Hospice and home health organizing: Nurses and patients deserve better!

NewsJanuary 23, 2024

Over the past two years, NUHW’s growing representation of nurses has been unfolding in an important but often overlooked setting: patients’ homes. We have welcomed RNs, LVNs, and NPs into our union from home health and hospices in Northern California operated by Sutter Health, Providence Health Systems, and Hospice East Bay. This new union organizing drive is an exciting development as the home health and hospice industry—rapidly growing due to the country’s aging population and increasing chronic disease burden—has historically been unorganized.

NUHW’s Home Health and Hospice Units

Sutter Care at Home: Alameda Hospice joined in early 2023, includes RNs and NPs.

Sutter Care at Home: Concord & San Leandro joined in 2022, includes RNs and LVNs.

Sutter Care at Home: Sacramento Hospice joined in early 2023, includes RNs.

Sutter Care at Home: San Francisco joined in 2022, includes LVNs and RNs.

Sutter Care at Home: San Mateo Hospice joined in 2022, includes RNs.

Providence Hospice of Sonoma County joined NUHW in February 2023 and includes RNs and LVNs.

Hospice East Bay joined November 2023, includes RNs and NPs.

Like nurses in inpatient and ambulatory settings, home health and hospice nurses are trying to do their critically important work in the face of understaffing, management efforts to maximize “productivity” while cutting costs, and the increasingly complex and serious medical and psychosocial needs of patients.

In recent years, the hospice industry has also shifted away from being run primarily by charitable organizations to becoming increasingly dominated by for-profit companies or “non-profit” corporations that use the for-profit playbook. This has led to declines in quality of care, slashing of labor costs, exploitation of unpaid family caregivers, and, in some cases, Medicare fraud. (See these recent exposes in the The New Yorker and LA Times.)

NUHW home health and hospice nurses—alongside the aides, social workers, chaplains, and spiritual care, and grief counselors in their bargaining units—are standing up against this corporatization and profiteering, which is hurting patients and their families. As recently organized NUHW nurses at Hospice East Bay and Providence Hospice of Sonoma County describe in this LA Times article, joining a union is a way to have a voice in advocating and protecting their patients.

Bargaining and organizing update

NUHW home health and hospice members at Sutter and Providence are currently bargaining first contracts and Hospice East Bay members are preparing for bargaining. Their priorities include adequate staffing and limits on patient caseloads for nurses and other care team members, an end to unrealistic and arbitrary productivity metrics, and higher wages to attract and retain staff. Winning strong first contracts is also a way for NUHW members to resist the transfer of decision making about patient care from the bedside to corporate offices, which has led to staffing cuts and less time for patient care and family education and support.

Additionally, NUHW hospice nurses employed by Sutter, Providence, and Hospice East Bay have advocated for key reforms to improve patient care as part of an ongoing regulatory process led by the California Department of Health. NUHW members submitted written commentary to the agency on hospice industry regulations and participated in two hospice stakeholder meetings held by agency staff in April and December.