Union, Heal Thyself

Will a lobbyist for a local healthcare union extend a bill proven bad for patients' health?

In February, Sal Rosselli, leader of the Service Employees International Union's local healthcare affiliate, roiled the U.S. labor movement by going public with his misgivings about a lobbying pact his union made with private nursing home chains, calling it "corporate unionism versus social unionism."

Rosselli needs to take the next step and urge Democrats in the state Legislature to undo the worst aspects of this SEIU sellout, which filled the pockets of nursing home owners while allowing them to worsen quality of care for patients.

Rosselli's February remorse came just in time: Earlier this month, a team of UC San Francisco researchers reported that the SEIU-nursing home industry lobbying alliance's main product — a 2004 bill supposedly aimed at improving patient care by increasing government subsidies to nursing home companies — was a disaster. In exchange for pushing the bill, SEIU was able to add hundreds of union members in selected nursing homes. Rather than using the subsidies to provide better patient care, the UCSF report said, nursing home owners and administrators pocketed the money.

"I thought they would have done more, especially on wages and benefits and some of the staffing," said the study's lead author, Charlene Harrington, director of UCSF's Health Policy in Nursing doctoral program. "But I was disappointed."

Harrington's research team found that, despite a $1.1 billion increase in government payments to nursing homes in California, conditions for patients actually declined from 2004 to 2006. Nurse staffing levels increased slightly, but because pay lagged behind the health industry, turnover worsened, with seven out of 10 nurses quitting each year. With the arrival of new staff, substantiated complaints about conditions leapt 41 percent. The average operating profit margin of nursing homes, meanwhile, increased 747 percent.

The facts on the ground have vindicated Rosselli, who has risked his career by repudiating the lobbying pact. By denouncing it as a sellout, he was attacking a corporate collaboration strategy the union's leadership cites as a recipe for long-term membership growth.

In retaliation, the union's national boss, Andy Stern, has hurled charges of corruption, election violations, and other alleged misdeeds at Rosselli that many see as a prelude to a local coup. Rosselli and other officials describe the accusations and counteraccusations as open warfare.

Presumably, Harrington's report might serve as key evidence boosting Rosselli's cause. But while Rosselli is engaged in a public struggle to regain this moral high ground, his chief lobbyist, Richard Thomason, seems to be quietly running in the opposite direction in California.

Thomason has publicly dismissed the report's conclusions as premature, and has described the 2003 union-industry pact in misleadingly positive terms as a "consensus" among health-care advocates. Most unusually, Thomason says he is pushing for an extension of the increased subsidies that the UCSF report suggests short-changed workers, patients, and taxpayers.

"At this point, we're talking about a one-year extension to give more time for us to see how it's played out," he said in an interview last week. "We'd like to get more results as to how it's been working." The UCSF study, he said, "hasn't produced significant results for improving quality. But it's still early to make any kind of judgment."

Until now, I've taken Rosselli's public misgivings about the nursing home alliance at face value. But Thomason's statements raise the question of whether his lobbying arm is pushing to maintain the status quo.

To the union's credit, Rosselli lieutenant John Vellardita, director of UHW-West's nursing home division, told me that he understands the union's lobbying strategy differently. Rather than saying nursing home corporations needed more time to stop pocketing public subsidies intended for patient care, Vellardita said they need more regulation.

"We will not support [the bill's] renewal without fundamental changes that guarantee better care in the form of beefed-up staffing to achieve a ratio of patients to staff of 4.1 to one," he said. "The problem is, there's nothing in the [California state] budget to beef up enforcement. So the starting point in any discussion has to be that they have enforcement. We want to see even greater improvement. And we want to see discussion to take place to hold the industry accountable."

For credibility's sake, Vellardita and Rosselli should make sure Thomason follows through on this promise.

Unmentioned in the UCSF study was the degree to which the SEIU was complicit in enabling nursing home companies to suck up public dollars without improving care. Rosselli has so far focused his dissident turn on the idea that the nursing home agreement gave his members a lousy payoff. That's indisputable: New union members were added, but only under an agreement that stymied the union's right to complain about bad conditions.

If what SEIU got out of the bargain was bad, what it gave in return was horrid.

In exchange for increased membership, the SEIU promised to use its clout with Sacramento Democrats to advance nursing home industry interests. This meant steamrolling the nursing home industry's traditional political enemies — including AARP and health advocates for disabled and elderly residents. Patients' advocates rankled healthcare executives by demanding that any increases in government subsidies be linked to specific requirements similar to a patients' bill of rights by increasing oversight and accountability, expanding and training staff, and taking better care of patients. They insisted that without these kinds of safeguards, the nursing home company owners and administrators would simply keep the money. It was this standoff the SEIU helped break.

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