By providing greater compensation, training opportunities, and control over workplace decisions, home care cooperatives have achieved greater continuity of care and half the turnover rates compared with traditional agencies. They demonstrate what is possible when HCWs are centered at an organizational level and what could be achieved if HCWs were centered at a system level. This latter possibility requires the following: (1) reclaiming care work as a public good and investing in it accordingly; (2) structurally empowering HCWs within the care team and broader economy; and (3) new narratives about HCWs that recognize their skills, value, and centrality in providing quality care.