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co-op.care
Boulder, Colorado  ·  the case for building our own

Your parents are going to need help.
Here's what Boulder is building instead.

15,000 Boulder residents over 65 today. 30,000 by 2030. Every talent finds a need. Every need finds a talent.
our Chief Medical Officer  family physician & hospitalist  ·   Blaine Warkentine, MD  the builder  ·   Kristin Apple  the strategist  ·   Our first family  Boulder, CO
Would rather read than click? Read it as an essay →
First presented at Boulder Startup Week · RegenHub
A Boulder family  ·  our first family

She is not
alone.

She will share her story.
Three problems. Every family hits them.
01
Home care is too expensive.
$45–55/hr agency rate in Boulder. Most families pay out of pocket — no insurance buffer, no HSA offset, savings drain fast.
02
Sick care is too expensive.
$100,000 in preventable hospitalizations — one family, one month. The system pays for crisis. It won't pay $4,800 to prevent it.
03
There is no infrastructure to support aging at home.
No care coordination. No physician a text away. No financial mechanism. 54% of Medicare hospital discharges go home without any skilled follow-up. Fifty-nine million Americans fill that gap for free — one trillion dollars of unpaid care every year. Not a funding problem. A structural one.
Home · 20 hrs/wk
$34K
per year
Assisted Living
$74K
per year
Nursing Home
$115K
per year
The $40K gap between home and assisted living is the difference between retirement savings and Medicaid spend-down.  ·  CareScout 2025
The answer isn't a better app. It's a different shape.

A business owned by the people who use and work in it — not by investors who need an exit.

CHCA
Cooperative Home Care Associates — New York City. 2,000 worker-owners. Turnover ~30% vs. 75% industry median (HCAOA, 2024). Founded 1985.
Mondragon
Basque Country. 80,000 worker-owners. $12B revenue. Survived every recession since 1956 — including 2008 with zero layoffs.
26 co-ops · 350+ villages
26 care co-ops operating nationally — every one outperforms investor-owned on retention. Village to Village Network: 350+ neighbor-to-neighbor communities across the US. Boulder is ready. PHI National, 2024.
+50%
survival advantage from strong social connection  ·  U.S. Surgeon General 2023
+35%
higher mortality risk from isolation — larger than smoking 15 cigarettes/day  ·  Surgeon General 2023
When caregivers are owners, they stay. When they stay, your parent has the same face every morning. That is the entire intervention. 12 million Americans qualify for Medicare home health. Only 4 million receive it. 8 million families are leaving a lifetime benefit untouched — not because they don't qualify, but because nobody showed them the door. Colorado CDASS pays family caregivers $17–20/hr W-2 — IRS Notice 2014-7 makes it income-tax-free for live-in caregivers. The cooperative is the employer of record. Co-op.care is the door. The trillion dollars of free care doesn't have to be free.
Discussion · 90 seconds

What problems have you experienced finding care for a loved one?

Turn to someone near you. You have ninety seconds. · go
co-op.care · Boulder, Colorado · five structural changes

Workers earn enough to stay. A physician is on your team from day one.

01 · Wages
$26/hr + equity
vs. $17.36 industry median. Surplus returned to worker-owners, not investors.
02 · Retention
~30% turnover
vs. 75% industry average. Same face every Tuesday. That continuity IS the clinical intervention.
03 · Physician
MD · DO · PA · NP
On your care team. Reviews LMNs. Signs advance directives.
04 · Ownership
One vote
Caregiver members set wages. Family members set priorities. No investor to answer to.
05 · HSA unlock
22–37% off
Physician LMN documents home care as medical care when it qualifies. IRS §213(d) has been in the code 30 years.
Old model
Agency charges $45–55/hr. Caregiver earns $17.36. 75% annual turnover. PE firm captures spread. Different stranger every three months.
co-op.care
$26/hr + equity. Physician included. ~30% turnover vs. 75% industry. Colorado CDASS pays family caregivers $17–20/hr W-2 — co-op.care is the employer of record. Member-owned. Surplus returned to workers.
Boulder · AARP #6 nationally · a question for this room

How does a community actually care for itself at scale?

Boulder should be the model for every city in America. Let's figure out what that looks like. Turn to your group — three minutes.
75%
of Americans 50+ want to stay home  ·  AARP 2024
+50%
survival advantage from community connection  ·  140+ studies
$100K
cheaper to be healthy at home vs. sick in a facility  ·  per year
Everyone in this room already has something to give.
You're not a visitor here

Ten skill categories. You have at least one.

Not "could you help." You already have it. Find the one that fits and tap it.
01

Food

Meals · groceries · Sunday dinner

02

Transport

Rides · errands · appointments

03

Hands-on care

Bathing · dressing · transfers

04

Movement

Walking buddy · PT support

05

Housekeeping

Cleaning · laundry · repairs

06 · teens

Smart home

FaceTime · Nest · tablets

07

Companionship

Sitting · listening · reading

08

Clinical

RN · OT · PT · CNA · MSW

09

Administration

Insurance · bills · scheduling

10

Witness

Directive signings · hard talks

Tap yours · we'll remember it · leave your email and we'll match you
Every person in this room has one. Not most people. Everyone. · 30 seconds
Fall · avg hospitalization
$18,658
leading cause of injury death, adults 65+  ·  NCOA
Prevention program · saved/person
$3,904
chair yoga · balance training · supervised movement
Avg HSA balance · ages 55–64
$8,339
mostly untouched — qualifies for fall-prevention LMN  ·  EBRI 2023
Witness · the conversation that produces this

Colorado Medical Orders for Scope of Treatment (MOST)

Send original with patient at all transfers
Colorado Medical Orders
for Scope of Treatment (MOST)
C.R.S. 15-18.7 · Enacted 2010 · coloradobioethics.org
Last name: Sample
First / Middle: Margaret W.
Date of Birth: 03 / 14 / 1942
Sex: Female
A  ·  Cardiopulmonary Resuscitation (CPR)
B  ·  Medical Interventions
C  ·  Artificially Administered Nutrition
Patient / Decision Maker: Margaret W. Sample (self)
Date: 05/04/2026
Physician: Co-op.care Physician, DO  ·  Boulder
CO License: ME-SAMPLE
What this is
Medical orders — not an advance directive. EMS and every care facility are legally required to follow it. It travels to every setting: home, ambulance, ER, memory care.
What makes it binding
Requires a physician, APN, or PA signature. Without one, these are preferences — not orders. With a physician's signature, they are Colorado law.
Where co-op.care fits
The Witness tile is the conversation. A co-op.care physician reviews and signs the orders. CareGoals stores the document. ComfortCard carries it in Apple Wallet — readable by any provider in thirty seconds.
"The ninth hospitalization doesn't happen when everyone already knows the answer."
Proof · La Crosse, WI Gundersen Health System · 30-year community experiment
90% of residents have advance directives — vs. 30% nationally.
~$8K less per person in end-of-life costs than the national average.
99% of forms retrievable at point of care — because someone kept them.
Facilitators trained in every hospital, hospice, and nursing home. The conversation became community infrastructure. Boulder has the same ingredients.
Give first · Brad Feld · your first move

What do you have to offer?

You just saw what the Witness skill produces. Every skill on that list becomes an act of community infrastructure. Give without expectation of return — the village doesn't work unless someone goes first.
01
Time and presenceHours · visits · a skill from the list of ten
02
Connections and introductionsA referral · a warm email · an open door
03
ExpertiseClinical · legal · business · tech · caregiving knowledge
04
Spread the wordTalk to BCH · share with a neighbor · host a kitchen table conversation
05
Become a memberComfortCard · $19/mo or $199/yr · comfortcard.org
06
Connect me to someone who needs helpI'm here · I have capacity · just point me at someone
07
Partner my wellness or community orgGym · yoga studio · senior center · faith community · neighborhood association
One of these is already true for you. Tap it. We'll hold it. When you need something — we'll know who to call.
Help us build this correctly. Get equity by the amount of time and energy you put into this — with us.

Every city in America is going to face what Boulder is facing. Thirty thousand people over 65 by 2030.

Free · $199 Value
It takes a village. Turns out this one has a lot to work with.

"We can all belong if we have something to offer."

4 questions · 45 seconds · free 1-year ComfortCard membership ($199 value)

no email required · no pitch · 45 seconds
1 of 4

Who are you here for?

a
My aging parent(s)They're living at home — I want a plan before crisis hits
b
My own future selfPlanning now so I don't become someone else's burden
c
Someone I already care forA spouse, sibling, or neighbor who needs support now
d
My community or clientsI work in wellness, health, or senior services
2 of 4

What's the hardest part?

a
Finding trustworthy, consistent careNew face every few weeks. Nobody knows the history.
b
Paying for it without going broke$45–55/hr. Insurance won't cover it. Savings drain fast.
c
Keeping everyone in the loopAdult daughter as coordinator. Everyone has a different version.
d
Navigating the system aloneDischarge paperwork. Insurance calls. Three different portals.
3 of 4

What could you bring to the grid?

a
Time as a caregiver or neighborMeals, rides, companionship, skilled hands
b
A wellness or health serviceMy gym, studio, clinic, or senior program wants to partner
c
Capital or strategic backingI want more than membership — let's talk when the structure is ready
d
Connections and community reachI can open doors — health systems, employers, neighborhoods
4 of 4

What's your next move?

a
Get my free year of ComfortCardFree 1-year membership · $199 value · no strings
b
Partner my wellness org or businessGym · yoga studio · senior center · faith community
c
I want a stake — not just a seatInterested in ownership when terms are ready · let's talk
d
Stay close — one email when Boulder opensNo pitch. No drip. Just the signal when it's real.
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