Cooperatives

Doug O'Brien, Real Clear Health - Cooperatives offer rural communities something direct and proven that the market alone has failed to deliver: Locally rooted, democratically governed health infrastructure that aligns health care delivery, workforce stability, and cost control directly and personally tailored to meet community needs rather than shareholder returns. When applied across the health ecosystem—home care, purchasing, and clinical services along with the ability to reach millions with healthcare messages—co-ops don’t just patch holes. They can transform how rural health works.

In rural communities, health care often does not begin in hospitals. It usually begins in homes—supporting older adults, people with disabilities, families managing chronic illness and behavior/diet changes that can prevent many healthcare needs. Yet home care workers are among the most undervalued in the health system, facing low wages and unstable hours, with little voice in their industry.

Home care cooperatives flip that model. As worker-owned enterprises, they give caregivers ownership, living wages, training, and a say in how care is delivered. The results are powerful: lower turnover, higher quality care, and stronger relationships between caregivers and patients. The difference is significant: turnover in the home care industry is as high as 80%; meanwhile, home care cooperatives report turnover rates between 15 and 30%.