NY’s unionized nursing homes had fewer COVID-19 cases, deaths
A new study says that New York nursing homes affiliated with labor unions had fewer…
A new study says that New York nursing homes affiliated with labor unions had fewer COVID-19 deaths and infections than those without union representation.
The study, which was published online last week in the peer-reviewed Health Affairs journal, reveals that among 355 nursing homes in the state for which COVID-19 data were available, the presence of a health care worker union was associated with a 30 percent lower mortality rate and 42 percent lower infection rate than homes without a union.
The study was carried out by a political scientist and two medical doctors who say they were curious why so much of the conversation around essential worker safety during the pandemic omitted the role that labor unions may have played – or could still play – in keeping workers healthy and safe.
“In these discussions, everyone seemed to forget the essential thing that labor unions were originally formed to do, which is protect the health and safety of workers,” said Adam Dean, an assistant professor of political science at George Washington University who studies labor politics. “So we wanted to look at – where are the places where unions may have had an impact during this pandemic?”
They decided to study nursing homes due to the availability of infection and mortality data, which was not widely available for other essential industries, Dean said. They narrowed in on New York facilities because the state was an early epicenter of the pandemic, he said, and used data from March 1 through May 31 — when the pandemic was at its height.
Dean said a key limitation of the study was missing death data from the state Department of Health, which has so far only reported nursing home resident deaths that occurred inside the facilities and not at hospitals. Many believe the official state death toll of nearly 6,500 nursing home deaths is a significant undercount.
A gap like that could skew results, Dean said, so the authors performed a series of so-called “robustness” checks — which swap out baseline assumptions with plausible alternatives to see if a conclusion still stands. The findings remained “robust” when adjusted for a range of variations, he said.
“One crucial thing that leaves us much more confident about the results than we otherwise might be is that the Centers for Medicare and Medicaid Services (CMS) has also released data on infections in nursing homes… and there’s a far greater number of nursing homes in that analysis,” Dean said. “And so for whatever concerns or doubts people have about the state data… I would say that we find very similar results when also looking at infections according to CMS data.”
Union advocacy
One possible explanation for the lower death and infection rates could stem from unions’ successful advocacy for personal protective equipment and infection control policies during the pandemic, the study concludes.
CMS required homes to report PPE supplies on a weekly basis, and the study found that unionized homes were more likely to report having one-week supplies of PPE on hand over a two-week time period at the height of the pandemic than homes without a union.
Of 399 facilities that reported PPE data to CMS, 96 percent reported having gloves and surgical masks, 95 percent reported having hand sanitizer, 92 percent reported having eye shields, 84 percent reported having gowns, and 83 percent reported having N95 masks. A regression analysis found that the presence of a labor union was associated with a 13.8 percent increase in access to N95 masks and 7.3 percent increase in access to eye shields compared to non-unionized homes.
Results were not statistically significant for the other types of PPE, and the study acknowledges that a range of factors beyond PPE could explain the association between labor unions and better outcomes.
“Labor unions representing health care workers perform several functions that may reduce SARS-CoV-2 transmission,” the study states. “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 New York, a number of unions that represent health care workers have rallied and advocated for safer working conditions during the pandemic, and demanded adequate supplies of PPE.
The Public Employees Federation (PEF), which has members in state-run veterans’ nursing homes and facilities for the developmentally disabled, wrote state Health Commissioner Howard Zucker in April to demand safer working conditions. 1199SEIU United Healthcare Workers East, which represents health care workers at hospitals and nursing homes, held rallies and vigils to advocate for better PPE, paid sick leave and more transparency from employers regarding outbreaks. The New York State Nurses Association sued the state and two downstate hospitals for failing to provide adequate PPE and safe working conditions for their members — though the lawsuits were eventually dismissed.
If the presence of a labor union did have something to do with the lower mortality and infection rates (the study only demonstrates correlation, not causation), 1199SEIU spokesperson Mindy Berman believes it is likely a result of the open communication between workers and management that unions can foster.
“One thing we heard from our members in the beginning was, ‘We don’t know what’s going on, where the COVID patients are, where they aren’t, what our protocols are,’” she said. “Fear was a big thing in the beginning. When you’re part of a union, there’s regular communication with management that we think helped reduce that uncertainty and fear.”
1199SEIU Executive Vice President Milly Silva echoed that sentiment in a recent panel discussion hosted by New York City’s WBLS radio station.
“At the nursing homes where management actually welcomed the input of the caregivers, the professional staff, our certified nurses aides – and there was constant communication about what was going on and what were the ways that they could make sure that staff and residents were protected – we saw that there were less cases of COVID,” she said. “We saw that workers were less likely to get sick.”
Policy implications
According to the study’s authors, their analysis is the first to demonstrate an association between labor unions and reduced COVID-19 infections and deaths in an essential industry.
One reason for that is the lack of occupational data on COVID-19 deaths.
“It’s very difficult to study whether or not the rates at which people are getting sick or dying is associated with the union status of workers because we just don’t know where many of these people work,” Dean said.
As it became clear early on that nursing homes were being hit hard by the pandemic (at least 40 percent of U.S. deaths have been in nursing homes), states began requiring facilities to report cases and deaths linked to residents and sometimes workers. Though there has been little uniformity to that reporting, the requirement has created unique data that is simply not available for most other industries.
The study’s results have significant implications for stakeholders worried about future waves of the virus, Dean said.
“I think the takeaway is that labor unions may play an important role in not only protecting health care workers, but also protecting nursing home residents,” he said.
“Nursing homes are the epicenter of the pandemic not just in the state of New York, but around the United States,” he continued. “So I think there’s a debate that should be had about the role of unions in reducing the worst outcomes from the pandemic.”
Future surges of COVID-19 infections in regions with fewer unionized nursing homes are “particularly worrisome” in light of the study’s findings, the authors write. If unionization was behind the smaller mortality and infection rates, Dean said, then labor unions would be responsible for having averted roughly 1,000 COVID-19 deaths in New York nursing homes during the first three months of the pandemic.
“In this case, labor unions didn’t just protect their members by fighting for PPE, they also ended up protecting residents in nursing homes and that provided a broader benefit for everybody,” he said. “Families were less likely to lose loved ones in nursing homes. It really speaks to the broader societal benefits that labor unions can provide beyond just their members.”
