‘A very real crisis’: Why these personal-support workers started a home-care co-op

Proponents say the business model is better for workers and clients. Critics worry it could take Ontario farther down the path to two-tiered health care
By Josh Sherman - Published on Nov 02, 2021
From left to right: Amy Firlotte, Danielle Turpin, and Denise Armstrong are co-founders of Home Care Workers' Co-operative. (Courtesy of Danielle Turpin)

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Danielle Turpin couldn’t stand working in a long-term-care facility anymore. “We were constantly short-staffed,” says the personal-support worker from Peterborough.

She reached her breaking point in June 2019. Chronic under-staffing had led to what she calls “unsafe work practices.” Some clients in her LTC home, she says, were missing baths and washroom access or not being repositioned in bed as needed: “The biggest thing for me, too: having to say no to our clients all the time.”

Turpin says she complained repeatedly, but “nothing really helped,” so the long-time PSW began researching different models to see whether she could better deliver care. She soon discovered workers’ co-ops — such as the New York-based Cooperative Home Care Associates — which let employees own a stake in an organization and direct its operations democratically. “I’m kind of a low-key labour activist in a way, and it’s very important to me: labour rights and workers’ rights,” she says.

So, this past summer, with fellow PSWs Denise Armstrong and Amy Firlotte, she launched the non-profit Home Care Workers Co-operative Inc. The co-op offers clients throughout Peterborough, Clarington, Cobourg, Port Hope, and Lindsay care in their own homes, something the vast majority of Ontarians prefer to an institutional setting. Labour experts say it is the first co-op of its kind in the province. While advocates of the co-op model say it improves both worker conditions and service quality, some critics warn that its emergence is a sign of broader failures in Ontario home care — which, they say, is increasingly becoming a two-tiered system.

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The staffing problems Turpin witnessed at her last job are prevalent in home care, experts say, and the labour shortage has become only more acute during the pandemic. “Staffing issues in home care have resulted in a very real crisis we now find ourselves in, where people are not getting the care they need,” Sue VanderBent, CEO of the advocacy group Home Care Ontario, tells TVO.org via email. Gruelling hours and low pay have led nurses and PSWs in home care to seek work elsewhere in the health-care system, if they remain in the field at all, and those requiring care report no-shows and rushed visits.

Turpin hopes her workers’ co-op can address at least some of these challenges by empowering those on the front lines of health care. “I’m trying to draw good PSWs to home care,” she says.

Agenda segment, May 17, 2021: Can Ontario afford its health spending?

The model is “basically an employee-owned enterprise, which operates on the co-operative principles,” explains Hazel Corcoran, executive director of the Canadian Worker Co-op Federation. Of the seven principles — among which are concern for community and providing education about co-ops — she says “one member, one vote” is a “fundamental” tenet: “It’s not one share, one vote; it’s not the capital that’s controlling the enterprise. It’s the labour, the people that work in it that control the enterprise.”

Both for-profits and non-profits can be structured as co-ops. But in either case, co-ops focus less on the bottom line: “Certainly profit is not the end in any co-operative; it’s the means to an end, and in the case of a worker co-op, the end is basically decent employment for people at which they have a voice,” says Corcoran, adding that many are focused on a social cause.

Turpin notes that her co-op, as any other, isn’t beholden to shareholders, something many private operators in Ontario’s health-care system can’t say. And because the PSWs set their own workloads, she notes, they’re able to spend more time with clients, who have “more control over their own care and how that works.”

As is common with other Ontario co-ops, anyone working for the Home Care Workers Co-operative can apply to become a member after six months to a year of employment, depending on hours logged. “Once they apply for membership, they’re actually applying to be a co-owner,” explains Turpin, who notes existing members vote on applications. Ownership is proportional to the number of service hours members contribute to the co-op’s operations, and members vote on a variety of items, such as what to do with surplus funds, which are always invested back into the organization. “One of the major things that we would vote on would be our wages or how we go about supplementing travel costs or things like that,” she says. “We could give bonuses. We could decide to put money into our education fund, because we want to offer more skills to our PSWs.” Including the three co-founders, there are currently 12 employees, who provide more than 250 service hours a week to roughly 20 clients.

Those employees earn an above-standard rate of pay: According to a 2020 staffing study from the Ontario government, PSWs in home and community care earn an average of $17.30 an hour (although the government has extended its $3/hour pandemic-related pay bump for eligible PSWs until March 2022). At the co-op, which offers seven paid sick days and compensation for travel, base pay is $22 per hour for members and $20.25 for non-members.  

The rates for clients come in at the higher end of the range: a 2019 guide from Closing the Gap Healthcare indicates that services from a PSW generally run between $28 and $35 an hour in Ontario — co-op clients pay the latter.

A handful of Turpin’s clients have those costs covered through the Family Managed Home Care program, which is for children with complex medical needs or in home schooling, adults with brain injuries, and “those in extraordinary circumstances,” according to the province. However, most clients, she says, have to pay out of pocket. That’s because the co-op hasn’t taken any government contracts: she says that, while they would open up subsidies for clients, they would require the co-op to cram in too many visits each day, which would compromise its ability to maintain care standards (such as a minimum of two hours per visit): “I’d rather push and advocate for our clients to get funding … so they can have more control over who they hire and what their hours are and what their schedule is.”

Agenda segment, March 3, 2021: Has Ontario failed long-term care?

But experts say it’s a problem when some can pay for better care than others. “I understand why they’re doing this, but, structurally, it’s the wrong call,” says Vivian Stamatopoulos, associate teaching professor in Ontario Tech University’s social-science and humanities faculty. “It will lead to … two-tiered-style health care and home care, and this is not the path we need … This should be a very significant red flag to our governments that this is a sign of glaring failure on their part.”

She argues that no health-care services should be “put in the hands of private entities” and that the real solution for Ontario’s home-care crisis is a publicly administered non-profit system with public-sector health-care staff. That, however, would require more funding from both the provincial and federal governments.

Turpin doesn’t oppose the kind of fully public home-care system that Stamatopoulos describes. “If that happened, then co-ops probably wouldn’t need to be created,” she says. However, within the current structure, she can’t see a better alternative: “We’re just trying to fix the problem that exists right now within our means, really. The more of these co-ops emerge, the more that puts pressure on the government to maybe create a better publicly funded system in the first place, and that would be my goal.”

In an email statement provided to TVO.org, a Health Canada spokesperson points to a 10-year, $4.2 billion health-funding agreement that the federal government and Ontario struck in March 2017. It contributes “$2.3 billion for better home care including addressing critical home care infrastructure requirements,” the statement reads. “Health Canada is engaged in research and policy analysis on home and community care across Canada.”

Ontario’s 2021 budget committed $2.6 billion for 30,000 LTC beds and upgrades, as well as $4.9 billion for care. “Over the same time, the province invested no new dollars in its home care system, despite an exodus of staff and indications many Ontarians are not getting the care they need at home,” reads the October 8 Home Care Ontario news release. Without more money for home care, government investments in LTC staffing will intensify the issue, the group warns. (The Ontario government did not provide a statement in response to repeated requests for comment about home-care funding.)

Headlines about abysmal conditions in long-term care and home care during the pandemic may inspire more health-care workers to go the co-op route, says Corcoran: “There’s interest in it.”

And that’s something Turpin would like to see. “I think it’s a very productive, proactive health-care model, an alternative to long-term care and traditional home-care companies,” she says. “Our goal is to have this replicated across Canada — for sure, across Ontario.”

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