Absence of conflict of interest.
Citation
Dean, A., McCallum, J., Kimmel, S. D., & Venkataramani, A. S. (2022). Resident mortality and worker infection rates from COVID-19 lower in union than nonunion US nursing homes, 2020–21. Health Affairs, 41(5), 751-759.
Highlights
- The study’s objective was to examine the relationship between union status for nursing home workers and nursing home worker COVID-19 infection rates.
- Using Centers for Medicare & Medicaid Services data and the Census Bureau’s Quarterly Workforce Indicators data, the authors used a statistical model to compare the COVID-19 infection rates of unionized nursing home workers to nonunionized nursing home workers.
- The study suggested that unionized nursing home workers had lower COVID-19 infection rates than nonunion nursing home workers.
- This study receives a low evidence rating. This means we are not confident that the estimated effects are attributable to unions for nursing home workers; other factors are likely to have contributed.
Intervention Examined
Unions for nursing home workers
Features of the Intervention
During the COVID-19 pandemic, nursing homes experienced high rates of infection and death for both residents and health care workers within the facilities. Prior research has shown that labor unions may improve workplace health and safety conditions, but studies have not determined if this was true during the COVID-19 pandemic. Unionized nursing home workers may have better access to paid sick leave policies and more frequent testing for COVID-19. This study examines the relationship between union status for nursing home workers and nursing home worker COVID-19 infection rates. Nursing home workers include nurses, nursing assistants, dietitians, maintenance workers, and other staff.
Features of the Study
The authors conducted a nonexperimental study to examine the relationship between union status for nursing home workers and nursing home worker COVID-19 infection rates. The intervention group includes 2,302 unionized nursing homes and the comparison group includes 11,147 nonunionized nursing homes across the continental United States. The study uses data from the Centers for Medicare & Medicaid Services and the Census Bureau’s Quarterly Workforce Indicators covering the time period from June 8, 2020 to March 21, 2021. The authors used cross-sectional, multivariate negative binomial regression analysis to compare the COVID-19 infection rates for unionized and nonunionized nursing home workers.
Findings
Health and Safety
- The study suggested that unionized nursing home workers had lower COVID-19 infection rates than nonunion nursing home workers.
Considerations for Interpreting the Findings
The authors note that unionized nursing homes may have been more likely to test residents and workers for SARS-CoV-2. The authors did not account for COVID-19 testing frequency which could influence infection detection and reports of COVID-19 worker infection rates. Therefore, the study is not eligible for a moderate causal evidence rating, the highest rating available for nonexperimental designs.
Causal Evidence Rating
The quality of causal evidence presented in this report is low because the authors did not account for COVID-19 testing frequency which could influence COVID-19 worker infection rates. This means we are not confident that the estimated effects are attributable to unions for nursing home workers; other factors are likely to have contributed.