Personal care attendants with the SEIU District 1199 NE health care workers union rally in front of the governor’s residence in Hartford, Connecticut, on August 3, 2021.
For the past sixteen years, Nicole Bongiovanni has been a lifeline for homebound people struggling with the ravages of aging, devastating disabilities, and chronic health conditions. But the pandemic proved to be her greatest challenge.
Bongiovanni says she spent seventy-three hours a week caring for three clients in southeast Connecticut. The clients were dependent on her for everything from eating, bathing, and using the bathroom to maintaining their precarious health and following safety protocols correctly. She did all this amidst the risk of COVID-19, which loomed large over her clients and herself.
“They lack hope and need a lot of emotional support,” Bongiovanni says in a phone interview. “One is a child who has severe disabilities; another is a paralyzed adult.”
The strain took its toll: Bongiovanni suffered a heart attack, which she says left her with $25,000 in debt to the hospital.
“Support staff—especially women, immigrants, and people of color—often bear the brunt of these cost-cutting measures, so our union took many steps to protect these workers during the pandemic.”
“I had no choice but to return to work five days after I was released,” she explains. “I have no sick days, employer-provided health insurance, or retirement savings. I earn $16.25 an hour, which is barely enough to keep food on the table. An individual health insurance policy would have consumed half my take-home pay.”
But Bongiovanni’s finances may improve, thanks to her membership in the New England Health Care Workers Union, Service Employees International Union (SEIU) District 1199, which is championing an economic bill of rights for health care workers on the front lines of the pandemic.
In May, the union scored a significant victory when it negotiated a contract for 2,800 workers at twenty-six Connecticut nursing homes. In addition to a minimum hourly wage of $20 for a certified personal nurse assistant and $30 per hour for a licensed practical nurse, the contract also includes medical insurance, retirement benefits, paid sick days, and funds for advanced training.
The union is now pushing a similar package for the 10,000 independent personal care attendants like Bongiovanni who care for 6,000 individuals across the state. On August 3, a group of these personal care attendants rallied at the Hartford residence of Connecticut Governor Ned Lamont, a Democrat; more than a dozen were issued tickets for trespassing. They called on the state of Connecticut to use the $200 million it received in federal COVID-19 relief funds to finance wage increases and benefit packages for home health care aides.
The pandemic has been a game changer for health care unions, says Rob Baril, president of SEIU District 1199 NE. It highlighted the dedication and skill of workers who put their lives on the line every day in hospitals, nursing homes, and home health care, he explains in a phone interview.
“The pandemic also revealed the fifty-five-year imbalance in the relationship between employers and workers—especially women and people of color—who are deprived of a living wage and resources to care for their families.” Meanwhile, “the managers of hospitals, nursing homes, and home health agencies receive lucrative salaries and benefits.”
Lifting the lowest paid health care workers out of poverty isn’t easy, says Cynthia Johnson, a home health aide in New Haven, Connecticut. “Without the union, we would be invisible and our concerns about the lack of personal protection equipment and no backup for our clients when we are ill would go unnoticed.”
Since the pandemic began, unions have devoted more attention to getting a better deal for health care workers, especially in contract negotiations for workers paid with funds from Medicare and Medicaid.
“It is imperative that government-provided funds are used to care for vulnerable patients and pay living wages for workers instead of enhancing the profits of corporations that administer these services,” Baril says.
Robert Bruno, director of the labor education program at the University of Illinois at Urbana–Champaign, predicts that campaigns based on the lessons of the pandemic will increase the membership and influence of health care unions.
Shana Sureck
From left, Karen Dowou and Certified Nursing Assistant Luz Taylor.
“The deaths of more than 3,600 American health workers during COVID-19’s first year strengthened the spines of workers who might have been on the fence about membership,” Bruno says in a phone interview. “The staggering infection rate of the Delta variant has created a new urgency in the health care system to institute changes to prevent deaths of patients and workers.”
The health care workforce includes twenty-two million workers—14 percent of the U.S. total workforce—according to the U.S. Census Bureau’s 2019 American Community Survey.
“Although the health care industry is one of the fastest growing segments of the economy, it doesn’t generate well-paying jobs with benefits,” explains Bruno. “Wages of $15 to $30 an hour are insufficient to support many health care workers in the areas where they live and work. The jobs also don’t provide long-term economic security, as health care workers discovered who were furloughed during the pandemic.”
Health care unions like the 170,000-member National Nurses United (NNU) lost no time capitalizing on these concerns. It criticized hospitals for their lack of preparedness and called for protections for patients and staff. The union organized seven new bargaining units in 2020, up from four the year before.
It won in right-to-work states including North Dakota and North Carolina, and in major hospitals in states including Maine, where previous organizing campaigns had failed.
In March 2019, CHI St. Alexius Health Medical Center in Bismarck, North Dakota, became the first hospital in the state to acquire a nurses’ union when its registered nurses voted to become an affiliate of NNU’s Minnesota Nurses Association. The victory was a landmark because North Dakota has so few union members: only 25,000, or 6.2 percent of the 338,000-employee workforce, according to recent data from the Bureau of Labor Statistics.
North Dakota regularly loses nurses to other states where wages are higher. Its average annual salary of $65,740 ranked thirty-third in the country, as a 2019 analysis by Forbes showed. To improve retention, NNU’s contract with CHI St. Alexius includes steps for raises based on experience.
NNU, which pioneered the concept of safe staffing standards in California in the 1990s, also emphasized workplace safety during negotiations. In addition to setting minimum staff levels for the emergency department, management at CHI St. Alexius agreed to give nurses the right to temporarily pause new patient admissions in their units if they needed time to catch up.
Emphasizing workplace safety has also proved to be a winning strategy for the NNU at the Maine Medical Center in Portland, the state’s largest employer, where nurses rejected unionization in 2000. In April, the hospital’s registered nurses voted 1,001 to 750 by mail to join the Maine State Nurses Association, an NNU affiliate.
Because of COVID-19 safety restrictions, in-person rallies could not take place, so NNU relied on social media to explain how union membership would help the nurses overcome overscheduling, inadequate meal and rest breaks, the shortage of personal protective equipment, and other concerns.
Maine Health, which operates Maine Medical Center, hired anti-union consultants to defeat the organizing campaign. This is a common practice, according to the Economic Policy Institute’s 2020 report “Fear at Work.” The Washington, D.C.-based think tank found that corporations, hospital systems, and other employers collectively spend $340 million a year on consultants who teach them how to exploit weaknesses of federal labor law to effectively scare workers out of exercising their legal rights to collectively bargain.
Maine Governor Janet Mills, a Democrat, rebuked the hospital for providing vaccinations to these union-busting consultants in contravention of Maine law. “Vaccinating out-of-state-consultants who came here to disrupt a union organization effort was an insult to the hardworking nurses trying to assert their rights and to those patiently waiting priority for their turns,” Mills said in a statement.
The events of the last two years have driven home the harmful consequences of the take-overs of community hospitals, faith-based nursing homes, and other providers by huge systems that put profits first, says Sal Rosselli, president of the 15,000-member National Union of Healthcare Workers (NUHW) at hospitals, nursing homes, and clinics in California.
Shana Sureck
Personal care attendants with the SEIU District 1199 NE health care workers union at the August 3 rally in front of the governor’s residence.
Since the 1990s, Rosselli explains in an interview, these systems have adopted just-in-time strategies that resulted in shortages of masks and ventilators, and just-in-time staffing that put patients and workers at risk during the pandemic.
“Support staff—especially women, immigrants, and people of color—often bear the brunt of these cost-cutting measures, so our union took many steps to protect these workers during the pandemic,” he says.
Despite being only 27 percent of the population in Sonoma County, Latinx residents accounted for 65 percent of COVID-19 infections. NUHW became concerned about the health of its members—many of them Latinx, immigrant women—who cleaned patients’ rooms and COVID-19 units in the six area hospitals owned by Providence Health System.
To ensure workers’ health, the union surveyed these members to ensure that Providence, a system of fifty-two hospitals in seven states based in Renton, Washington, was providing proper equipment and sufficient training.
Early in 2021, NUHW members at the Sequoias Portola Valley retirement community near San Francisco learned that management had decided to subcontract the jobs of dietary workers and housekeepers to Morrison Living, a Georgia-based company that provides services for retirement homes in forty-two states. The union negotiated a new three-year contract that addressed workers’ concerns about job security and retention of health benefits; it also provided for 10 percent raises over the life of the contract and an employer-funded flexible spending account for out-of-pocket medical expenses.
NUHW also took steps to give teeth to California’s landmark mental health bill, which requires insurance companies to provide full coverage for treatment of all mental health and substance use disorders. Signed by Governor Gavin Newsom, a Democrat, in September 2020, the law created parity with coverage of physical conditions.
But a serious loophole soon became apparent: Although HMOs and insurers were required to offer patients initial appointments within ten days, they were permitted to allow patients to wait for weeks or months for follow-up appointments. In July, NUHW members appeared before the State Assembly Health Committee in support of a measure that would require follow-up appointments within ten business days unless the treating clinicians certified that waiting longer would not harm patients.
Efforts like these will have positive, long-term consequences for the union movement, especially health care unions, predicts Aaron Sojourner, an associate professor and labor economist at the University of Minnesota. In 2018, the Pew Research Center found that a majority of Americans, 55 percent, held a favorable view of unions versus 33 percent who held anti-union views. The same year, researchers at the Massachusetts Institute of Technology reported that about 48 percent of nonunion workers—58 million workers and half the nonunion workforce—would join unions if they could.
Sojourner believes these numbers will likely grow, as the pandemic has increased the desire of workers for a greater role in decisions that affect their working lives. They also began to question the broader structure of the workplace and its impact on those they served.
“Standards and practices in hospitals, nursing homes, and other parts of the health system will receive more scrutiny,” says Sojourner, whose research has found that, from 1985 to 2009, unionized workplaces in various industries were 30 percent more likely than nonunionized workplaces to face a health and safety inspection by a state or federal agency.
Sojourner is also optimistic that more union members may “run for public office and take their places in state legislatures and Congress, which have been dominated by members who received their leadership training in corporations and trade associations.”
And that’s just the beginning, Sojourner says: “Increased participation of union members in public policy positions could bring about significant changes in health care financing. The public may be more inclined to support these changes because of their experiences during the pandemic.”