Is striking a new norm in healthcare industry?

Buffalo, N.Y. (WBEN) – Workers at five nursing home facilities in Western New York went on a seven-day unfair labor practice strike on Tuesday, as caregivers at these facilities are looking to secure a new contract to properly address staffing, fair wages and benefits.

Workers represented by 1199SEIU will continue to strike until next Tuesday, May 27, where caregivers will not report to work, but instead walk picket lines daily from 6 a.m. until 6 p.m. at each facility.

This strike marks the latest labor battle between healthcare workers and the company or network associated with the facility in question. With healthcare workers being pushed to the brink during contract negotiations, is going on strike now the new norm?

Local healthcare administration expert Larry Zielinski says to anticipate more-and-more labor actions going forward from unions, especially in New York State.

“Healthcare workers all over the country are under duress in all parts of the healthcare provider continuum. The tip of the spear is skilled nursing facilities, who are just really in an incredible Catch 22, in terms of the requirements that are being put on them by states. And then the reimbursement that is just really inadequate to cover their costs,” said Zielinski in an interview with WBEN. “New York is one of the most unionized healthcare states in the country, and where the workers are organized, you can certainly count on seeing more healthcare labor actions, especially in skilled nursing facilities.”

Local labor expert Art Wheaton from Cornell in Buffalo says these strikes are becoming more common and have proven effective in many cases, but it’s also risky.

“One of the biggest risks is you are not making very much money while you are on strike, so you’re not getting a regular paycheck. You will eventually get strike pay, which is a greatly reduced amount, and you could lose your job. They could permanently replace you if the strike is over economics, so if you’re striking over wages or benefits, then they can permanently replace you under Labor Law,” said Wheaton with WBEN. “The rewards, if you have enough power at the bargaining table, you can get significant increases in wages and benefits, and your working conditions. It’s always a balance between how much power you have at the table. Does the other side have to agree, or can they say, ‘We’ll look for something else?'”

With the way the population is aging, Zielinski believes the increased demand for acute care services and skilled nursing services is helping drive these strikes as a means to get deals done.

“People are living longer-and-longer, they’re not necessarily living better, but they’re living longer. And they’re living with very complicated multiple chronic diseases,” Zielinski said. “I mean, a typical elderly person now has multiple chronic diseases: Hypertension, congestive heart failure, asthma, diabetes, cancer diagnosis, mental health diagnosis, very, very complicated people that need help. And you’ve got a healthcare workforce that is still recovering, really, from the pandemic. I think hopefully we’re turning the corner on that, but very stressed.”

With the way healthcare reimbursement is constantly under duress, especially as the nation fights with the constantly increasing costs of care, it’s a situation that is rife for distress.

“If you think about skilled nursing, where this is their core service, their core service is taking care of these very complicated nursing home eligible, by definition, patients. And the other thing about skilled nursing facilities is it is predominantly funded by Medicaid, so there’s very limited Medicare reimbursement in a nursing home,” Zielinski noted. “It is predominantly private pay, and then when private pay assets are diminished, people go on Medicaid, and 60-plus percent of nursing home reimbursement is Medicaid. And Medicaid is the poorest payer in the healthcare payer world. States are constantly under duress in terms of their Medicaid budgets.”

Zielinski adds the reimbursement woes in healthcare is an untenable situation, especially with skilled nursing facilities being the most dysfunctional.

Wheaton says there are quite a few reasons why more-and-more strikes seem to take place as a way to get contracts agreed to between healthcare workers and their companies.

“It’s what is the economics for the area? Are we having a boom where there’s lots of available jobs and low unemployment and lots of growth? Then striking is easier, because even if you got fired or lost your wages, you could find something else. The other one is who’s in office? It can make a difference for the President of the United States, because they have some control over the National Labor Relations Board, which could be the determining factor on whether it’s an unfair labor practice or not, which comes into play, especially in the private sector and public sentiment,” Wheaton explained. “If the public is on your side, the public can put more pressure on the employer to say, ‘Hey, make a deal. We really need those workers. They’re important and we value them, so pay them.'”

In the local case between the 1199SEIU workers and the area nursing homes, Zielinski says the State of New York has mandated staffing ratios that nursing homes have to comply with, but they’re compensating nursing homes with totally inadequate rates, predominantly Medicaid, which is state driven.

“It’s a state/federal partnership, but the reimbursement rates are set by the state, and the reimbursement is totally inadequate. So they’re putting two counter demands on nursing homes: No. 1, you must staff at a certain level; No. 2, we’re not going to pay you to staff at a certain level, we’re going to underpay you dramatically. So what nursing homes are doing is they’re doing their best to try to juggle this conundrum,” Zielinski said.

So who has the upper hand in these particular negotiations?

“I would say the workforce, the unions have the upper hand initially, until they drive the industry or the particular provider that they’re dealing with into an untenable financial situation,” Zielinski answered. “We’ve seen that happen, most recently, at Weinberg campus. Did the union have the upper hand there? I guess they did, but then the facility went out of business and all those union workers are laid off.

“Labor has a very strong position. They need workers, they have these state mandates, and the workers are under incredible stress. But on the provider side, there’s just no money there because of the reimbursement rates. And now you’re complexifying all of that with a sicker-and-sicker elderly population that is going to get more elderly as the ‘Baby Boomers’ age and go into the Medicare system.”

Wheaton agrees with Zielinski, knowing it’s a difficult situation for both sides of the negotiating table.

“A lot of the nursing homes are not in great financial shape, and we have seen some go bankrupt here in Western New York because they’re not getting enough money for the employers to pay for what’s going on. You also have a shortage of workers. There really are not an overwhelming number of people willing to do the work, or do the work for that amount of pay,” Wheaton said. “There’s leverage on the workers’ side, because there really are not enough nursing home nurses or caretakers for the number of people that need it. So it’s a balance of power, and it’s a matter of the best solution is one that you can negotiate. Neither side will be happy. The management won’t be happy, the union won’t be happy. You’ve got to try to get something that both sides can live with.”

And it’s not just with the healthcare industry we’re seeing more strikes. Wheaton says all across the board, strikes are taking place in almost every sector, nationally and locally.

“You’ve seen strikes for the transit workers for the airport, that was the Teamsters who went out on strike. You’ve had several healthcare strikes in Western New York. You’ve had strikes for UAW, both GM and Ford had strikes going around that impacted Western New York. It’s in a lot of different sectors. You had the Screen Actors Guild, the Writers Guild. You’re seeing strikes in almost every sector you can imagine,” he said.