Taking care into the hands of carers


By Avila Kilmurray

“YOU can’t have great care without great jobs,” says Aoife Smith, Social Enterprise and Care Coordinator at the Migrant Rights Centre Ireland (MRCI).  She bubbles with enthusiasm describing the launch of Ireland’s first ever carer-owned cooperative for Home Care (The Great Care Co-op).

The fact that the initiative is migrant-led reflects the number of people with migrant backgrounds that are experienced home care workers.

They care about the jobs, but equally important, explains Aoife, they value care and they value the people they look after. 

MRCI has been campaigning for the rights of migrant workers since 2001.

In 2017 it found itself in a new space when awarded funding under the European Social Fund to create sustainable employment in home care and to tackle labour disadvantages of migrant home care workers in Ireland.

That gave the green light to an idea that was already being worked up by a number of home care workers themselves: the establishment of a not-for-profit cooperative.

Launch of the Great Care Co-op

The Challenge

Home care workers recognise the value of care.

They know their clients and are often part of the extended family.

Aoife described the frustration that many expressed at the way privatised home care is currently delivered.

With an emphasis on hours and profit, carers can find themselves rushing from client to client, watching the clock and struggling to manage with inadequate supplies.

Some women reported that they might have to visit 16 different homes each day.

In a 2015 submission, the Irish Human Rights and Equality Commission expressed concern at the lack of employment rights for home care workers.

MRCI continued to explore options with women who are home care workers themselves.

Founding members of the Great Care Co-op, with Aoife Smith (MRCI)

Determined to engage in blue sky thinking, the breakthrough came when the group looked at two different initiatives – the Cooperative Home Care Associates in the Bronx, New York and Buurtzorg, in The Netherlands.

The Bronx-based organisation stresses the importance of providing good employment conditions.

The Dutch model was set up by four Public Health nurses with an emphasis on a person-centred model of care.

Both have expanded rapidly, with Buurtzorg growing to meet the needs of 14,000 people over the past 14 years.

An evaluation by Ernst Young reported that the multi-disciplinary care approach had a client satisfaction rate of 4:5 and was estimated to be 40% more cost effective than other providers.

Starting from the client perspective it works to assemble a care package that underpins independence and supports an improved quality of life.

This was music to MRCI, which advocates a community development approach:

Using a whole person approach to assess personal, social, emotional and care needs, the Co-op maps the client’s network of informal care and involves them in designing the care plan.

They also consult with professionals such as the client’s GP, public health nurse, dentist, chiropodist and others.

The emphasis is on promoting self-care and independence. A number of older people argued that ’80 is the new 50’.

The approach was piloted in Dalkey (Dublin). Local community members were invited to feed in their views about home care through a number of community meetings.

The local Active Ageing Association helped out. A Drop-In Clinic to listen to local people was organised.

Both potential home care clients and their family members contributed to the discussion.

The feed-back allowed the Co-op group to refine its approach.

The care product that developed was not cheaper than other providers, but it was competitive.

It also offered workers pension entitlement and training opportunities, as well as wages that were €2.00 above the going rate.

But most importantly it adopted a self-managed neighbourhood approach that values the insight of the carers and allows them the flexibility and autonomy to provide care when, where and how it is needed.

The care teams can create schedules and rosters based on their inside knowledge and relationships with their clients and support network to generate better client outcomes.  A win-win situation for all concerned.

From Concept to Provision

Turning the idea into practical reality was not an easy process.

It needed support and injections of external expertise – legal and social enterprise – but most important was the tenacity of the women themselves.  A Co-op Board was established.

The Great Care Co-op Board Meeting

The model had to be tested, piloted and refined, while the Board had to decide on a legal structure.

They were determined that the Co-op would be run by experienced frontline staff in a non-hierarchical manner (as is the model of Buurtzorg in The Netherlands) and that what they were establishing was a mission-driven, not-for-profit co-op, with any profits being reinvested back into the company.

The Great Care Co-op employed its first worker in May 2020, caring for its first client.

Aoife explained how the group hope to grow it organically, creating care hubs initially across the South Dublin area.

The aim is to have six hubs up and running by 2022. 

"We thought we would get there faster,” she said. “But it is important to get it right.”

The emphasis on community participation and co-design was essential, but so too is an approach that is not only informed, but directed, by migrant workers themselves.

Seeing migrant workers as an essential part of the Irish solution for home care is a core aspiration of the initiative.

  • Watch a video released by the team at The Great Care Co-op: