Workers Run Home-Care Business

TWELVE hours a day, three days a week, Christine Edey cares for a disabled man in a small apartment in the South Bronx. The man was in a highway crash and has no use of his arms and legs. Ms. Edey assists with his daily routine and helps with the computer course he is taking at home (he taps the keys with a pencil in his mouth). As much as anything, she brings humanity to difficult and lonely hours. ``We fight. We quarrel. We talk. We don't talk,'' she says.

At night, she walks the forbidding blocks to the subway that will take her home.

In one sense, Edey isn't that unusual. There are more than 90,000 home-care workers like her in New York City. They are mainly women, mainly black or Hispanic. They work primarily for private companies, at low pay and with little hope of advancement. Edey's company is different, however. The pay is top scale, with extra for hard cases like hers. The company strives to provide full-time work, which is rare in the field.

Most important, the company offers an opportunity to advance. Through a special program, Edey is on her way to becoming a full-fledged nurse.

There's a reason why the owners of Cooperative Home Care Associates (CHCA) take such an interest in their employees: The owners are the employees. Edey isn't just a home-care worker. She's also a member of the company board. She helps make decisions on conditions and pay, and how much the company will grow. This has given her a whole different perspective on what many consider unskilled, menial work. ``The pay's not that great, but that's not the important thing,'' she says. ``It's close-knit and family-like.''

After a halting start five years ago, CHCA has done well enough to inspire similar enterprises in Boston; Oakland, Calif.; and Waterbury, Conn. It is part of a growing trend of helping the unemployed by helping them start their own businesses. (Though Edey herself previously worked in a hotel, 80 percent of CHCA's employees were on welfare before they joined the company.)

CHCA also represents a promising new way to blend the business side of home care with social ideals. ``It was a bright ray of light in a system that didn't have many,'' says David Gould, a vice president at the United Hospital Fund in New York, an independent foundation that helped fund CHCA's start-up in 1984.

In the early 1980s, Rick Surpin, who started the home-care co-op, was working at the Community Service Society in New York, the oldest such institution in the United States.

Traditionally, the society had focused on social service and advocacy, but Mr. Surpin convinced the leadership to try a new direction: building enterprises that would employ the poor.

His first effort, a worker-owned construction company, had been unsuccessful. Home care looked more promising to him.

As most people know by now, Americans are growing older, and families that are fragmented and scattered no longer provide the help grandparents used to receive.

Home care really became a business in 1983, the year the Medicare system imposed fixed payments for various hospital procedures. Since longer stays no longer meant more compensation, hospitals started moving patients out the door as quickly as possible.

With federal and state funding, home care has burgeoned into a $7-billion-a-year industry, from almost nothing 10 years ago.

Since Medicare and Medicaid are based on a medical model, much of the money gets channeled through hospitals, which in turn contract out the work to private companies. Most of these operate as a cross between a temporary agency and McDonald's: low-wage jobs for mostly unskilled women in the urban labor force.

Surpin wanted to build a different kind of company, one that offered genuine opportunity, especially to women, while providing better care in the home. He says he thought it wasn't enough to simply fund minority-owned versions of the corporate care providers.

``This was a different model, in which everyone shares,'' he says.

The failed construction company had taught him an important lesson. He had started with the politically ``correct'' view that management should evolve from the workers. But the leader of the group turned out to be a poor manager and a mediocre carpenter to boot.

``We started looking at how we could blend the ideological with the practical,'' Surpin says. ``Owners shouldn't be just the first people to walk in the door. They have to earn their membership by proving they at least are good workers.''

Employees can join CHCA after a three-month probation. If they decide to join, they invest $1,000 in weekly installments of $3.50 over five years. (They get full voting rights after a $50 initial payment.)

Close to 100 of the 170 employees have joined to date. Last year the worker board was able to vote a $500 bonus for each member, the equivalent of a shareholder dividend in a conventional corporation.

Today, the CHCA administrative staff occupies a modest suite of offices in the heart of the South Bronx. The biggest challenge was building a culture of cooperation in an enterprise in which the employees generally don't see one another.

At CHCA, all new workers go through the same two-week classroom training, and there are regular team meetings throughout the year. Employees take excursions together, and the company Christmas party is a big event; one quadriplegic client comes and dances in her wheelchair.

Employees say this cooperative approach provides an atmosphere in which their best instincts can flourish. Sarah Lee, for example, was drawn to home care through her experiences as a girl in North Carolina, after her father had a stroke.

``I like people,'' she says. ``I like helping them. Some of my cases don't have anyone [to care].''

Ms. Lee spent 12 years working for conventional home-care businesses before she came to CHCA. The office staffs for her former employer were ``snappy,'' she says, and gave her the runaround.

At CHCA, by contrast, the staff is on her side. ``All the workers love working for this company,'' she says.

The word ``family'' comes up a lot among CHCA employees. ``I think about my family in the way I treat a person,'' Edey says. ``Compassion, patience, understanding - we stress that really a lot.''

AGENCIES that use CHCA are enthusiastic about its work. ``My experience [with them] has been really good,'' says Pamela Dixon, Bronx borough manager of the Visiting Nurse Society. ``They all have a share in that company, so maybe they take a little more pride in what they do. It's not just a job.''

For local labor unions, however, CHCA has been a puzzle. Unions have organized about half of the city's home-care workers, bringing gains in wages and benefits. But how to deal with workers who are also owners?

``Not having anyone to negotiate with, not pushing an employer to improve working conditions but instead pushing themselves - that's a funny situation,'' one union staff member says.

CHCA employee-owners find the union benefit plans attractive. But they aren't sure they want to share control with a union office downtown.

As owners, they face problems most employees don't worry about, such as how big CHCA can grow without losing the special atmosphere. The current plan is to have about 200 to 300 employees, 70 percent of whom are on full-time salary, which is virtually unheard of in home-care circles.

The nursing career track poses difficult choices as well. For one thing, the cooperative will pay these workers for the time spent in class, which means finding temporary replacements for 20 of the best people. On top of that, CHCA runs the risk of losing these workers if it cannot find a way to incorporate nursing into its business package.

But it's a risk the company was willing to take. ``We're doing this with the idea [that] the company will grow,'' Edey says, reflecting her position as both owner and employee. ``It's going to help people. The way we work, we help each other out.''