Category Archives: Ideas and Issues

Solving the Nursing Home Turnover Crisis

nurse turnover, nursing home crisis, healthcare, certified nursing assistant

March 3, 2021

New Orleans      Nursing homes have been a flashpoint during the pandemic as death rates for residents and staff have been tragic and appalling. The situation was seen as so critical that vaccines were prioritized for the homes, where now the struggle is getting sufficient staff to participate, even as families have pushed for loved ones to get protection so that they can return to visit and assist in care. Families and the elderly themselves are increasingly resistant to moving into nursing homes as the pandemic continues, yet the demand for reforms have not been as loud and strident as the situation would seem to demand.

A recent study by academics at UCLA and Harvard received some deserved attention by looking at the impact of turnover of nursing staff in the homes as perhaps an underlying part of the crisis. The topline of the story was that after examining the payroll data from the Center for Medicaid and Medicare Services (CMS) the average turnover was 128% in the more than 15,600 homes for which data was available. This current turnover more than doubles previous studies.

The report was graciously shared with Local 100 United Labor Unions by its lead author, Professor Ashvin Gandhi, and its conclusions, from a union perspective, are almost an “I told you so” moment from countless years of recurring bargaining sessions with employers at the homes that we represent. Inadequate wages and benefits were felt to be a major trigger for the turnover. Certified nursing assistants (CNAs) on the firing line experienced universally high turnover rates, and provide the bulk of nursing home staffing, despite usually poor wages and benefits.

The authors found three patterns emerging from the data on turnover:

  • There was a direct correlation between turnover and regions with lower per capita income indicating “inadequate pay.”
  • Turnover tended to be higher in for-profit homes and within nursing home chains where support for staff was a lower priority.
  • A higher Medicaid census of clients because of its lower reimbursement rates meant a reduced capacity to provide adequate pay and benefits.

Looking at the geography of turnover was disturbing as well. States like Texas and Oklahoma drug the bottom with turnover rates between 118 and 165% annually. Arkansas and Louisiana, where we represent nursing home workers, ranged between 98 and 118%. The lack of job alternatives may account for the relatively better turnover in Mississippi, Alabama, and Georgia in the 39 to 73% range. The best states were California, Alaska, Wisconsin, New York, New Jersey, and Connecticut. I might add that unionization rates are somewhat better in some of those states as are nonprofit concentrations.

The authors weren’t singing “Solidarity Forever,” but their recommendations for reform would fit nicely in union contracts and lobbying campaigns. They suggested that the feds and states earmark increased reimbursement to improved wages and benefits. They also felt including nursing workers in health insurance programs and not penalizing them for sick leave would make a huge difference. Amen!

In the stages of mourning for nursing home deaths, now should be time to demand change at every level.


President Biden Says, “Join the Union!”

biden union president workers rights america

March 2, 2021

New Orleans      John Lewis of the United Mineworkers Union and one of the founders of the Congress of Industrial Organizations, the CIO behind the hyphen in the AFL-CIO, famously had scores of organizers signing up tens of thousands after the election of Franklin Delano Roosevelt claiming that “The President says join the union!”.

It’s taken almost eighty years but this time it was Joe, not John, and President Biden came close in a video message — ironically on Twitter — to inferring the same thing, since neither really said those words. As importantly, he pointed out that this is not just his administration’s policy and program, but is a fundamental part of the National Labor Relations Act, and therefore the policy of the entire federal government. That’s not just his opinion, that’s a fact.

The occasion may have been triggered by the mail balloting beginning for Amazon workers at the almost 6000-strong Bessemer, Alabama plant, but his clarifying call for workers to join and support unions speaks directly to the entire working class.  He doesn’t mention Amazon, and that’s a good thing, because this applies to everyone whose shoulder is on the wheel, when he says,

Unions put power in the hands of workers. They level the playing field. They give you a stronger voice for your health, your safety, higher wages, protections from racial discrimination and sexual harassment. Unions lift up workers, both union and nonunion, but especially Black and Brown workers.

That was the heart of his message to workers, but he also has a message for employers as well, saying…

There should be no intimidation, no coercion, no threats, no anti-union propaganda. No supervisor should confront employees about their union preferences. Every worker should have a free and fair choice to join a union. The law guarantees that choice. And it’s your right, not that of an employer, it’s your right.

His message here is interesting, and just might speak to a new set of understandings for union organizing. No intimidation, coercion, or threats are all subjects for a charge before the NLRB. Anti-union propaganda is a fair game now, and should be outlawed or at least restrained, because such boss-messages do intimidate, coerce, and threaten. Pointing out that joining a union is a workers’ right and choice, and not that of the employer, is also an important twist. Too often current interpretations of US labor law, pretend that this is an even fight, when the employer controls the workplace, most communications, and the resources in a campaign that dwarf what the union can assemble in an election.

Biden’s emphasis on the union’s ability to protect against racial discrimination on the job and sexual harassment is also very significant, even though all unions may not be quite as ready to embrace this responsibility as he claims. He’s not hiding behind the long delays and toothlessness of the EEOC. He’s speaking to his base and the critical base his party wants to build and maintain. He’s also sending a message to construction and building trades that they better step up their game. He’s close to them, but he recognizes in this statement that many of them were way too transactional and cozy when playing footsie with former president Trump.

The media is talking about the fact that this is the most pro-union statement by a president since Harry Truman was in the office. One columnist quotes a Harvard professor claiming that presidents Carter and Clinton were anti-union. That’s not true at all, but to the degree they embraced neoliberalism, it too often ended up much the same and created a false sense of countervailing power that doesn’t exist in the workplace. Biden seems to be issuing a clarion call that curtseying before the altar of neoliberalism is also dead, and that’s also calling up the tune for a happy dance for all of us as well.