MODELS FOR PRACTICE

FOCUS AREA: ACCESS TO LONG-TERM CARE SERVICES

Program Name: Cooperative Care

Location: Wautoma, Wisconsin

Problem Addressed: Access to Long-Term Care and Rehabilitation Services

Healthy People 2010 Objective: 1

Web Address: www.co-opcare.com

SNAPSHOT

Home and community-based services in rural areas encounter a variety of challenges including shortages of trained professionals and limited resources. Waushara County’s Department of Health and Human Services developed an innovative rural model of home care—Cooperative Care—wherein the employees are also the members and business owners. The county made a commitment to do two things: offer quality care for people who need support services in the county and support a service model that values the role and responsibilities of the direct service provider.

THE MODEL

Blueprint: Cooperative Care is a member-owned cooperative designed to provide in-home services to rural Wautoma, Wisconsin, and surrounding counties. Cooperative Care serves those who are elderly, developmentally disabled, or chronically mentally ill and provides all in-home services such as personal care, range of motion, and medication support, as well as home care including cleaning, lawn care, and meal assistance. Waushara County is the primary funder through a number of government-funding programs including the Community Integration Program (CIP), Community Options Program (COP), and Medical Assistance (MA) while the remaining 10–12 percent of revenue is derived from private pay sources. Staffing includes an executive director, business manager, scheduling clerk, and over 80 members/owners, about 60 of whom are actively working.

Making a Difference: The program’s mission focuses on developing relationships built on values. Therefore, satisfaction of the members, clients, and community are important outcome measures. A recently completed client survey found 96 percent of clients reported satisfaction on all aspects of care they received. A member survey revealed satisfaction with leaders as well as improvements in other areas that often contribute to high turnover and dissatisfaction. Members receive higher wages, paid time off, holiday pay, health insurance, and other benefits previously unavailable to them. Turnover of Cooperative Care’s workers is 0 percent, with membership growing from 40 to 80 members. This stands in stark contrast to the USDA’s turnover estimate of 40–60 percent annually among other home care businesses. Members report feeling less isolated due to training opportunities, meetings, cooperative newsletters, and other social events. These elements are important given that isolation is a key contributor to caregiver burnout. Finally, Cooperative Care’s fiscal performance exceeded expectations, netting a small profit allocated between retained equity, loan repayments, and distribution of cash pay out of patronage funds based on hours worked. While the initial cost to the county was 40 percent higher than its predecessor program, the benefits are many including improved access to a more sustainable pool of care providers, a better trained and supported pool of providers, reduced risk, improved coordination of service delivery as identified by county case workers, and the pride that comes with taking care of community members who need support while fairly compensating the workers hired to do so. Cooperative Care plans to expand its service area to surrounding counties—an opportunity unavailable under the previous business arrangement.

Beginnings: Waushara County is a rural area in east-central Wisconsin, with few industries. Many county residents must travel 40–50 miles to an urban area to find employment. This area also has a high number of retirees. Of the 23,000 residents who call this county home, 20 percent are over the age of 65. Therefore, home and community-based services are an important health concern. The Waushara County Department of Health and Human Services developed the In-Home Providers Program to serve adults who are elderly, low-income, or disabled. This organization served the county for more than 20 years but faced financial difficulty due to declining reimbursement rates and high employee turnover, which was exacerbated by lower than average wages and few benefits. To combat these challenges, the director of the Waushara County Department of Health Services (DHS) proposed developing a cooperative program modeled after the Bronx, New York, co-op established in 1985 called Cooperative Home Care Associates. The DHS director was awarded $50,000 in grants from the Community Links fund, a program of the State Department of Health and Family Services, for the purpose of exploring the feasibility of implementing a rural cooperative to provide in-home services.

With collaboration from the U.S. Department of Agriculture, State of Wisconsin Division of Long Term Care Personnel, and other stakeholders, the first steps toward development of this program began in 1999. An initial exploratory meeting between project coordinators and the workers of the Waushara County In-Home Providers program was held to assess worker interest level and determine the key areas of concern (benefits, training, and isolation). Based on this first meeting and a worker survey, a steering committee was formed and a business plan developed. The results of a market analysis and feasibility study were also incorporated into the final business plan completed in January 2000. In early 2001, Cooperative Care filed its articles of incorporation under Chapter 185 of the Wisconsin statutes, and by June 1, 2001, the first cooperative members were added to the payroll. The county contracts with Cooperative Care, although the cooperative is free to expand to other counties.

Challenges and Solutions: Cooperative Care’s innovative rural model was recognized from a pool of 1,000 applicants as one of the top 15 finalists to receive the Innovations in Government Award through the John F. Kennedy School of Government at Harvard University. The program has attracted national attention from other communities wishing to replicate the model. To this end, Wisconsin Senator Herb Kohl has made one million dollars available in grants for replication of the cooperative in other rural areas of the country.

PROGRAM CONTACT INFORMATION

Kathie McGwin

Cooperative Care

P.O. Box 620

Wautoma, WI 54982

Phone: (920) 787-1886

Fax: (920) 787-1888

E-mail: mcgwin@co-opcare.com