A worker-owned cooperative for home care, with a member-owned mutual on top, on a federated care grid. The margin that private equity extracts today goes back to caregivers and families instead.
The extraction to flip
Home care runs on a broken deal: agencies pay caregivers $14–17/hr, keep about 63% of the revenue, and ship the margin to private equity. Behind them stands the largest unpaid workforce there is.
The model
Caregivers earn $26/hr W-2 plus equity and a vote. The moment someone is paid to give care, they become an owner. No gig work, and no one skims the margin off the top.
Families join a cooperative that pools mutual aid and risk — instead of an insurer that stopped insuring, an agency that keeps 40–60 cents of the dollar, or a payer with a conflict at the worst moment.
Independent local co-ops on shared governance software and one marketplace — modeled on rural electric cooperatives. One engine, many neighbor-owned nodes. Verified care hours are a currency layer: exchangeable, giftable, or used yourself.
Who pays — and why now
Care already has payers — Medicare, Medicaid, and families’ own pre-tax dollars. What’s changing is where the money flows. Medicare is shifting to reward keeping people well at home: hospitals are now held financially accountable for the 30 days after a surgery, and new programs are starting to pay for in-home dementia care and family-caregiver support — with palliative care at home proposed to follow.
co-op.care is how a health system delivers on that — the operator for the home tail, paid out of the savings it creates. The same payer is simultaneously purging providers it can’t trust — retroactive clawbacks, tightened enrollment — which makes provable, attested, member-owned care exactly the profile Medicare wants to keep. The cooperative’s mission isn’t charity; it’s precisely what payment reform now funds. We don’t need the system to change — it already is.
Why a cooperative investor
Funds whose own roots are cooperative and mutual are the few who’ll pressure-test this structure rather than ask us to abandon it. It’s the cooperative-and-mutual model aimed at the care economy — at exactly the moment AI makes the human acts (care, attestation, trust) the scarce thing, and ownership the moat a model can’t copy.
Why not the ACA co-op graveyard
The fair objection: government-blessed health co-ops mostly collapsed. They failed for a specific, diagnosable reason — they were federally created, top-down, with stakeholders excluded from governance. The models that worked share the opposite design: owned from below, locally governed, built on outcomes. Community-Owned Health Plans (employer-owned, ERISA-native) have run 25–30 years; Alaska’s Nuka System cut ER visits ~50% and held 97% satisfaction for two decades; La Crosse, Wisconsin drove last-two-years-of-life spending to $48,771 vs a $79,337 national average. Health-policy research (Health Rosetta) names the governance scale where this works — the “Goldilocks zone” of 25,000–500,000 people: large enough for economies of scale, small enough to capture savings locally. That is the co-op.care node. We are the corrective to the failure mode, not a repeat of it.
Where it stands
Pre-revenue, Boulder-first, building the first node. Already in place: Medicare/Medicaid reimbursement through a management-services organization; a family-caregiver hours ledger; a member card for care data; a digital advance-directive standard now used for e-notary directives; a network of supporting sites; and 200 Boulder families signed up.
The honest constraint right now — confirmed by an experienced cooperative developer — is recruiting the founding caregiver-owners. That’s trust-building, not technology. We’d rather name the real gap than oversell.
We’re not raising right now. What we’d value is your read on the model — where the worker-ownership and mutual thesis is strongest, and where you think it breaks.