Union Impact on Minimum Staffing Rule

Oct 6, 2023 | Minimum Staffing

News Digest: Unions play a role in the minimum staffing push


Union ‘demand’ brought about minimum staffing rule: Becerra

Health and Human Services Secretary Xavier Becerra this week took part in a national union event supporting the proposed nursing home staffing rule, giving the labor audience and their leaders credit for advancing the controversial measure.

“We are here because so many of you made the demand, quite honestly, the push to make sure that we establish real standards … that in the law … we have something that says we are going to provide quality, quality care for residents but also a quality environment for the folks who do the work,” Becerra said in a Facebook live event sponsored by the Service Employees International Union, or SEIU.

The union claims to be the largest serving healthcare workers in North America, representing more than 1.1 million members. It is heavily involved in the Kaiser Permanente strike, in which 75,000 workers are off the job for three days to protest staffing levels and wage negotiations in other healthcare settings.

But leaders took time out Wednesday to continue their assault on the nursing home sector, with Becerra a surprise guest during the hour-long event. Becerra praised President Biden’s advocacy for union workers, especially those in nursing homes, noting his administration is the first to attempt more stringent staffing regulations.


Marselas, Kimberly. “Union ‘Demand’ Brought About Minimum Staffing Rule: Becerra.” McKnight’s Long-Term Care News, 6 Oct. 2023, www.mcknights.com/news/union-demand-brought-about-minimum-staffing-rule-becerra.


Biden as ‘Union President’: Organized Labor’s Interests Are Baked Into Proposed Minimum Staffing Rule For Nursing Homes

A component of the minimum staffing proposal that has received little notice thus far is that labor unions may have some weight in determining the staffing levels needed for a particular building.

This feature was the source of discussion among attendees at the annual conference for the American Health Care Association and National Center for Assisted Living (AHCA/NCAL). As operators develop facility assessments to address the specific needs of each resident unit to align with the minimum staffing requirements, it might benefit them to note that the Biden Administration’s staffing proposal encourages unions to provide input.

The addition has flown somewhat under the radar, with nursing home operators focusing more on the 24/7 registered nurse rule, lackluster funding support and the absence of licensed practical nurses (LPNs) from the minimum staffing proposal released on Sept. 1.


Stulick, Amy. “Biden as ‘Union President’: Organized Labor’s Interests Are Baked Into Proposed Minimum Staffing Rule for Nursing Homes.” Skilled Nursing News, 4 Oct. 2023, skillednursingnews.com/2023/10/biden-as-union-president-organized-labors-interests-are-baked-into-proposed-minimum-staffing-rule.


New union voice joins fight for nursing home staffing minimums

Leaders of two major unions brought out the top brass and dug deep into their ranks so that nursing home staff, family members and a current resident could share the ways understaffing has affected them during a live, virtual event Thursday.

The SEIU and the AFL-CIO billed the Facebook event as a rally in support of a federal nursing home staffing mandate, but speakers were also more than willing to lob broad accusations of corporate profit-taking in the healthcare system.

In particular, union speakers and Rep. Jan Schakowsky (D-IL) attacked the American Health Care Association for protesting the Biden administration’s planned staffing minimum, whose release is expected any day.


Marselas, Kimberly. “New Union Voice Joins Fight for Nursing Home Staffing Minimums.” McKnight’s Long-Term Care News, 13 July 2023, www.mcknights.com/news/new-union-voice-joins-fight-for-nursing-home-staffing-minimums.


Unions Fired Up Ahead of Minimum Staffing Proposal, as Trade Groups Urge Biden to ‘Reconsider’

The federal minimum staffing proposal appears to be at the center of a union call to action as labor strikes continue in different cities. This, while the nursing home industry anxiously awaits what could be a major upset to facility access amid an ongoing workforce shortage.

The American Federation of Labor & Congress of Industrial Organizations (AFL-CIO), in favor of the mandate, most recently called on nursing home workers to share their stories and testimonials to the Department of Health and Human Services (HHS).

Corporations, the organization said, are “doing everything they can” to lobby HHS against releasing the minimum staffing standard. The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), for one, on Tuesday sent a letter directly to President Joe Biden to reconsider the unfunded mandate.


Stulick, Amy. “Unions Fired up Ahead of Minimum Staffing Proposal, as Trade Groups Urge Biden to ‘Reconsider.’” Skilled Nursing News, 13 July 2023, skillednursingnews.com/2023/07/unions-fired-up-ahead-of-minimum-staffing-proposal-as-trade-groups-urge-biden-to-reconsider.


Drowning in worry? Unions offer new staffing rule entanglement

It feels like day 500-something that we’re all still waiting for details of a new federal staffing mandate.

If you didn’t already have major anxiety over that looming threat, Axios this week offered a new cause for stress in this alarming headline: “Staffing standard could boost unionization efforts in nursing homes.”

State-level staffing ratios have been embraced by unions, with many reporting victories at the bargaining table since local laws were passed. With every worker lost now threatening a nursing home’s ability to comply with required levels, it makes sense to think that union-backed staff would feel empowered to demand higher pay and better benefits.

But could the rule truly lead to more efforts to unionize? That remains to be seen


Marselas, Kimberly. “Drowning in Worry? Unions Offer New Staffing Rule Entanglement.” McKnight’s Long-Term Care News, 5 July 2023, www.mcknights.com/daily-editors-notes/drowning-in-worry-unions-offer-new-staffing-rule-entanglement.


Why CMS Staffing Mandate Could Jumpstart Union Efforts in Nursing Homes

Nursing home and labor leaders believe more labor organizing will happen in conjunction with the forthcoming federal staffing minimum mandate, as the sector has historically seen a low proportion of workers covered by union contracts.

Having a federal standard in place could begin collective bargaining efforts, or maybe remove this sticking point in labor negotiations, according to an article published in Axios. However, a mandate with waivers could dilute such a rebound in staffing, reform advocates warn.

Only 16% of nursing home workers were represented by labor unions in 2021, according to Adam Dean, a labor politics expert at George Washington University who was cited by Axios. Dean led a study, which was published in Health Affairs, which found facilities with unionized workers saw 10.8% lower Covid death rates among residents and 6.8% lower Covid infection rates for workers.


Stulick, Amy. “Why CMS Staffing Mandate Could Jumpstart Union Efforts in Nursing Homes.” Skilled Nursing News, 5 July 2023, skillednursingnews.com/2023/07/why-cms-staffing-mandate-could-jumpstart-union-efforts-in-nursing-homes.

More News in this PBJ Topic

LPN Exclusion Triggers Confusion & Questions

News Digest: Mandated Nursing Minimums Ignores Key Nursing Role CNA's, LPN's and RN's form the backbone of skilled nursing facilities.  All three roles are used in calculating and determining a facility's Five Star staffing rating.  Yet the...

read more

Understanding Staffing Compliance Issues & Exemptions

News Digest: Proposed Rule Includes More than Minimum Staffing Lost in the uproar over minimum staffing requirements for RN's and CNA's are a number of additional provisions in CMS' Proposed Minimum Staffing Rule.  A delayed rollout and provisions...

read more

Comments on Staffing Rule Pour in to CMS

News Digest: Overwhelming Response to CMS' Proposed Rule on Minimum Staffing The 60 day comment period for the Proposed Minimum Staffing Rule ended November 6, 2023.  AHCA and Leading Age associations led efforts to generate industry response. ...

read more

Plans to Defeat CMS’ Proposed Minimums Rule

News Digest: Various Strategies Floated to Avoid Proposed Minimum Staffing Rule With widespread opposition to CMS' Proposed Rule, a variety of tactics are under consideration to overcome the potential regulations.  Both a Congressional over ride...

read more

Congress Weighs in on Proposed Staffing Rule

News Digest: Legislative branch questions proposed executive rule Federal legislators in Congress vocally responded to CMS' proposed rule.  While CMS considers public comments and works on the Final Rule in 2024, the congressional push back can...

read more

Ideas Emerge to Overcome Workforce Shortages

News Digest: Minimum Staffing Rules Incent Plan to Hire More Nurses As some view a minimum staffing requirement as almost an inevitability, strategies begin to emerge to accomplish tactics such as increasing the available pool of nursing, lowering...

read more

Supporters of Staffing Mandate Speak Out

News Digest: Consumer Advocates, Unions and Some Congressman Support the Staffing Mandate With the loud and consistent negative reaction to CMS' proposed minimum staffing standards, one could fail to recognize that supporters of the new rule...

read more

Scrutiny on Private Equity & REIT Staffing Performance

News Digest: How does private equity investment affect nursing home staffing and minimum staffing requirementsOnly 6% of real estate investment trust (REIT) assets are in compliance with the federal minimum staffing proposal for nursing homes,...

read more

Analyses predict high cost of staffing mandate

News Digest: Billions needed to comply with minimim staffing mandate Competing estimates of the cost to get all skilled nursing facilities to a minimum staffing level all come in with multi-billion dollar price tags. From CMS' estimate of over $4B...

read more

Strong Early Pushback to Proposed Staffing Rule

News Digest: Staffing Shortages and Perceived Benefits Questioned Advocates and the industry absorbed and reacted to CMS' Proposed Rule for Minimum Staffing standards, and quickly shifted into promoting their views.  Many questioned the ability to...

read more