Cooperative Home Care Associates (CHCA) holds a significant place within the U.S. worker cooperative and long-term care landscape. For decades, it has been the largest worker cooperative in the country by some distance. CHCA workers are also members of the largest union in the country, 1199Service Employees International Union-United Healthcare Workers East (1199SEIU). Through its own developmental path and partnership with the union, CHCA has established itself as a key touchstone for others seeking to build cooperative models at scale. But it also faces ongoing challenges reconciling its mission with the structural inequalities and profit-driven imperatives of the home care and larger healthcare systems. This profile charts CHCA’s efforts to advance workplace democracy and job quality internally and shift a broader set of conditions that devalue home care labor, contributing to serious workforce shortages in the field.