Ever since the coronavirus devastated the Life Care Center of Kirkland in the state of Washington in February, nursing homes have rapidly become the country’s deadliest hot zones. Harrowing scenes abound all throughout the country: residents dying left and right over a matter of days; staff falling ill as they plead for more personal protective equipment (PPE); bodies piled in a shed for want of space.
We need to recognize the sheer magnitude of this nursing home crisis. Although the Centers for Disease Control and Prevention (CDC) only recently required facilities to report cases and still hasn’t released any data, the latest estimates indicate that one-third of all coronavirus deaths have been workers and residents in the long-term-care sector. But this is certainly an undercount. States bearing the brunt of the pandemic are announcing much higher figures — and disturbing signs show this trend is accelerating.
In Connecticut, nearly 60 percent of all coronavirus fatalities have occurred in nursing homes. The proportion over the last week has shot up to 90 percent. Ranking among the wealthiest states as well as the most unequal, Connecticut presents a textbook case of austerity’s violent consequences. Thousands of vulnerable residents have been condemned to die in the wealthiest country in the world.
Alongside the elderly, people with disabilities, and those with chronic illness who reside in nursing homes, the usually invisible workers who care for them have been thrust into the spotlight. While the Trump administration remains criminally negligent and employers scramble to save face, care workers are desperately attempting to protect residents at the greatest possible risk to themselves and their own families.
My union, District 1199 New England, represents seven thousand nursing home workers, including CNAs and nurses, cooks and housekeepers, laundry aides and therapists. So far, we’ve counted more than a thousand infections and at least ten deaths among these members.
But numbers alone fail to capture the crisis confronting care workers on the front lines. At our hardest-hit chapter, for example, where forty-three residents have lost their lives, a longtime rank-and-file leader named Francene Bailey contracted the virus and transmitted it to her mother, a retired hotel housekeeper, who died shortly afterward. This is yet another example of tragedy that could have been prevented had our society treated nursing home workers and residents with dignity.
The Political Economy of Nursing Homes
Having moved here from Jamaica in the 1980s and now toiling for the country’s largest nursing home corporation, Francene is a typical care worker. In an industry where the vast majority of bosses are white men, 80 percent of our members are women and 80 percent are black or brown, many of them immigrants from the Global South. In other words, they are a key part of the core of the twenty-first-century American working class that has been forged through a half century of global economic restructuring.
The social catastrophe sweeping through nursing homes is a direct result of the devaluation of these women’s labors, something socialist feminists have argued for more than a generation. Nursing home workers earn rock-bottom wages and often work multiple jobs. Despite the increasing complexity of nursing home care, they are still demeaned as unskilled. Perhaps worst of all, they are forced to work under appalling staffing levels. Every nursing home worker will tell you that this problem plagued the industry long before the coronavirus arrived.
The pandemic has exposed and sharpened a paradox: essential workers alternately receive routine praise and blatant disrespect. Last month, care workers in Connecticut accused bosses of hoarding PPE and released photos showing they had been left with no choice but to repurpose garbage bags to wear while working. In response, a high-ranking public health official alleged that workers preferred to wear the bags.
Profits from women’s work are siphoned into the coffers of private companies that now own 70 percent of nursing homes nationwide. These corporations rely almost entirely on public funding through Medicaid and, to a lesser extent, Medicare. (Growing after the enactment of these programs in the 1960s, the enormous private-sector industry is in fact a creature of public policy.) In Connecticut, Medicaid insures three-quarters of nursing home residents and an even higher ratio in the cities, where the pandemic has taken the heaviest toll on patients of color.
Although companies complain about woeful balance sheets, the industry collects billions of dollars in revenue per year and converts that public money into private profits while fleecing workers and poor residents alike. And in the absence of proper regulatory oversight or any semblance of democratic control, owners have designed byzantine corporate structures that divert funds from patient care. In keeping with the financialization of the broader economy, the rise of Wall Street’s influence in the form of private-equity ownership and real estate investment trusts has allowed capital to wrap its tentacles around nursing homes.
In a nutshell, this state-subsidized private industry accumulates profit by exploiting working-class caregivers (disproportionately women and people of color) who provide services to working-class residents (disproportionately people of color). It’s no wonder such a model has proved a complete failure in addressing the crisis today.
Care Workers Combat Austerity
Alone, the adulation of nursing home workers will never generate lasting changes to the terms and conditions of their work, the industry structure, or the quality of care. Public applause doesn’t translate automatically to a living wage or to dignity and respect on the job. As past experience shows, workers’ united action on a mass scale offers the only road forward.
Rank-and-file members are fighting back already through direct actions in dozens of facilities across the state. They have demanded and won PPE, greater safety measures like testing, and hazard pay for all through the tried-and-true tactic of marching on the boss together. In some cases, workers entering a shift have collectively refused to begin work until managers hand over the PPE they urgently need. This is the kind of raw, wildcat struggle erupting on the shop floor.
Actions like these lay the foundation for our union’s contract campaign approaching in six months. Drawing on roots in the CIO tradition, as 1199NE alumnus Jane McAlevey explains in her beloved No Shortcuts, we negotiate contracts with numerous firms such that all expire at the same time, a sort of de facto sectoral bargaining enabling as many workers as possible to brandish the legal strike weapon in unison. Because governmental decision-making plays a crucial role in shaping the nursing home industry, workers challenge both the state and private employers. Only by deploying this strategy have they secured some of the highest standards in the country, like improved staffing, better wages, and employer-financed pensions, health care, and training.
Our union is ratcheting up this strategy in 2021, when almost all our contracts across the public and private sectors expire simultaneously: not only in nursing homes, but also in hospitals, group homes, state agencies, and home care. The purpose is to maximize our power by bringing together thirty thousand members throughout health care to pursue a common campaign as one industrial union.
With Mitch McConnell encouraging state governments to declare bankruptcy, the budget wars next year will most likely exceed the contests that followed the Great Recession in scope and intensity. On the one hand, the ruling class will mobilize to deepen the austerity regime, slash working-class living standards, and destroy our organizations. On the other hand, the Left faces a rare opportunity to go on the offensive through coordinated fights.
As proponents of the “Bargaining for the Common Good” strategy are pointing out, more than 3 million union members will be negotiating new contracts starting in 2021. Can we build a coalition that unites workers who are on the front lines with workers who are unemployed, both of whom have been thrown to the wolves? Can we advance an expansive vision promising universal social goods financed by the billionaire class that has been expropriating low-wage workers for decades?
As we enter the next Great Depression, we look back at the last and remember a crisis when workers of every color expanded their power by creating the most vibrant, daring, and successful labor movement this country has ever seen. We have no way of knowing whether the conflicts looming ahead spell the regeneration of unionism or its continuing demise. But the long-term-care sector will be a key battleground in that project.