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Unionized nursing homes have lower COVID-19 mortality rates

September 14, 2020

Topics: Quote of the Day

By Adam Dean, Atheendar Venkataramani, and Simeon Kimmel
Health Affairs, September 10, 2020 (Ahead of print)

Abstract

More than 40% of all reported coronavirus disease 2019 (COVID-19) deaths in the United States have occurred in nursing homes. As a result, health care worker access to personal protective equipment (PPE) and infection control policies in nursing homes have received increased attention. However, it is not known if the presence of health care worker unions in nursing homes is associated with COVID-19 mortality rates. Therefore, we used cross-sectional regression analysis to examine the association between the presence of health care worker unions and COVID-19 mortality rates in 355 nursing homes in New York State. Health care worker unions were associated with a 1.29 percentage point mortality reduction, which represents a 30% relative decrease in the COVID-19 mortality rate compared to facilities without health care worker unions. Unions were also associated with greater access to PPE, one mechanism that may link unions to lower COVID-19 mortality rates.

From the Introduction

Labor unions representing health care workers perform several functions that may reduce SARS-CoV-2 transmission. Unions generally demand high staff-to-patient ratios, paid sick leave, and higher wage and benefit levels that reduce staff turnover. They educate workers about their health and safety rights, work to ensure that such rights are enforced, demand that employers mitigate known hazards, and give workers a collective voice that can improve communication with employers. In the specific context of the COVID-19 pandemic in New York, labor unions advocated for access to PPE and new infection control policies.

Study design and data sources

We conducted cross-sectional regression analyses to estimate the association between the presence of a health care worker union and COVID-19 mortality rates in nursing homes in New York State during the 2020 COVID-19 pandemic. We used publicly available data from the New York State Department of Health (NYSDOH) on COVID-19 mortality. We used proprietary data from 1199SEIU United Healthcare Workers East (1199SEIU), the International Brotherhood of Teamsters, and the Communication Workers of America (CWA), as well as publicly-available data from the New York State Nurses Association (NYSNA) to determine if a labor union represented health care workers in each facility.

From the Discussion

Among 355 nursing homes in New York State for which data on COVID-19 mortality rates were available, the presence of a health care worker union was associated with a 30% lower mortality rate from COVID-19 among nursing home residents. The findings were robust to adjustment for a range of covariates and specification checks for bias from missing data. We also found that nursing homes with labor unions had greater access to PPE and lower COVID-19 infection rates, two important mechanisms that may link unions to lower COVID-19 mortality rates.

However, more research is needed to understand the numerous mechanisms through which unions may influence COVID-19 mortality rates, such as staff training, reducing use of part-time workers, implementing infection protocols, and giving workers a collective voice in the workplace.

Our finding that unions are associated with reduced COVID-19 mortality rates in nursing homes is consistent with previous findings that unions improve safety and health standards for workers, help to co-enforce those standards with employers, and also reduce workplace injuries and accidental deaths. Health care worker unions, in particular, are also associated with improved patient outcomes.

We also found that chain nursing homes were associated with higher COVID-19 mortality rates. Previous research similarly finds that nursing home chains are associated with lower quality care.

Conclusion

Residents in nursing homes have been disproportionately affected by COVID-19. The presence of a health care worker labor union was associated with a 30% relative decrease in the COVID-19 mortality rate compared to facilities without unions in the State of New York. Health care worker unionization may play an important role in ensuring access to appropriate PPE and implementing infection control policies that protect vulnerable nursing home residents.

https://www.healthaffairs.org…


Comment:

By Don McCanne, M.D.

“The presence of a health care worker labor union was associated with a 30% relative decrease in the COVID-19 mortality rate compared to facilities without unions in the State of New York.” Not only that, but “chain nursing homes were associated with higher COVID-19 mortality rates.”

How do health care labor unions reduce COVID-19 mortality in nursing homes? “Labor unions representing health care workers perform several functions that may reduce SARS-CoV-2 transmission. Unions generally demand high staff-to-patient ratios, paid sick leave, and higher wage and benefit levels that reduce staff turnover. They educate workers about their health and safety rights, work to ensure that such rights are enforced, demand that employers mitigate known hazards, and give workers a collective voice that can improve communication with employers. In the specific context of the COVID-19 pandemic in New York, labor unions advocated for access to PPE and new infection control policies.”

On these pages we frequently differentiate business ethic from service ethic in health care. With a business ethic, profit rules. For example, chain nursing homes are expected to manage the operations in a manner that maximizes profits for their passive investors. With a service ethic, the expectation is that everyone involved in the nursing home strives to provide the best care possible with the available resources. Professionalism on all levels drives the care provided. This study confirms that the difference is very real. Unionized health care workers save more lives.

As another example, when you see demonstrations in support of Medicare for All, the participants are frequently members of California Nurses Association/National Nurses United. They are not there to advocate for more profits for Wall street investors. They are using their own time to advocate for affordable, comprehensive health care not only for their own patients, but for everyone.

Health care unions are about professional service for the patients. We need to have them everywhere throughout the health care system. In fact, we need unions everywhere to help correct the scourge of excessive inequality in income and wealth, which is a major contributor to health care injustice and other injustices throughout our society. We can do better, much better.

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About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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