PROJECT SUMMARY Geoffrey Gusoff, MD, MBA, MS is a clinician-researcher, family physician, and post-doctoral fellow in the National Clinician Scholars Program at UCLA. Dr. Gusoff’s work integrates insights from business, clinical care, and aging research and focuses on the impacts of participatory business models like home care cooperatives on job quality, care quality, and access in long-term care. Severe workforce shortages and high turnover rates among home health aides (HHAs) increasingly prevent older adults from accessing the care they need to age in place. Studies suggest HHA shortages and turnover are largely driven by poor working conditions, including irregular hours, low wages, and the exclusion of HHAs from workplace decisions (e.g. patient care planning). In this landscape of high turnover and poor working conditions, home care cooperatives – businesses designed to prioritize HHA participation in workplace decisions – have achieved higher wages, greater patient retention, and half the turnover rates of other home care businesses according to industry data. This data suggests the cooperative model may be associated with better worker retention, job quality, and care quality, but empiric research is needed to investigate these potential associations and their underlying mechanisms. This proposal will develop and deploy a survey to HHAs at cooperative and non-cooperative home care agencies to measure the association between the cooperative model and HHA workforce outcomes (turnover, job quality, and care quality) and evaluate potential mechanisms of that association. With the goal of creating a marketable tool to improve the lives of HHAs and their patients across the US, the proposal will also partner with home care cooperatives to design and pilot test a digital training product aimed at improving HHA turnover, job quality, and care quality by deepening HHA workplace participation. To effectively complete the proposed studies and lay the foundation for a successful career in long-term care research and entrepreneurial innovation, Dr. Gusoff will complete needed training in survey design, geriatrics, and implementation science. To fill critical gaps in his business training to date, he will also complete an “MBA 2.0” in cooperative entrepreneurship, which will provide the practical skills needed to develop transformative, participatory business models within the long-term care sector. To accomplish these research and training aims, Dr. Gusoff will draw on a diverse mentorship team of national and international experts including Primary Research Mentor Catherine Sarkisian (geriatrics and community partnerships), Entrepreneurial Mentor David Hammer (Executive Director of ICA Group, the leading home care cooperative developer in the US), Ron Hays (survey development and psychometric evaluation), Moira Inkelas (implementation science), Madeline Sterling (home health aide workforce), and Debra Saliba (long-term care quality). This research, ...