Mass General Brigham union could shape hospital-at-home’s future

June 18, 2024 9:33 am

Nurses at one of the nation’s largest hospital-at-home programs have unionized, a move they hope could influence the future of in-home acute care and encourage more people working in home healthcare to join unions.

The union vote at Boston’s Mass General Brigham comes as hospitals push aggressively to expand care outside of their walls, while a worker shortage and increased demand for healthcare contribute to rising labor strife among caregivers.

Approximately 80 Mass General Brigham home hospital nurses voted overwhelmingly on May 16 to join the Massachusetts Nurse Association. The National Labor Relations Board certified the union to represent the nurses on May 24 and they are in the midst of selecting a bargaining team that will begin negotiating a contract with the hospital system within the next few months.

Plans to organize began about six months ago, according to Nahall Rad, a registered nurse who has been with Mass General Brigham’s home hospital program for six years. He said the nurses wanted a seat at the table with health system management as the acute care at home program evolves. The hospital system is set to expand the number of patients the program can accommodate from 50 patients a day to 200 over the next few years.

“From a nursing perspective, we want to ensure that our patients are getting the highest level of care possible,” Rad said. “I think a lot of the nursing staff has felt there have been times when that hasn’t happened or their voices weren’t quite heard. There seems to be a disconnect between the people making the large decisions and the rest of us that are on the front lines.”

A spokesperson for Mass General Brigham said in an email the hospital is disappointed the nurses elected to organize, but did not think unionization would impact expansion of the home hospital program.

“As an organization dedicated to providing safe, high-quality care to our community, we recognize the importance of working collaboratively with our nurses, physicians and other healthcare providers to address the needs of our patients and community. We remain focused on that critical mission,” the spokesperson said.

Mass General Brigham’s home hospital nurses decided to organize about a year after the provider’s residents and physician fellows voted to join a union and at a time when interest in union membership is rising among healthcare workers. That interest is driven by increased workloads, worker burnout and changes in the way providers are delivering patient care, such as acute care at home, according to labor experts.

“Much of these organizing efforts are based on similar themes that healthcare professionals increasingly have no voice in the implementation of new care delivery models or other decisions that are made by larger and more consolidated health system executives that are far away from the actual delivery of care,” said John August, director of healthcare labor relations for the Scheinman Institute of Conflict Resolution at Cornell University’s School of Industrial Labor Relations.

Hospital-at-home programs could be fertile ground for unions. The concept is relatively new in the U.S. It took off during the COVID-19 pandemic when the Centers for Medicare and Medicaid Services launched the Acute Hospital Care at Home waiver that let hospitals treat some patients where they live, rather than in facilities. Patients participating in the program get twice daily nurse or paramedic visits and are also monitored through telehealth and other technologies.

The waiver expires at the end of this year, but the 330 hospitals across 37 states that offer home hospital programs are aggressively lobbying Congress to make the waiver permanent or extend it. There is bipartisan support in both chambers to extend the waiver at least another five years.

But National Nurses United, a labor union representing 225,000 nurses nationwide, wants the waiver to end and hospital-at-home discontinued. A report on the union’s website said the program, which it dubs “Home All Alone,” puts patients at risk by not providing 24/7 access to a registered nurse or other clinical and technical resources that in-facility care offers. The union also said nurses working outside of hospital walls cannot draw on the clinical expertise of other staff such as pharmacists and respiratory therapists, if a patient’s condition worsens.

National Nurses United did not respond to questions on representation of hospital-at-home nurses. The Service Employees International Union and the American Federation of State, County and Municipal Employees, also did not respond to requests for comment about representation of home hospital nurses at facilities beyond Mass General Brigham.

UMass Memorial Health’s 33 home hospital nurses are members of the Massachusetts Nurse Association and are covered under the same bargaining unit as its other nurses, according to a spokesperson for the Worcester, Massachusetts-based hospital system. The program’s five paramedics belong to the National Association of Government Employees. But nurses who work for other large in-home acute care programs, such as those run by the Cleveland Clinic and Peoria, Illinois-based OSF HealthCare, do not belong to unions.

Registered nurses in the U.S. are largely nonunion workers, with only about 17% belonging to labor organizations, according to August.

Rad thinks the Mass General Brigham home hospital nurses might influence nurses at other hospital-at-home programs to organize and help shape the future of acute care in the home.

“We hope the direction we move things in, in partnership with our management team, will set the stage for a way that we can positively influence other home hospitals that are either already started or those programs that are on the cusp of starting,” Rad said.