C. User-Owned Social Care Primary Cooperatives

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  REVIEW OF NATIONAL EXPERIENCE IN PROMOTING AND SUPPORTING
   THE CONTRIBUTION OF CO-OPERATIVES TO SOCIAL DEVELOPMENT:
 
  CO-OPERATIVE ENTERPRISE IN THE HEALTH AND SOCIAL CARE SECTORS
      A GLOBAL REVIEW AND PROPOSALS FOR POLICY COORDINATION
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CHAPTER II.    

C. USER-OWNED SOCIAL CARE PRIMARY CO-OPERATIVES [TYPE 1.2.1]

Information in each of the following sections will be presented
by country, irrespective of the type of social care co-operative.

Social care co-operatives of this type are known to exist in
Canada, Finland, Lebanon, Philippines, Poland, Romania, Sweden,
the United Kingdom and the United States.  Resources did not
permit a comprehensive global survey, and it is very probable
that they exist also in other countries.

In Canada, child-care and nursery school co-operatives are well
developed.  The oldest known co-operative nursery school began
operations in 1937 in central Toronto.   A study undertaken
during 1991 and 1992 identified over 900 such co-operatives
serving 40,000 families in all parts of the country.  Although
some operated in isolation, many had established regional
organizations. In September 1991 the Parent Co-operative
Preschools International, which had acted as a resource
organization for these regional councils,  set up a Task Force
on Canadian Childcare Co-operatives to review the condition of
this type of co-operative.  It also studied the feasibility of
forming an Association of Canadian Childcare Co-operatives, and
recommended that it be established.  This Association was set up
in Toronto in May 1993.  In a number of Canadian cities, parents
who had been members of childcare co-operatives when their
children were young continued their interest in co-operative
forms of education by later setting up co-operative primary
schools.  

These co-operatives were the first to develop programmes for
children with special needs: this occurred in Hamilton, Ontario
in the early 1970s and by the early 1990s three such programmes,
in Hamilton and also in London and Toronto, were in operation. 
They received public funding to provide consultation and support
services to day care and nursery co-operatives serving children
with special needs.45/

During the 1990s in the Province of Quebec, Canada there has been
a growth in the number of co-operatives providing home services,
particularly to elderly persons. Some were provider-owned, but
the majority were user-owned. Most received ad hoc subsidies from
regional or national government authorities. The third level apex
cooperative organization in Quebec (Conseil de la cooperation du
Quebec) recently adopted a resolution asking the provincial
health ministry to reserve at least half of home service
contracts for this type of co-operative. 46/ 

In Finland in late 1995 there were six co-operative creches and
one co-operative residence for elderly persons.47/

In Lebanon, in 1985 a group of persons with disabilities joined
a previously existing Friends of the Handicapped Association,
transforming it into an organization operated by, as well as for,
persons with disabilities. It was this newly constituted
association which promoted the first independent living centre
run by persons with disabilities, formed in 1986 in Tripoli,
others being set up subsequently elsewhere. The Association has
promoted development of transportation, education, health and
social care services, job creation and lobbying for the rights
of persons with disabilities.48/

In the Philippines a number of co-operatives affiliated with the
National Confederation of Cooperatives (NATCCO) established
daycare centres for their members. These were so successful in
meeting needs within the communities in which the co-operative
operated that they were subsequently opened to non-members.  
This was the case, for example, in the Palompon Community Credit
Cooperative, in Leyte, and in the Oyao Multi-Purpose Cooperative
in Nueva Vizcaya.49/

Worker-owned production and service provision co-operatives whose
members are persons with disabilities have been particularly well
developed in the form of "sheltered work places" in some eastern
European countries, notably in Poland. This is an example of a
system which originated in the need to resolve the problems of
large numbers of war-disabled persons, many of whom displaced
persons.  It is particularly relevant to the current situation
in many countries, where there are very large numbers of persons
in similar personal circumstances.  Begun immediately after the
Second World War, they were integrated in the centrally planned
economic and social welfare structures of the socialist regimes. 
In 1980 in Poland, for example, there were 435 such co-
operatives, employing 272,000 persons, of which 74 per cent were
persons with disabilities. They were grouped into 17 regional
unions, and had a national apex organization: the Central Union
of Invalid's Co-operatives. These co-operatives produced goods
which were protected as State monopolies.  With transition to a
market economy, these monopolies ended, and although the disabled
workers' co-operatives continue to operate, they now face
considerable financial difficulties.50/

In Romania in 1992 there were 850 handicraft co-operatives, with
300,000 members of which 20,000 were persons with disabilities. 
These cooperatives provided medical and social insurance, health
treatment, holidays, training and vocational education for their
members.51/ 

From the late 1980s until 1994 in Sweden national and local
governments (municipalities and county councils) created a legal
and economic environment increasingly favourable to operations
undertaken by entrepreneurs, both co-operatively organized and
others, within the social care sector.  User-owned, provider-
owned and multi-stakeholder social care co-operatives have
appeared.55/  However, since 1994 there has occurred a change in
local government policies reversing the earlier trend.   In some
cases, pressure has been exerted on the new provider-owned social
care co-operatives to return to the public sector.52/

Users - for example, a group of elderly persons - have first
formed an association, then applied for public financial support,
and finally hired professional and paraprofessional workers to
provide the required services, to themselves or to persons in
need for whom they have responsibility (as family members or as
individual or institutional guardians). As of September 1995
there were an estimated 1,600 such user-owned co-operatives, of
which 1,400 were childcare co-operatives.  About 64 per cent of
their income was obtained from local or national governmental
authorities as payment for care provided to beneficiaries of the
national health and social security insurance system.53/

Citizens perceive user-owned social care co-operatives as a means
to more directly influence their living conditions and to ensure
better quality services.  They have been willing to participate
in their development and to contribute to their operation.

Psychiatric care has been provided by co-operatives owned
primarily by patients, with, in some cases, membership by
professional staff, at Husomtarna and in the Enskede-Skarpnack
psychiatric section of Stockholm County.  This type of co-
operative has increased substantially in numbers in recent years.

Residential service co-operatives have been established by
persons with disabilities in Goteborg, Jonkoping and Stockholm
in the form of residential co-operatives.  They engage employees
to provide the personal services they need, mostly home help and
personal assistance, but they own and manage the co-operative
themselves.  Those whose members were primarily persons with
mental disabilities employed resident staff.  They have been set
up also by elderly persons.  An example is provided by the
Stockholm Association for Independent Living (STIL), established
in 1987 by persons with serious disabilities which required them
to seek regular care.  Members wish to avoid dependence upon a
single carer, and each manages the work of their carers, giving
them the status of employer and not client. They are able to
choose their own carers, rather than be dependent upon an
inflexible public service.  The co-operative functions as a
recruitment and organizational enterprise on behalf of its
members.  In November 1992 it had 85 members, and by 1994 over
100 in the Stockholm metropolitan region.  It manages about 400
carers, each engaged on a temporary basis.54/

Child-care and nursery school co-operatives, in the form of
parent-owned user co-operatives, were first started in Sweden
during the mid-1970s.  Some were sponsored or supported by
housing co-operatives: but the majority were autonomous ventures
undertaken by parents.Prototypes were often the "anti-
authoritarian kindergartens" which had been set up in the then
Federal Republic of Germany. To a significant degree parents
wished to gain greater influence over the daily care received by
their children: that is their objective was to some extent
ideological. However, they were motivated also simply by a wish
to obtain a satisfactory day-care service, given the absence or
inadequacy of contemporary arrangements: more recent surveys
showed in fact that the ideological goal, although still present,
had been surpassed by that of a simple interest in securing
satisfactory day-care.  Member (parent) satisfaction was high,
so that even when places became available in public sector day
care centres, they preferred to keep their children in a co-
operative centre. Here, although required under the terms of
membership to contribute a considerable amount of voluntary work,
they felt they were able to influence directly the type of care
provided to their children.

Most co-operative daycare centres looked after between 12 and 20
children.  Some had a particular pedagogical profile (such as
Montessori), but this was not generally the case.  The co-
operatives' members were the parents and, in a few cases, the
staff, and together they formed either a type of non-profit
organisation or an economic association.  The latter was usually
considered the more suitable structure, with limited liability
for board members and a requirement for each member to
participate.  There were no legal regulations governing the price
of shares, so often the members "purchased" only a symbolic share
for membership. The members elected a board with a chairman and
a treasurer. In many cases the board was comprised of one
representative for each family, and thus equal opportunity for
direct participation in important decisions concerning finances
and fees, employment of teachers and educational principles. 
When the board made a decision all  members were informed and a
high degree of member acceptance could be expected.  This model
could result in a certain lack of efficiency - arriving at
decisions could be time-consuming but as acceptance by members
was usually high, implementation was relatively easy.  Each
member was expected to provide voluntary assistance with
administration and/or maintaining the premises.  In many co-
operatives they also worked directly with the children and helped
with cooking on a rota basis. The time required from each parent
varied from one to 60 hours per month.  

The position of the employees could vary considerably between co-
operatives and could sometimes cause problems.  Teachers in
parent-owned co-operatives were formally subordinated to a board
of parents.  On the other hand, the teacher instructed the
parents in the performance of day-to-day work at the facility. 
Normally the staff had great influence in the management of the
co-operative, both participating in board meetings and providing
a co-ordinating function. Staff conditions of employment (such
as wages, hours and fringe benefits) seemed a little more
favourable than those of their municipally employed counterparts.

The employees of co-operatives had to learn how to work with
amateurs and be prepared for the possibility of having their
professional role questioned, without feeling threatened or
defensive. They had to be certain of their objectives, but on the
other hand, be sensitive to the needs and opinions of parents. 
Establishing a good relationship between parents and staff could
sometimes be hard, but studies showed that in a majority of co-
operatives the parents and employees were satisfied in this area.

Most income of parent-co-operatives came from municipal
subsidies. The basis on which they were granted could vary from
town to town, but commonly a co-operative received an annual
amount per child, depending on age. The local authorities also
granted the co-operative an annual contribution corresponding to
the costs of the premises.  Before commencing operations, parent-
owned co-operatives also normally received a one-off amount for
buying necessary equipment.  

The board decided annually about the fees charged to members. 
The members could influence their level of payment by doing more
or less voluntary work, but the final decision was made by and
for the group of members, i.e., parents could not determine their
own fees simply by doing more or less work.  Normally the total
of parents' fees covered about 20% of the co-operative's costs.

During the late 1970s and the 1980s government authorities were
on the whole reluctant to permit and even less to fund such user-
owned co-operatives.  However, numbers grew from five co-
operatives in 1975 to 150 ten years later, and then to 500 in
1989, 933 in 1992 and 1,400 in 1995. In 1994 12 per cent of all
children in day-care centres were in co-operative centres, which
existed in 80 per cent of municipalities.  Most were in the
larger urban centres, but they were numerous also in rural
districts, where the demand for their services was very great. 
They were largely financed by subsidies from central and local
governments.55/ 

In the United Kingdom there were in 1995 between 40 and 50
"social employment co-operatives" which provided work for persons
with disabilities, or recovering from mental illness. Among the
best known were Daily Bread, a wholefood retailer and wholesaler
that employed persons recovering from mental illness; Pedlar
Sandwiches, a catering co-operative employing persons with mental
illnesses;  Adept Press, a printing business employing persons
with hearing impairment; Rowanwood, a producer of wooden
panelling products, which employed persons with learning
disabilities; Gillygate Wholefood Bakery, an employer of persons
with learning disabilities; and Teddington Wholefood Co-op, which
had developed recently from a day care centre, and which employed
persons with learning disabilities.56/

In the United States the United Seniors' Health Co-operative in
Washington, D.C., a service co-operative owned by elderly persons
provides programmes concerning both the health and social well-
being of elderly persons.57/  It constantly seeks innovative ways
in which to achieve its objectives. In 1992, for example, it
initiated as founder member the "Cooperative Caring Network",
through which volunteer members help each other remain
independent.  This Network expanded rapidly during 1993, when 12
community service organizations joined the network. During 1994
it was hoped to bring the total of such organizations to 20, and
the number of volunteers to 3,000.

This is a volunteer "service exchange" programme which encourages
those people who receive help to serve others as well. It links
generations and increases opportunities for independence. It is
based on the concept of "giving and receiving". Its purpose is
to assist older people and persons with disabilities to remain
in their homes by offering ways in which they can continue to be
active and valuable to the community and to themselves. This
arrangement contributes to the removal of the emotional
difficulties experienced by many obliged to receive help, by
transforming their situation into one of both receiving and
giving within a network for mutual self-help.

Participants in the Network earn "care credits" by providing
voluntary services such as friendly visits, telephone
reassurance, respite care, transportation, shopping, counselling
and help with financial management. These credits can then be
used to obtain help they may need for themselves (whether at the
same time or later), or they may donate the credits to another
individual participant or to one of the participant
organizations.

Software has been developed to manage the Network: for example,
to keep track of volunteer hours, match providers with
recipients, report recipient activities, credit and debit
individuals' accounts and generate quarterly reports.  By this
means an expansion in the participants in the Network can be
managed effectively, and a larger base of services, volunteers
and other resources established and kept operational.  A
programme of this type could be applied to a very wide range of
social care services.

The Co-operative has undertaken a number of research projects,
working in collaboration with research, consumer and professional
organizations.  During 1993, for example, it completed a review
of international trends in measures taken by governments to help
people with disabilities to continue to live at home and operate
within their own communities.  During 1994 it was intended to
develop a new programme in the area of mental health and aging.

During 1993 USHC undertook a research study of home care for
older persons. Its professional staff interviewed more than 30
experts and researchers and conducted focus groups made up both
of consumers and providers of home health care. On the basis of
this combination of expert knowledge and first-hand experience,
a practical guide for elderly persons who want to find reliable
at-home care was prepared and published. (Anne Werner and James
Firman, Home care for older people: a consumer's guide). The Co-
operative employed the same methods to produce or update other
major publications, some of which have become best sellers for
mass market distribution by commercial publishers.

USHC has continued to improve its computer services to help low-
income persons of all ages obtain the public benefits to which
they were entitled. The co-operative was formed primarily to deal
with the fact that many eligible persons did not receive the
public and private health and social care benefits to which they
were entitled.  This was so partly because it was difficult to
obtain the relevant information, and partly because few service
providers themselves understood all of the complicated
requirements of each of the many available programmes.

To remedy the situation USHC developed Benefits Outreach
Screening Software, created to meet the needs of elderly persons.

By 1993 it had been installed in over 400 sites in 23 States and
in the District of Columbia. In 1993 the Co-operative developed
a version of the programme to help persons of all ages.   As a
result service organizations could quickly and easily determine
an individual's or family's eligibility for all entitlements. 

Applications of the software have been widespread and successful.
In the State of Ohio it has been implemented throughout the
public service. During 1993 USHC worked for the Social Security
Administration with Howard University and the service
organization Bread for the City in Washington D.C. on outreach
projects. This collaboration resulted in the distribution of over
one million dollars to eligible people who had never applied for
such benefits or who had become too discouraged to continue their
applications. With funds from a foundation, USHC conducted a
feasibility study to determine the best approach to
implementation of this programme in the State of Maryland.   The
Co-operative also began a major new demonstration project in New
York City in collaboration with the Jewish Association of
Services for the Aged, Catholic Charities and the Urban League. 
The service will screen persons of all ages, and automatically
complete applications to major entitlements programmes.

During 1994 it was intended to launch a new Personal Advocates
Service through which volunteers would help frail persons to
understand and obtain the health and social services to which
they were entitled.