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,"
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
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. …