An open protocol and a member-owned federation, so any community can run — and own — its own care.
63 million Americans are family caregivers (AARP and National Alliance for Caregiving, Caregiving in the US 2025) — no badge, no record in the EHR, no measurement of outcomes they produce. Home care agencies lose about 75% of their caregivers every year (Activated Insights, 2025 Benchmarking Report). The gig economy is Standard Oil trying to deliver electricity one household at a time.
A century ago, a cooperative grid fixed the same infrastructure gap in a generation. Vimty applies that model to aging care: the shared protocol, and a federation the communities themselves own. Boulder is Node One — being built now. Today co-op.care takes sign-ups, runs a family assessment, and keeps a time bank; paid care begins once it is licensed and staffed, and caregivers become worker-owners when they are paid. What it is not yet is a national grid. This is the standard and the invitation; the license opens when Boulder is proven.
Here for a parent, not a protocol? The family door onto this same grid is co-op.care — see what your family qualifies for, and join the Boulder circle.
Caring for someone now? Start at co-op.care. Want a node in your community? Put your city on the map.
The proof of concept
In 1930, only about one in ten American farms had electricity (Richmond Fed, Econ Focus, 2020). Private utilities ran lines to profitable urban density and stopped. Rural communities were simply not worth the capital per mile of wire. The market verdict: you do not get power.
Franklin Roosevelt signed the Rural Electrification Act in 1936. The mechanism was not a government utility. It was government-backed cooperative loans to communities that would form their own cooperatives, build their own lines, and own the infrastructure they depended on.
By 1953, more than 90% of American farms had electricity (NRECA). The Rural Electrification Act turned 90 in 2026. It has outlasted every gig-economy power scheme because its incentives compound: the member-owners who need the electricity are the same people who own the grid.
The cooperative grid — then and now
The gig economy is Standard Oil trying to deliver electricity one household at a time. The cooperative grid is the Rural Electrification Act. We know which one is still running 90 years later. — the Vimty thesis
The care grid — same model, same form
Generation
Caregivers produce care hours. Worker-owned cooperatives employ them W-2. The same shift that delivers care produces the clinical observation.
co-op.care →Transmission
Planned: shared care software, physician review of AI output (HarnessHealth), and a user-owned memory (chanio) — the protocol layer, to be licensed at cost to every node. The wires that carry it.
harnesshealth.ai →Distribution
Local cooperatives — the last mile into each home. Community-owned, locally governed. Each node owns its own equity. The grid interconnects them.
Start a node →Metering
Care-hour credits — the kilowatt-hours of the care grid. Earn a care hour in Boulder. Redeem it in Amsterdam. The ledger keeps the account.
How care credits work →Standards
Omaha System to FHIR mapping — the voltage standard. Designed so an observation from any node can travel to any clinician.
HarnessHealth →Ownership
Member-owners hold equity in their local cooperative, not in a holding company above them. Democratic governance. The incentive structure that made the REA last.
How ownership works →This is the design, not a running network: agents across seven layers of a member's life, with a physician behind anything clinical. The care comes first. As the network matures, that care would also leave a record, signed by a physician only where a physician actually reviewed it, and used for anything beyond care only with member consent. It is a product of the care, never the reason for it.
Brands are doors; layers are the rooms. Layer 6 operations — the care — sustain everything; Layers 1–4 + 7 hold the member; Layer 5 is the record the care leaves behind. That is the design. Today Boulder is the first node being built, and nothing is called attested unless a physician signed it.
The unmeasured layer
The family caregiver is the single most important variable in whether a discharge holds, a medication is taken, a fall is prevented, a hospital readmission is avoided. None of that caregiving shows up on a claim, a chart, or a board-level dashboard.
It does show up — in strain, in absenteeism, in cost shifted to emergency departments, and in outcomes the health system takes credit or blame for without knowing the real cause. ARCHANGELS calls caregiving intensity the vital sign organizations did not know they were missing. That framing is correct. The implication is that the industry is running blind on the variable that matters most.
When we talk about aging infrastructure, we do not mean hospitals, senior-living towers, or another app. We mean the human layer that is already doing the work. It needs a record, a structure, and a way to compound.
Why current fixes fail
U.S. home care runs on about 75% annual caregiver turnover (Activated Insights, 2025 Benchmarking Report). Matching a family to a worker who will churn inside the year is not infrastructure. It is a fee on catastrophe.
Platforms are applying AI to scheduling to hold caregivers longer. That helps. But the caregiver still builds value inside somebody else’s platform, and the improvement is priced in to the platform, not the worker.
A 2026 wave of peer-reviewed studies is converging on the same conclusion, four studies in three journals in the space of months: chatbots cannot be the patient-facing clinical interface without a physician in the loop.
I warned three years ago that these systems were “purveyors of authoritative bullshit” that should not be trusted. That is still true — and it very much applies in medicine. — Gary Marcus, April 2026, revisiting a 2023 warning in light of four new peer-reviewed studies
The gig economy churns the worker. The unsupervised chatbot hallucinates the plan. Neither has the structural shape the aging population needs.
The shift under all of this
Julien Bek of Sequoia framed the shift cleanly in March 2026. The next wave of AI winners will sell outcomes, not tools. Pure software gets replicated by incumbents, underpriced, or built in-house. The durable companies are full-stack — they own the care model, the patient relationship, the clinical data, and the operations. AI embedded across that stack reinforces the service, instead of being the service.
A copilot sells the tool. An autopilot sells the work. — Julien Bek, Sequoia Capital, “Services: The New Software” (March 5, 2026)
In healthcare the shift is already moving: services companies are embedding AI across a care-delivery stack they own end-to-end. The bet is that the margin profile of a services business changes when AI takes real cost out of care delivery.
Vimty’s argument is one step past Sequoia’s: if services are the new software, then the ownership structure of the service is the moat. Capital-owned services compound for the fund. Worker-owned services compound for the worker, the family, and the community around them.
Community leverage = the moat
The home-care-specific proof already exists. Cooperative Home Care Associates (CHCA) in the Bronx has been running the model Vimty is arguing for since 1985 — more than 1,600 caregivers and staff, about half of them worker-owners (CHCA), with turnover reported far below the industry’s. Forty years. One of the largest worker cooperatives in the United States.
The Mondragon Corporation is the broader proof the worker-owned model scales. Founded in the Basque Country in 1956, it reported €11.06B in 2023 sales and about 70,500 people employed (Mondragon Annual Report 2023). Co-operatives UK reports that about 80% of co-operatives survive their first five years, vs. 44% of other businesses (The Co-operative Economy, 2018). Worker ownership is not idealism. It is a survival characteristic.
A platform uses AI to hold the worker. A cooperative makes them the owner. The moat is not the model — it’s the legal form.
The replication proof
In 2006, Jos de Blok started Buurtzorg, a Dutch nonprofit, with one small team of nurses. No venture capital. No franchise agreement. A back office of a few dozen people. One shared protocol: self-managing teams of up to 12 nurses and common technology, with every team in control of its own work.
By 2022: more than 10,000 nurses in about 900 self-managing teams across the Netherlands, and the model now in use in 25 countries, including the US, UK, Japan, Sweden, and Australia (Buurtzorg International). A 2009 Ernst & Young study found Buurtzorg met patients’ needs using about 40% of the authorized care hours, against about 70% for other agencies (Commonwealth Fund, 2015).
The replication mechanism is not a brand extension. It is a shared protocol. Buurtzorg maintains the common technology layer; each team runs its own work. Vimty’s step past Buurtzorg is ownership: each community would own its cooperative — the employer relationship, the family relationships, and the equity.
Vimty’s architecture is designed for the same replication. co-op.care is building the first node, in Boulder. The stack is the protocol. The next community adopts it, builds its own cooperative, and the network grows — not as a franchise, but as a federation. Each node locally owned. Each node on the same technology and physician-review layer.
When a community is ready to join
Nothing here is for sale today. These are draft terms for once there is a proven network to join; we publish the shape now so the model is transparent, and any amounts will be set with the first communities. Every community that federates signs a Protocol License Agreement. It is not a franchise agreement: the community owns its own cooperative, its own employer relationships, and its own equity. The PLA covers the three things that keep the network coherent: access to the shared technology stack, a care-hour solidarity contribution that funds the next node, and a one-time setup that covers onboarding and legal scaffolding.
The equity is always local. The protocol is always shared. The solidarity contribution is the wire maintenance that keeps the grid connected. — Protocol License Agreement, draft Vimty federation terms
The build — three layers, at different stages
Vimty is not a product. It is the argument for a three-layer stack, each layer a separate build, each answering a different structural failure. Together they remove the architectural harms (gig labor, unattested AI output, vendor-held records) before attempting to add capability on top.
Operator + physician review + memory. The three layers are separately buildable and structurally interdependent. No one of them works without the other two.
The pre-institutional moment
Enough scientific foundation to be serious. Not enough institutional infrastructure to be systematic. A credibility spectrum that runs from rigorous research to influencer advice. No agreed scoreboard for what aging well even looks like.
Public health’s early wins came from removing harms first — clean water, vaccines, sanitation — before it tried to add capability. The architectural harms in aging today are fragmented data, gig labor, and unattested AI clinical output. Vimty’s thesis is that those harms have to be removed first. The capability layer comes next, and safely.
MIT AgeLab launched a Longevity Preparedness Index in October 2025 to try to measure what preparedness for a longer life looks like at the individual level. Joseph Coughlin’s broader argument in The Longevity Economy is that an aging society is the most misunderstood market of our era. Vimty’s contention is that individual preparedness is not enough. The unit of preparedness is the community, and the infrastructure is cooperative.
Community leverage is how removal happens. Capital alone cannot retain the caregiver, audit the chatbot, or hold the record. A cooperative can.
The real token
In 1995, Japan’s Sawayaka Welfare Foundation created Fureai Kippu — loosely, “caring relationship ticket.” The mechanism: help an elder today, earn a time credit, keep it in a mutual-aid ledger, redeem it when you or your family need care — or transfer it to a parent in another city through a clearinghouse.
It is one of the longest-running care tokens there is. Not speculative. Not blockchain-dependent. A cooperative-ledger time credit backed by actual care capacity in every affiliated organization. One hour given earns one hour redeemable.
Contribute ten hours. Get the future you want. — The Vimty network at scale: mutual aid as infrastructure
Vimty extends this model to a federated cooperative network. co-op.care’s time bank is live: an hour given is an hour banked. Credits are member-owned, cooperative-held, and — as the network federates — redeemable at any affiliated community. When you age, wherever you are, the hours are yours.
The equity stake in this network is not central. A cooperative owned by a central entity is not a cooperative. Vimty is the protocol layer — shared care software, HarnessHealth physician review, chanio memory — designed to be licensed to each community at cost. No equity in the infrastructure layer. No central extraction.
Each community that federates forms its own locally governed cooperative entity. The stake — the real token — is in that entity. Its workers hold equity in their community’s cooperative, not in a holding company above them.
| Community | Cooperative entity | Status |
|---|---|---|
| Boulder, Colorado | Limited Cooperative Association (LCA) — Colorado Title 7 | Being built |
| UK | Co-operative Society (registered with FCA) | Form mapped |
| Germany | Eingetragene Genossenschaft (eG) | Form mapped |
| Netherlands | Coöperatie (U.A.) | Form mapped |
| Japan | 労働者協同組合 — Worker Cooperative Corporation Act (2022) | Form mapped |
| Australia | State-registered Cooperative (Co-operatives National Law) | Form mapped |
| Canada | Coopérative de travail — Quebec (strongest ecosystem; EVA co-op is a live homecare precedent) | Form mapped |
| Your community | Your local cooperative form — we help you find it | Express interest → |
Boulder is the first node, still being built.
Each subsequent city that joins operates its own cooperative, governed by its own members.
The Vimty stack is the shared infrastructure. The equity is always local.
Notes: Germany eG requires membership in a cooperative audit association (Prüfungsverband), adding
formation overhead. Japan’s Worker Cooperative Corporation is new (2022) and carries minimal
homecare operational track record so far.
Canada’s strongest cooperative ecosystem is Quebec.
The real token is a care hour, or a stake in your community’s cooperative. Locally held. Locally governed. Not pooled at the center.
Where this comes from
This is not a new idea. In 2011 it was Vimty — an all-digital advance directive, built to do one stubborn thing: get people to talk about the end of their lives before a crisis decided for them. To make it real, it had to solve digital notarization across state lines — assembled around interstate commerce, before most of the country allowed remote online notarization at all. The technology worked. The problem did not move.
In 2016 it became CareGoals — the same mission, aimed at the reimbursement rails this time: the Advance Care Planning codes and the Annual Wellness Visit, the two places Medicare will actually pay a clinician to have the conversation. The codes existed. The conversation still didn’t happen at scale. Many years and several good tools later, it is still not solved.
The lesson took a decade and a half, and it is the whole reason for Vimty now: the problem was never the document or the billing code. It was that no one owned the relationship or the record. A form can’t make a family talk. A code can’t retain the caregiver who’d be in the room. Only a community that owns its own care — the people, the record, and the outcome — can hold a conversation that outlasts a single visit.
Vimty is the fifteen-year mistake finally worth making — because for the first time the pieces exist: AI to clear the friction, and a cooperative to own what’s left.
The Rural Electrification Act built a cooperative grid now serving 42 million people across 56% of the American landscape (NRECA). It is 90 years old and still running. Boulder is node one of the care grid, being built now. Two doors: a family looking for care starts at co-op.care; a community that wants its own node puts its city on the map.
Just caring for someone? Start at co-op.care, the family door. The grid exists so that door can open.
The replication protocol is the same one that built the rural electric grid: a shared technology layer, a cooperative legal form, and locally owned infrastructure. Put your city on the map now; the stack and legal scaffolding open once Boulder is proven. Boulder is node one. Your city could be node two.