Cooperative Home Care Associates: How the Co-op Works

Cooperative Home Care Associates (CHCA) is a worker-owned home care company in New York. Its own website calls it a licensed home care agency owned by its caregivers, founded in 1985 in the Bronx, and a Rutgers University case study calls it, for decades, the largest worker cooperative in the United States "by some distance." Its workers can become members by buying a share, worker representatives hold most of the board seats, and its workers are also members of the union 1199SEIU.

This profile explains what CHCA is, how its ownership and governance work, how its numbers have changed over time, and what outside researchers say about the model. It draws on CHCA's own site, a December 2022 case study by Sanjay Pinto of the Rutgers Institute for the Study of Employee Ownership and Profit Sharing, and pages from PHI, the nonprofit CHCA helped create. For worker co-ops in general, see worker cooperatives; for other examples, see worker cooperative examples.

At a glance

How CHCA began

CHCA's site says it was incorporated in the Bronx in 1985 with 12 home health aides as its founding members. The Rutgers case study says it was founded with the intention of creating a scalable model that would expand voice and improve job quality for home care workers, as an example for other industry players. It won its first contract with Montefiore Hospital and had grown to 60 workers by the end of its first year.

The case study says CHCA's formation was supported by an initial $485,000 investment from the Community Service Society of New York, a charitable organization, and by significant support from foundations. That outside money paid for basic operations and for a training program that, the case study says, today gives free job training to hundreds of local residents each year.

From the start CHCA has described its approach as "quality jobs, quality care": the idea that good jobs are the foundation for good service. The case study says CHCA used that philosophy to help grow its business, and that in the late 1980s it convened a working group in New York City of employers and representatives from labor and consumer groups to push the same agenda.

In 1991 CHCA created a separate organization, now called PHI, to help develop its training programs and research the home care workforce. A 2015 PHI news item quotes a Democracy Collaborative report saying PHI was spun off from CHCA in 1991 "to gain access to both training resources and philanthropic support." CHCA is described by PHI as its affiliate.

What CHCA does

CHCA's website lists the services its caregiver-owners provide. They include help with personal care and hygiene, mobility and daily tasks, meal preparation and light housekeeping, support for people with disabilities and chronic conditions, companionship, and respite for family caregivers. The site says its home health aides can offer short- or long-term physician-directed care.

The site describes four ways to pay for care:

Eligibility for any of these depends on the program or insurer involved, so CHCA's own pages are the place to ask what applies to you. The site also offers a free consultation to families looking for care.

How worker ownership works at CHCA

The Rutgers case study describes how membership and governance work, with dates and sources for each figure.

Becoming a member. Workers can become members by purchasing a share for $1,000, and new recruits attend a three-hour workshop on the benefits of membership. A footnote in the case study quotes a 2011 study describing the buy-in as one share and one vote, with an initial $50 payment and a loan from the co-op for the remaining $950, repayable over five years, so that joining is not cost-prohibitive. Those terms come from the case study's sources, so confirm current terms with CHCA directly.

How many workers are members. The case study says that just under half of CHCA's workers are members, a proportion that dropped when CHCA absorbed other agencies and has generally ebbed over time. It says staff and worker leaders have been discussing how to raise the rate.

What members receive. Members receive dividend payments in years when the co-op is profitable. All workers, members or not, are eligible for a 401(k) plan, a benefit the case study notes many home care workers do not have.

Who governs. As CHCA has grown, the case study says, democratic control has been exercised more through representatives than directly. Worker representatives hold 8 of the 13 seats on the board, and all members can vote for them. The board has substantial authority, including the power to hire and fire the CEO. Workers also have other channels for input, including direct lines to the CEO, who holds regular office hours.

What studies say about participation. The case study reports a study comparing CHCA with a conventional for-profit agency and a nonprofit agency of similar size, in which CHCA workers reported significantly higher participation in decision-making, higher trust in management, and higher job satisfaction. That is one study as summarized by the case study, not a guarantee of how any worker co-op will perform.

CHCA's own site says workers have "a voice and a stake in our shared success" and that caregiver-owners have a voice in decisions that affect the care they provide. Its careers page lists co-ownership opportunities and profit-sharing among the benefits of the job.

The union partnership

CHCA's workers are members of 1199SEIU, which the case study calls the largest union in the country. CHCA's timeline says it signed a collective bargaining agreement with 1199SEIU in 2002. In 2007, it says, it worked with 1199SEIU leaders to develop the first Labor-Management Committee in home care, meant to prepare more home care workers for leadership responsibilities in the cooperative.

The case study describes CHCA as combining two kinds of governance: a worker cooperative governed through representative channels by its membership, and a "model employer" for its union partner. It reports early tensions over the union's role in a cooperative, because CHCA's leaders thought the union was sometimes too adversarial and union representatives feared that the co-op's governance model would be taken as enough to protect workers' interests. The two organizations have since built what the case study calls a robust partnership, including joint work on policy campaigns, training and recruitment.

Job benefits described on CHCA's careers page come through 1199SEIU, CHCA-sponsored programs and statutory benefits. The union-provided list includes health insurance, life insurance, a pension fund, paid time off and bereavement benefits.

Training and career paths

CHCA says it offers free home health aide training in English and Spanish at locations in the Bronx, Manhattan, Queens and Staten Island, and that graduates become certified home health aides with guaranteed employment through CHCA. Its site says that since opening it has provided free training to over 10,000 prospective home health aides. It lists other free programs, including personal care aide training, an alternative competency demonstration, a competency evaluation program and a transition program for certified nursing assistants.

CHCA says it was awarded a Direct Caregiver Flexibility Grant by the New York State Department of Health for a five-year initiative running from January 2026 through December 2030, to expand training for personal care aides, home health aides and certified nursing assistants.

On career paths, the case study says CHCA has piloted a senior home care aide role, and that 45% of its administrative staff started out as home care workers, a proportion CHCA staff believe is significantly higher than at most other home care agencies. It adds that CHCA's funding for that pilot was limited and that wider adoption would require more public investment.

How the numbers have changed

Size figures for CHCA differ by source and year. Reading them together shows a long arc rather than one number.

The case study also reports that in the 2021 fiscal year CHCA brought in nearly $57 million in service revenues, of which 96% went to payroll and related expenses for frontline home care workers and 4% to administrative overhead. It says 99% of home health aides and personal care aides at CHCA are women, three-quarters are Latina, and 1 in 5 identify as Black.

Mission and certifications

CHCA states three goals: to provide reliable, high-quality home health care for people who are elderly, chronically ill or living with disabilities; to offer the highest possible salaries and benefits while building a profitable worker-owned company; and to give workers opportunities to learn and grow as members of a health care team.

Its website says it became the first home care company in New York to earn B Corp certification in 2012, and that in 2017 it became a founding member of Certified Employee-Owned, an organization promoting employee ownership. The case study dates a benefit corporation certification to 2018, so check with the certifying body for the current status of any certification.

The challenges the case study describes

The Rutgers case study is direct about difficulty. It says CHCA must reconcile its mission with structural inequalities and profit-driven pressures in the home care and wider health care systems.

• Reimbursement rates. Government reimbursement rates limit how much CHCA can pay. CHCA has worked with 1199SEIU and others on a "Fair Pay for Home Care" campaign in New York, which the case study says won a $3 per hour total pay increase phased in over 2022 and 2023, short of the full increase sought.
• Competition. CHCA competes with larger, more profit-oriented agencies that can invest more in branding and marketing.
• Membership share. The share of workers who are members has dropped over time, as noted above.
• Workforce recruitment. The case study links CHCA's workforce decline to the COVID-19 period and says CHCA has been working with the union on recruitment.

Copies and spin-offs

The case study says CHCA helped inspire co-ops in direct care and other parts of the economy and backed replication in other cities. In 1993 it helped create Home Care Associates in Philadelphia, which the case study says has a workforce of around 170. Cooperative Home Care of Boston was formed the following year but shut down five years later amid a home care industry crisis in Massachusetts. The case study cites a report saying 14 home care worker cooperatives were active in the US in 2020, working in both private-pay and publicly funded systems.

Frequently Asked Questions

What is Cooperative Home Care Associates?

A worker-owned, licensed home care agency in the New York area, founded in 1985 in the Bronx. Its caregivers can become owner-members, and its own site says it is a certified B Corp.

Is CHCA the largest worker cooperative in the US?

The Rutgers case study says it has been the largest worker cooperative in the country "by some distance" for decades, and PHI described it in 2015 as the largest worker-owned cooperative in the nation. Its workforce has changed since then, so ask a current source if rank matters to you.

Does every CHCA worker own part of the company?

No. The case study says just under half of CHCA's workers are members. Members buy a share and vote, and members receive dividends in profitable years.

How much does it cost to become a member?

The case study says a share costs $1,000, and a footnote describes an earlier arrangement of a $50 initial payment with a loan from the co-op for the rest. CHCA sets the current terms.

Is CHCA unionized?

Yes. Its workers are members of 1199SEIU, and CHCA says it signed a collective bargaining agreement with the union in 2002.

What is the relationship between CHCA and PHI?

The case study says CHCA created PHI in 1991 to help develop its training programs and research the home care workforce. PHI describes CHCA as its affiliate.

How can someone get care from CHCA?

CHCA's site describes private pay, long-term care insurance, veterans' referrals through the VA, and Medicaid routes, and offers a free consultation. Contact CHCA to find out which applies.

Can I train as a home health aide there?

CHCA says it offers free home health aide training and other free programs, with an application process that includes an open house session, a pre-screening exam, required documents and interviews.

Where to go next

• Worker cooperatives: the full guide
• Worker cooperative examples
• How to start a worker cooperative
• Employee-owned company: ESOP, EOT or worker co-op
• Sell your business to employees
• Patronage refunds