2004 Finalist
Waushara County, Wisconsin
Innovations in American Government Awards
Innovations in American Government Awards

While the health care system in the United States has been broadly acknowledged as needing a serious overhaul, little attention has been given to the specific problems facing rural communities. These communities are in need of quality health services for their aging populations, especially those who want to remain living in their own homes.

When it comes to in-home care (which is up to ten times more cost-efficient for the state than institutionalized care), good help is quite literally hard to find, and even harder to keep; the national turnover rate for elderly and disabled care runs from 40-60%. At the same time, demand is soaring due to the aging of the Baby Boom generation and the increased lifespan brought about by material prosperity and advances in medicine.

In 1999, a group of 50 low-income women working as caregivers in Waushara County met with the Department of Human Services to plan a radical change in the way their industry was organized. In 2001, after determining the needs and priorities of caregivers and their clients, the group started Cooperative Care (CC), a worker-owner cooperative providing home care services to elderly and disabled people in rural central Wisconsin.

Before Cooperative Care, caregivers in the county had low wages and no access to benefits; they contracted their services individually to those in need or the state bodies responsible for their care. The strenuous physical demands of intensive care giving left many of them with work-related injuries, and morale was generally low. This sort of systemic problem affects not only the caregivers, but their clients and the health system as a whole, which must deal with the consequences of rapid turnover and worker dissatisfaction.

The first program of its kind tailored to a rural setting (previous cooperatives in New York City and other large cities were designed to meet a host of different problems), CC provides a dependable and stable workforce to meet long-term needs, and empowers caregivers (mostly lower-income women) by giving them a voice in how their business is run. As an employee-owned business, participating caregivers earn rebates of CC's profits based on the total hours they have worked for the co-op within a year, averaging $440 per member-owner in 2003.

Other benefits of the program include increased pay, worker's compensation, unemployment insurance, overtime pay, 10 days paid vacation, travel reimbursement, and partial coverage of health insurance premiums. Caregivers who complete Certified Nursing Assistant training are eligible to increase their wage by $2 an hour. As a result of all these changes, turnover among CC workers has been reduced from a former 18% to less than 1%, and 98% of surveyed caregivers in the county were very satisfied with their jobs.

Unfortunately, due to diminishing governmental budget allocations for care giving, there is a delicate balance between raising wages for caregivers and serving as many needy clients as possible; 85% of the co-op's client base in Waushara County is funded through Wisconsin's Medicaid program, and the remaining portion pay privately for care giving services.

Nevertheless, by empowering its employees, raising their job satisfaction, and training them to handle broader client populations, CC has dramatically increased the level of service in Waushara County. U.S. Senator Herb Kohl (D-Wisconsin) has been one of many officials supporting the program, advocating for a federal budget item to replicate similar rural cooperative programs across the country.