Cooperative Home Care Associates has 2,300 workers who enjoy good wages, regular hours, and family health insurance. With an investment of $1.2 million into the cooperative sector, New York City is hoping to build on the group's success.

Before Zaida Ramos joined Cooperative Home Care Associates, she was raising her daughter on public assistance, shuttling between dead-end office jobs, and not making ends meet. “I earned in a week what my family spent in a day,” she recalled.

After 17 years as a home health aide at Cooperative Home Care Associates (CHCA), the largest worker-owned co-op in the United States, Ramos recently celebrated her daughter’s college graduation. She’s paying half of her son’s tuition at a Catholic school, and she’s a worker-owner in a business where she enjoys flexible hours, steady earnings, health and dental insurance, plus an annual share in the profits. She’s not rich, she says, “but I’m financially independent. I belong to a union, and I have a chance to make a difference.”

Can worker-owned businesses lift families out of poverty? “They did mine,” Ramos said. Should other low-income New Yorkers get involved in co-ops? She says, “Go for it.”

New York City is going—in a big way—for worker-owned cooperatives. Inspired by the model of CHCA and prodded by a new network of co-op members and enthusiasts, Mayor Bill de Blasio and the New York City Council allocated $1.2 million to support worker cooperatives in 2015’s budget. According to the Democracy at Work Institute, New York’s investment in co-ops is the largest by any U.S. city government to date.

Cooperatives are businesses owned and controlled by their members on the basis of one member, one vote. Given enough time, worker-owned cooperatives tend to increase wages and improve working conditions, and advocates say a local co-op generally stays where it’s founded and acts as a leadership-building force.

“There is no greater medicine for apathy and feelings of living on the edges of society than to see your own work and your voice make a difference,” says a report on co-ops by the Federation of Protestant Welfare Agencies in New York.

Selling the council on co-ops

This January, as a new mayor (who ran on combating inequality) and a progressive majority of the City Council were taking office, the Federation’s report inspired Councilmember Maria Del Carmen Arroyo to think about co‑ops. “A bulb went off,” she said.

Arroyo, incoming chair of the Community Development Committee, represents a South Bronx district that’s still one of the poorest in the nation, even after years of “development.” National retailers, attracted by tax breaks, typically pay low wages and squeeze out local businesses. Partly in response, the Bronx is also home to an array of co‑ops, from the large CHCA to the small Green Worker Cooperatives, which incubates local green businesses.

When Arroyo convened a first-of-its-kind hearing on co-ops this February, New Yorkers packed not one but two hearing rooms at City Hall.

Among the co-op members who testified was Yadira Fragoso, whose wages rose to $25 an hour—up from $6.25—after becoming a worker-owner at Si Se Puede, a cleaning co-op incubated by the Brooklyn-based Center for Family Life. Translation at the hearing was provided by Caracol, an interpreters’ cooperative mentored by Green Worker Cooperatives.

By spreading risk and pooling resources, co-ops offer people with little individual wealth a way to start their own businesses and build assets. That said, if starting and sustaining a successful cooperative business were easy, there would probably be more of them.

As of January 2014, just 23 worker-owned co-ops existed in New York, of which only CHCA employed more than 70 people. Nationwide, according to data from the U.S. Federation of Worker Cooperatives, roughly 300 worker-owned cooperatives average 11 workers each. Lack of public awareness and funding, as well as a weak support system, holds co-ops back, researchers say, and cumbersome city paperwork doesn’t help.

A working model

CHCA is over 90 percent owned by women of color and yet (because of the co-op’s many owners) it hasn’t qualified as a minority- and women-owned business, Arroyo told the hearing. (Such businesses enjoy privileges in bidding for contracts.) “There’s no earthly reason we can’t change that,” Arroyo said.

If they are to change anyone’s life for the better, though, co-ops have to be successful businesses, and that’s hard, says Michael Elsas, CEO of CHCA.

The co-op was founded in 1985 on the premise that if workers owned their own company they could maximize their wages and benefits, and if workers were better trained and better treated, they’d offer better care to their clients. Creating the worker co-op was the first step. But to truly change life for their workers in a race-to-the-bottom industry such as health care, the founders knew they’d have to change the industry.

To that end, CHCA worked on several connected tracks. To raise industry standards, not just for CHCA workers but across the field, CHCA started the worker-run Paraprofessional Healthcare Institute (PHI) that trains agencies across the country while also fighting for policy shifts. (PHI was instrumental in the campaign that recently expanded the Fair Labor Standards Act.)

To better address the needs of home care clients, in 2000 they created Independence Care System (ICS), a multibillion-dollar managed-care company, which contracts with the city to work with chronically sick and disabled adults. With ICS, CHCA filled an unmet need while also creating its own primary customer to fuel the co-op’s growth. ICS is responsible for 60 percent of CHCA’s business, and the co-op has grown from 500 workers in the late 1990s to 2,300 today.

Workers become “owners” with a buy-in of $1,000, paid over time. Of today’s 2,300, some 1,100 are worker-owners, Elsas says. The company had $64 million in revenues in 2013. They’ve raised wages, but more important to workers like Ramos are the regular hours, the family health insurance, and membership in the Service Employees International Union Local 1199. In short, respect.

CHCA occupies two floors of a new office building on Fordham Road. Peer-mentors answer caregivers’ calls at desks, with plenty of cushioned sitting-room space for talking. In the PHI training lab, there are no model plastic dummies. Workers in training learn what it’s like to be both caretaker and patient.

Wages for CHCA’s health care workers stand at $16 an hour including benefits, Elsas says. It’s not affluence, but it’s still almost twice market rate. Workers enjoy guaranteed hours—an average of 36 a week, compared to an industry norm of 25 to 30. They’re paid for business meetings, and in a state where the CEO-to-minimum-wage-worker pay ratio stands at 405: 1, the ratio at CHCA hit its highest (11:1) in 2006. Turnover stands at 15 percent, compared with an industry standard close to four times that.

“If I didn’t like it here, I wouldn’t have stayed all these years,” Ramos says.

Asked about New York’s new co-ops, CHCA’s Elsas hesitates. He’s all for making it easier for co-ops to get contracts, but he’s concerned about scale.

“I’m just not sure that setting up 26 new small co-ops will help change policy or practice,” he says.

Helen Rosenthal was changed by a small co-op: Her mother started one of the first nursery co-ops in Detroit, and she saw how lives improved. Now she chairs the New York City Council’s powerful Committee on Contracts, where she’s helping push the co-op legislation. “With co-ops, democracy is built into the legal DNA,” she said.

Administered by the Federation of Protestant Welfare Agencies (FPWA), the city’s new funds will go to 10 nonprofits (among them, Green Worker Cooperatives and the Center for Family Life). The groups must create “234 jobs in worker cooperative businesses, reach 920 cooperative entrepreneurs, provide for the start up of 28 new worker cooperative small businesses, and [assist] another 20 existing co-ops.”

With so few co-ops in existence, creating more is better, says Hilary Abell, author of a new study from the Democracy Collaborative titled “Pathways to Scale.” More is better. Co-ops thrive in a mutually supportive ecosystem. “But the biggest need right now is certainly for larger businesses, capable of hiring 100 workers and up,” she says, adding that start-ups may not be the best path to scale: “There are 200,000 small businesses in the U.S. today, employing half of all America’s workers. Most have no succession plan.” Might some be ripe, she asks, for takeover by their workers?

After 92 years of the Federation’s fight against poverty, its leaders are clear: “Making sure that a safety net exists is not enough to help New Yorkers have satisfying lives. We needed a new approach to workforce development that would not only reduce poverty but also promote upward mobility, and that’s where co-ops can be an anchor,” says Wayne Ho, FPWA’s chief program and policy officer.

Funding for supportive nonprofits is not the only thing co-ops need from cities. In Spain, Northern Italy, Quebec, and France, robust worker co-ops benefit from laws that help co-ops access capital and public contracts. In New York, even as public dollars flow to big businesses as incentives, public spending is on the chopping block. The first city-sponsored trainings with a new, cooperative-inclusive curriculum started this summer, but passing co-op-friendly laws is going to take political power—of the sort that elected today’s progressive city leadership.

This $1.2 million won’t end poverty, but it’s a step in the right direction, says Christopher Michael of the New York City Network of Worker Cooperatives. “We have all the raw ingredients of a successful policy initiative: engaged groups, a bit of a track record and support in the city council…

“This is just a start.”

Laura Flinders - YES! Magasine

The Co-operative Life Ltd. agrees with calls by the medical community for a Royal Commission into intellectual disability group homes as they continue to put at risk the health and safety of their residents. Support for the Royal Commission came after the ABC’s Lateline program featured the story of Jason Coulstock, 40, who lives with an intellectual disability. For the past 16 years Jason lived in a state-run group home where he was subjected to violence, starvation and being over-prescribed drugs to control his behaviour. This led to Jason being hospitalised with drug-induced toxicity, needing to be revived three times. “Last night we saw on the ABC just how bad the situation is. Stories like Jason’s are not one off events. The community led by its political figures cannot let this abuse continue, the system needs to be overhauled and the first step in this process is through a Royal Commission,” said Ms Kaczmarek. Ms Kaczmarek said that programs like the Co-operative Life’s, Life Home program, where people living with an intellectual disability are central in working with their family and Life Home staff to live in a home environment of their choosing, with the supports they choose, should be looked at by the federal government as a new care model. “ We started our own program because we were horrified at the level of abuse we were seeing in the current group home environment. We knew that there had to be a better way for people living with an intellectual disability to be cared for with dignity and to assist them live a life they wanted. “Already we have two Life Homes running in Sydney which has seen people who suffered through the old system turn their lives around by being empowered to tell us what care, home environment and social activities they and their families would like them to receive,” said Ms Kaczmarek. Political support and willingness to work for the betterment of people living with an intellectual disability are crucial in any real improvements happening, said Ms Kaczmarek. “We know that our model of care works both financially but more importantly, in terms of quality of the care that is provided. Our model makes sure that people feel empowered to live, participate and contribute to their local community, that’s the real measure of success,” said Ms Kaczmarek. The Co-operative Life will be actively seeking support from state and federal politicians to push for change to the intellectual disability group home program and plans to meet with as many political figures as possible in the coming weeks.

Joe is happy because his mother-in law is happy. With The Co-operatives help, Joe and his wife Aileen are able to keep Aileen’s mum Anna healthy, happy and at home. The Co-operative team have worked with Aileen, Joe and Anna to build a dedicated support team around Anna so she can continue to live in her own home.

Anna is orginaly from Croatia, The Co-operative team were able to match Croatian support workers to Anna. Her team help her with her cooking, her gardening, taking her to the RSL and to her church. They have developed a trusting, warm, friendly, professional relationship with Anna at the centre of the care. Before The Co-operative was involved, Anna’s care was fragmented, with different people providing rushed and impersonal care.

Now everyone is happy, Anna has the attention she needs for her physical, emotional, relational and spiritual needs are being met in a respectful way. Joe and Aileen are happy as they have their life back. The story does not end there. As the NDIS rolls out, Joe has engaged The Co-operative to help him with planning and coordination so he makes sure he gets the funding and the right supports he needs to continue to live his own life.

“Much as been published about the care and treatment of Alzheimer's patients.

It is a devastating disorder in which the patients, along with their families, are deeply affected.

Sleep problems and all forms of dementia, sadly, often go hand in hand. Understanding what contributes to sleep problems in your loved ones suffering with Alzheimer’s and other dementia related disorders can help restore their sense of dignity.

A recent article in the New York Times (http://nyti.ms/2ckecTK) discussed the feeding of dementia patients through feeding tubes. While often necessary, the author concludes such methods does not add to either the quality of the patient’s life not adds time to their lives.

Why sleep problems are so common?

Many older adults have problems sleeping, but people who have Alzheimer's often have an even harder time. Alzheimer's might reverse a person's sleep-wake cycle, causing daytime drowsiness and nighttime restlessness. These sleep disturbances often increase as Alzheimer's progresses. Swallowing may become a problem.

Eventually, round-the-clock naps might replace deep, restorative nighttime sleep.

Sometimes other health problems affect sleep as well, such as:

Obstructive sleep apnea, which happens when throat muscles relax during sleep and obstruct airflow through the nose and throatRestless legs syndrome, a condition that causes discomfort when sitting or lying down, which can make it difficult to fall asleep or stay asleepDepression

How to promote a good night's sleep?

Sleep disturbances can take a toll on both you and your loved one. To promote better night time sleep:

If sleep for your loved one remains a problem, talk with their physician …

Ira Weisberg

President and CEO at Amherst Pharmaceuticals

In 44 BC, Marcus Tullius Cicero wrote a short dialogue on the joys of one’s advanced years called On Old Age. You can read it in translation in our edition, How to Grow Old, translated by Philip Freeman. In the meantime, take these nuggets to heart as time draws you inexorably onward.

Those who are unhappy in their youth will be unhappy in their old age as well. Begin cultivating the qualities that will serve you best when you are young and you will have a pleasant winter of life.Nature will always win. Certain things are meant to be enjoyed at different times of life, and trying to cling to youthful activities in old age will lead to frustration and resentment.The old and the young have much to offer one another. In exchange for the wisdom and experience of age, young people give joy to the twilight years.Use your increased free time productively. Cicero himself wrote extensively. He expounds on the joys of gardening for older people. Find an interest and pursue it!Do not fear death. Your soul will either continue on, or you will lose all awareness. Either way, the best thing to do is make the most of the time you have left.

There you have it! Armed with this knowledge, you too can enjoy a fruitful old age. For the rest of Cicero’s thoughts, pick up a copy of How to Grow Old.

This week Andrew (Team coordinator - North) tells us a nice story about one of his client:

I asked my client if he felt that his quality of life had improved since I started supporting him, this is how he responded:

He likes that I'm punctual all of the time, other carers don't care (in his opinion), and turn up whatever they like.

He thanked me for helping prompt him to remember everything that he needed each day

He was happy that I told him when he had food on his clothing or on his face, others have neglected to tell him and then he has spotted this later on after he's been out in public which made him feel embarrassed.

Positive reinforcement - he's thankful for the fact that I keep on going over the same things with him because of his memory loss due to his ABI and that I’m non-judgemental.

I asked him about quality of care?

He said that I'm extremely consistent in carrying out my duties.

I asked my client about recent positive care experiences when in my care?

He was very happy with my services, and especially happy in me putting him in contact with a sex worker (via Touching Base Inc.)This organisation facilitates sex workers and people with a disability coming together), as my client has 2 sisters that he relies on for support he was finding it difficult to broach the subject with them, his other main care support worker is also female. I arranged an appointment with a sex worker and met her first on his behalf to talk through his ABI and injuries etc. My client had a very positive experience with the sex worker and I surprised him afterwards by taking him to meet the guys at the brewery in Newtown, I know the guys there extremely well and they treat him like a king for the afternoon. My client was quite emotional at the end of the day. He even went as far as telling me that he loved me. This is something he had never said before.

I asked him about his frustrations?

My client mentioned that the above had been his main frustration, but he was now happy in regards to this and is looking forward to the next visit.

His other main frustrations are that people just don't listen to him! He then thanked me for always listening!

A support worker turns up the radio in the car, and he then can't be heard. He has raised this and yet it still continues.

He gets frustrated on a weekend as he tends to be alone at home in front of the TV. His sisters both have children in their families and tend to be out and about doing their own thing.

I finally asked him to describe me using 3 words? This is what he said:

Bald, headed, bum!

He went on to say that I have brought humour back into his life and that he loves that we can have a laugh! He said that I treat him like a human being! He also said that I bring him back into line!

Each carer asks themselves how to spend time with their customer. If the customer’s health allows, the first thought that arises is often a walk. This becomes a questionable option when the weather outside is wet grey and cold or the walk outing simply is not a preference?

A lot depends on our customer’s interests. A good way to pass time is by listening to music, share reading books, and if the state of health of our senior does not allow, reading books out loud for their enjoyment works.

Many older people with fondness go back to the past to their youth and tell stories of their life. The commitment to listening to the stories not only will give happiness to story teller, but also will help us to understand them and better meet the customer’s needs, while moving us in time and expanding our knowledge about their view of the changing world.

Talks build bonds between people, particularly older people who need to feel listened to for trust to develop.

Remember it is worth talking!

Not every senior is a boring senior...

It is useful for carers to have cards up their sleeve, or chess or checkers, because you never know when they may surprise you and what pleasure will arise from having our elder citizen’s teach you a game like checkers.

Man learns through life ...

The customer introduces us into their life without judgement it's worth the journey so enter!

Your customer is in a wheelchair, and what he loved in his youth was playing football! Take him to a match to watch a nearby team.

Your client loved to always look nice! She will be happy for sure if you paint her nails, as she cannot master this now with trembling hands.

There can be thousands of ideas! So get to work!

Dr Guy Turnball, Managing Director of CASA (Care and Share Associates), tells us about his social enterprise and how it makes a difference.

CASA is social enterprise that provides domiciliary care in the North of England. Its unique selling point is the employee ownership model: investment in, and business contribution by, the staff means a significantly happier workforce and a lower rate of staff turnover. This positively impacts the quality of the service and ensures consistency and continuity of care.