Unionized Nursing Homes Literally Saved Lives at the Pandemic’s Height

A new study finds that the COVID-19 mortality rate in unionized nursing homes was more than 10 percent lower than in their nonunion counterparts. Unionizing the whole industry, the numbers suggest, would have saved the lives of 8,000 nursing home residents.

Nursing homes that are unionized have lower COVID-19 mortality rates than those that are nonunioinized. (Ridofranz / Getty Images)

When it comes to the health care sector, unions literally save lives.

Since the COVID-19 pandemic began in the United States, nursing homes have been ground zero for the illness, accounting for one in six COVID-related deaths. Now, a new study shows that unionized nursing homes across the country had a 10.8 percent lower COVID-19 mortality rate among residents than their nonunion counterparts, as well as a 6.8 percent lower COVID-19 infection rate among workers.

“With more than 75,000 COVID-19 deaths among residents in nonunionized nursing homes during our study period, our results suggest that industrywide unionization would have been associated with approximately 8,000 fewer resident deaths,” write the study’s authors. Such is the cost of the hyper-exploitation of nursing home workers, and union busting by some of their employers.

The study, authored by Adam Dean, Jamie McCallum, Simeon D. Kimmel, and Atheendar S. Venkataramani, and published in Health Affairs, uses data provided by the Service Employees International Union (SEIU) for all forty-eight continental US states from June 8, 2020 through March 21, 2021. In calculating COVID-19 mortality rates among nursing home residents, the authors studied 13,350 homes, of which 2,242 were unionized (unsurprisingly, the Northeast had the highest percentage of unionized nursing homes, while the South had the lowest).

There were 90,870 COVID-19 deaths among the residents of these homes during the period of study, and the union difference was significant. Per the study: “The mean resident COVID-19 mortality rate was 0.25 per 1,000 resident-days; in the 11,108 nonunionized nursing homes, it was 0.35 per 1,000 resident-days.”

As for nursing home worker COVID-19 infection rates, “the mean worker COVID-19 infection rate was 1.66 per 1,000 worker-days; in the 11,147 nonunionized nursing homes, it was 2.21 per 1,000 worker-days” (here, the authors used a slightly different cohort of nursing homes, based on which homes reported worker infection data). Notably, the authors found the union difference was smallest in the South, hypothesizing that this is a product of right-to-work laws that weaken those few unions that do exist in Southern nursing homes.

Why is there such a difference in COVID-19 outcomes between union and nonunion nursing homes?

“It’s pretty simple — the safer we are, the safer they are,” Rosalind “Ros” Reggans, a certified nursing assistant from Chicago, told the study’s authors. “And with a union you have more [personal protective equipment], you can get a day off if you’re sick, you get more COVID pay . . . you can negotiate with your supervisor face to face to make things work. All of that helps residents, too, because we’re not infecting them as much if we have better standards for ourselves.”

Unions help workers speak up about workplace hazards and suggest improvements with less fear of retaliation. A union offers a collective voice, and an infrastructure for raising concerns. In nursing homes during a pandemic, where stakes could hardly be higher, it meant workers could also push for policies that better protected themselves, which in turns better protects residents. A union nursing home that ensures workers have adequate personal protective equipment (PPE) and the necessary paid sick leave and staffing levels to allow unwell workers to isolate will slow the spread of the illness inside the facility, among both workers and residents alike.

Prior studies of health care institutions have found a similar positive relationship between unions and health outcomes. In 2020, the study’s authors found that unionized nursing homes in New York had a 30 percent lower resident mortality rate during the spring of 2020. Their 2022 study extends those findings. It is also consistent with a 2016 study which found that hospitals with a successful union election outperform those with a failed one in “twelve out of thirteen potentially sensitive nurse-patient outcomes,” with the largest changes occurring in the year of unionization.

Similarly, writer Jay Caspian Kang’s look at the Bay Area’s pandemic response in January of 2021 showed how low pay in nursing homes — particularly for certified nursing assistants, who in California make an average of $30,000 per year — sped the virus’s spread. Workers unable to get by on the pay offered at one home take on second and third jobs at other homes. Unwittingly, workers who were contagious became vectors for COVID-19. Understaffing, too, was a key part of the story: in a home that doesn’t employ enough people, asymptomatic but COVID-positive nurses will be pressured to keep working. Plus, a home without adequate staffing won’t offer the care required during a pandemic, leading to worse outcomes once residents catch the illness.

As Kang writes of a 2020 study on COVID-19 transmission and nursing homes, “A nursing home that didn’t rely on shared staff could cut infections by forty-four per cent.” While unions don’t always succeed in ensuring safe staffing levels and a livable wage for workers, workers stand little chance of addressing those issues, particularly in for-profit nursing homes, without them.

“As COVID-19 infections continue to affect nursing homes, facilities without unions may be especially vulnerable to poor outcomes for patients and workers,” write the authors of the new study. The pandemic continues, and nursing homes are still centers of not only COVID-19 outbreaks, but deaths, filled as they are with society’s most vulnerable people. Unionizing these facilities is a necessity, and now there is no question that any employer fighting such efforts is prioritizing profits and control over the lives of not only workers, but residents as well.