Research in the May issue of Health Affairs revealed that the presence of labor unions in nursing homes was associated with a 10.8% lower resident mortality rate and a 6.8% lower rate of infection among staff during the summer 2020 and winter 2020-2021 waves of the COVID-19 pandemic.

Figure. Disaster recovery workers exit the Life Care Center in Kirkland, Washington, in March 2020 after cleaning the facility. The nursing home was at the center of the outbreak of COVID-19 in Washington State. Photo by Ted S. Warren / Associated Press.

Although national data on nursing home resources during the pandemic are spotty, researchers have identified factors that may be associated with worse COVID-19 outcomes, including staff shortages; insufficient personal protective equipment; the absence of paid sick leave; and the fact that many staff are employed by more than one facility, increasing opportunities for COVID-19 spread. Various studies undertaken during the pandemic have shown that for essential workers in other industries, labor union advocacy was associated with stronger infection prevention policies and fewer COVID-19 infections. This latest study from Health Affairs indicates that nursing homes with union representation similarly experienced better COVID-19 outcomes for both residents and staff.

The researchers used proprietary data from the Service Employees International Union (SEIU), whose database included all union-organized nursing homes in the continental United States, not just those represented by the SEIU. In homes with unionized staff, various worker categories were represented, including certified nursing assistants, RNs, dietitians, and maintenance workers. Mortality data for nursing home residents came from the Centers for Medicare and Medicaid Services.

The researchers found that average COVID-19 resident death rates were lower in unionized nursing homes even though these homes tended to have higher average occupancy rates and resident acuity levels than nonunionized homes, as well as higher rates of Medicaid-supported residents. RN-to-resident ratios were higher in the unionized facilities. Lower resident COVID-19 mortality and lower worker infection rates in unionized homes held even after adjusting for staff COVID vaccination rates.

Commenting on the study, LPN Karen Hipple, whose Pennsylvania nursing home is unionized, told AJN, "When [we] join together, we're empowered to speak out when we see unsafe conditions or practices that put our residents at risk. During the COVID pandemic, we weren't afraid to demand what we needed . . . so we could provide the quality, dignified care our residents deserved." The study's lead author, Adam Dean, assistant professor of political science at George Washington University, said the results "highlight the important role that labor unions can play during the pandemic," adding that "by fighting to lower COVID-19 infection rates for nursing home workers, unions may also be decreasing COVID-19 mortality rates for nursing home residents."

To date, nursing home residents have accounted for more than 150,000 COVID-19 deaths in the United States. Dean and his research team estimated that industrywide unionization in nursing homes could have resulted in 8,000 fewer resident deaths during the first two waves of the pandemic.-Betsy Todd, MPH, RN