Unionized Nursing Homes Saw Lower COVID-19 Mortality Rates, Better PPE Access: Study

Nursing homes in New York with unionized workforces had lower mortality rates from COVID-19, as well as greater access to personal protective equipment (PPE) and lower COVID-19 infection rates, according to a new study released September 10 in the journal Health Affairs.

Specifically, health care unions in nursing homes were associated with a 1.29 percentage point mortality reduction, or a 30% relative decrease in COVID-19 mortality compared with nursing homes without organized workforces, the study found.

“Unions were also associated with greater access to PPE, one mechanism that may link unions to lower COVID-19 mortality rates,” authors Adam Dean of George Washington University, Atheendar Venkataramani of the University of Pennsylvania, and Simeon Kimmel of Boston University noted in the study abstract.


The authors examined all New York State nursing homes for which the state Department of Health (NYSDOH) reported data on confirmed COVID-19 deaths, excluding facilities where there were no data reported or data on key variables were missing. Facilities that reported zero deaths were included.

Ultimately, 355 nursing homes — out of 621 identified in the state and 385 included in the NYSDOH’s COVID-19 mortality report — were included in the study.

Out of those 355 nursing homes in the sample, 246 had workforces represented by a health care union.


Access to PPE is a crucial part of protecting the frontline nursing home workers and the residents for whom they care, and the study found that unionized buildings had better access to some of the most needed items during the COVID-19 pandemic.

“Specifically, unions were associated with a 13.8% relative increase in access to N95 masks and a 7.3% relative increase in access to eye shields,” the authors wrote.

A union presence was also associated with a 42% relative decrease in COVID-19 infection rates among residents, though the authors acknowledged that more research is needed to understand why that was the case.

In any event, the association of health care workers with lower mortality rates during the first COVID-19 surge in the U.S. is noteworthy, the authors concluded.

“Future surges of COVID-19 infections in regions with fewer unionized nursing homes are therefore particularly worrisome,” they wrote.

Companies featured in this article: