Unionized nursing homes have lower COVID-19 mortality rates, study finds

Unionized nursing homes have a 10.8% lower resident COVID-19 mortality rate and a 6.8% lower worker COVID-19 infection rates than non-unionized nursing homes, according to research published this week.

Using data from the Centers for Medicare and Medicaid Services and the Service Employees International Union, the Health Affairs research analyzed 13,350 nursing homes between June 8, 2020 and March 21, 2021.

Labor unions representing nursing home workers have asked for numerous policies to decrease worker infection risk and lower resident mortality rates, including paid sick leave, access to personal protective equipment, surveillance COVID-19 testing, higher staffing levels, and the isolation of infected residents, said Adam Dean, lead author of the study and assistant professor in the department of political science at George Washington University.

“By protecting workers from getting sick, they ended up saving potentially thousands of lives of residents in nursing homes around the country,” Dean said.

Nursing homes have been in crisis since the pandemic began, with facility residents accounting for one in every six deaths due to COVID-19 in the U.S., a total of 150,000 deaths out of around one million, according to CMS.

More than 1 million clinical staff and other nursing home employees have tested positive for COVID-19 since April 2020, and more than 2,300 workers have died.

Healthcare worker unions were present in 16.8% of nursing homes, or 2,242 facilities, and played an important role in advocating for workplace safety for nursing home workers and their residents, the study found.

Unionized facilities had lower licensed practical nurse and certified nursing assistant staff-to-resident ratios, lower rates of Medicare-supported residents and lower COVID-19 infection rates in the surrounding community. The unionized nursing homes also had higher registered nurse staff-to-resident ratios, rates of Medicaid-supported residents and more were for-profit facilities.

The study accounted for a number of variables across nursing homes, including the Five-Star Quality Rating System score, chain and for-profit status, staffing shortages, the percentage of white patients, and differing state policies and age groups, Dean said.

In unionized nursing homes, the mean resident COVID-19 mortality rate was 0.25 per 1,000 resident-days during the study period, and the mean worker COVID-19 infection rate was 1.66 per 1,000 worker-days. For the 11,108 non-unionized nursing homes, the resident mortality rate was 0.35 per 1,000 resident-days and the worker infection rate was 2.21 per 1,000 worker-days.

Only 6.4% of nursing homes were unionized in the South, compared with 22.4% of nursing homes nationally. The region also had a higher density of restrictive right-to-work laws, which could weaken labor unions’ safety efforts.

Industrywide unionization and the associated lower mortality rates could have led to approximately 8,000 fewer resident deaths for the non-unionized nursing homes that had more than 75,000 COVID-19 deaths among residents during the study period, according to the study.

“These sort of positive spillover effects that unions can provide by protecting workers, are also spilling over to the rest of society,” Dean said.