John O’Connor

Ben Franklin famously assured us life has two guarantees. They are higher taxes and death. If Ben were alive today and owned a nursing home, he’d probably add a third: Unions will ruin everything.

Skilled care operators tend to see unions and their members as sycophants at best, predators at worst. Unions, it seems, are always demanding higher wages and better working conditions. Lofty goals, perhaps. But each can put a real strain on already tight budgets.

Unionized employees also can undermine the ability of managers to, well, manage. But perhaps most unforgivable of all, they often serve as a catalyst for more rules and regulations.

Conversely, unions generally distrust facilities for holding what might be called a cavalier attitude toward working conditions, patient care and service quality.

But could a twist in this fundamentally adversarial relationship be in the offing? As McKnight’s is reporting, new research suggests that unions might be just the medicine nursing homes need if/when staffing mandates take hold. 

A first-of-its-kind research letter published in JAMA Network Open concludes that among unionized facilities, there’s a significant drop in staff turnover. In 2021, about 17.3% of nursing homes had union representation, and the researchers found a 3.2% relative decrease in turnover in these communities. But the real kicker is this: In counties where more than 75% of nursing homes were union shops, the reduction in staff turnover was an impressive 17.1%.

Dr. Adam Dean, an associate professor at George Washington University, who led the research, stated the obvious: “Unions fight to make jobs better for workers, and that could mean higher wages and better benefits, safer working conditions … infection control policies, PPE and protection from COVID-19 during the pandemic. So in all the ways that unions fight to make jobs better, we would expect workers to stay in those jobs because they’re better jobs.”

Imagine that?

What’s interesting here is the timing of this research letter. It’s no secret staffing minimums are a hot and controversial policy matter right now. What Dean is suggesting is that if employers can see unions as partners, the result could be a win for workers, employers, and, most importantly, residents.

Those are certainly desirable outcomes. But nursing homes embracing unions? Any way you slice it, that is a very big ask.

Frankly, it’s a request many operators are unlikely to honor. Unless they have no other choice.

John O’Connor is editorial director for McKnight’s.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.