The cooperative difference: perceived drivers of higher care quality at home care cooperatives.

Introduction: The quality of care provided by home care workers (HCWs), on whom millions of Americans rely, is undermined by practices, structures, and policies that marginalize this workforce. Home care cooperatives-agencies co-owned and controlled by HCWs-represent a promising model for reducing HCW marginalization and improving care, but the specific ways in which the cooperative model may facilitate higher care quality are not well understood. Methods: We conducted 32 semistructured interviews with HCWs and other staff across 5 home care cooperatives to identify perceived drivers of improved care quality at cooperatives. Results: Respondents identified 4 main drivers of improved care quality at cooperatives: (1) increased HCW input into patient care decisions; (2) additional motivation derived from being co-owners; (3) preferential selection of high-performing, mission-driven HCWs; and (4) access to high-quality, hands-on training. Conclusions: Increasing the prevalence of these perceived quality drivers through the expansion of home care cooperatives, the adoption of cooperatives' practices by traditional agencies, and the implementation of industry-wide policies that facilitate them may significantly improve care quality across the home care sector. However, additional research is needed to determine the role each perceived driver plays in home care quality.