"Now They've Got to Treat Folks Right"

Magazine cover with three photos of elderly people

This article originally appeared in Southern Exposure Vol. 13 No. 2/3, "Older Wiser Stronger: Southern Elders." Find more from that issue here.

This article was compiled from reports by Paul Sweeney, the Multinational Monitor, and The Bureau of National Affairs. 


I wish everybody could work one day in a nursing home. For one thing, they would then know what work is. . . . It's hard to give the right type of patient care because we're working short of help." 

These are the words of a nursing home aide who works for Beverly Enterprises in Texas and is taking part in one of the most successful union organizing drives going today. 

In scattered pockets across the entire South, nursing home workers who are near the very bottom of the economic heap are organizing for better pay and working conditions — and winning. By waging a "corporate campaign" involving the mobilization of community support for improved patient care, the unions are successfully negotiating contracts with Beverly Enterprises, the nation's largest nursing home chain. 

"In a lot of these places there is little understanding of unionization and little experience with unions," says Stewart Acuff, Texas coordinator of the Service Employees International Union (SEIU) Beverly organizing drive. "One key to the campaign is the strength and courage of these women. They organize for their own individual reasons but also for the sake of the people they work with and the patients they take care of." 


"You couldn't work here if you didn't care about the patients. I've got a momma. I wouldn't want anybody to mistreat her. You kind of look at it as if you 're with your kids. Their minds go back to when they were children." 


"It's not the patients that cause me trouble; it's the ones over me. I've been there seven or eight years but the people over me don't know a single patient. . . . We had one patient who wasn't acting right. We kept telling the charge nurse. She said she'd check the patient but told us to keep watching her. Then the patient died that night. " 


"We need a better place to work. The patients are mistreated. You can see them suffer. You can see a patient fall. They [the supervisors] will come tell you to take care of it. You could be in a shower attending to someone else. Why can't they do it? They just won't. They just figure it's our job to do it. " 


Southern Exposure tried to talk to Beverly representatives about the corporate campaign and the quality of care in Beverly nursing homes, and we asked to visit several facilities. The company declined the requests. "We just can't participate," said Carole Trimble, Beverly's public relations official. "Beverly Enterprises is proud of its record. But we don't believe we have anything to add." 

For fear of reprisals from their employers those workers interviewed would do so only on the grounds that their names not be used. 


Over the past two years SEIU and the United Food and Commercial Workers (UFCW) have combined to win a whopping 58 out of 82 elections at Beverly-owned homes — unions generally win under 50 percent of their certification elections. Many of these nursing homes are in the South. And many union members have just completed year-long negotiations for their first contract. 

A composite portrait of a Beverly employee is that of a woman, in most cases black, making little above minimum wage — even after years of work for the company. Most don't work quite full-time, as Beverly would then have to pay out more in benefits. Many qualify for subsidized housing and food stamps. The taxpayer thereby subsidizes the profits of Beverly by supplementing the wages of Beverly employees. 


"I make $3.65 an hour. After you pay gas and transportation to work, you can't realize much out of it. You need to pay $10 every six months for a health card to work. Uniforms cost $20. The shoes that you have to wear, nurses shoes, cost $35. You get through four days of work and have one day off and you're so tired. One of Beverly's people encouraged us not to go union. A lady from Fort Smith, Arkansas. She said the union would be against the nursing home." 


While the number of organized Beverly workers does not yet constitute the "critical mass" necessary to force significant improvements in wages, benefits, and patient care, the unionization of service sector employees is reason for celebration in an otherwise bleak labor picture. "Beverly can buy up homes faster than we can organize them," explains Cecille Richards, Texas organizer for SEIU. "But we are attacking the myth that Southerners cannot be organized, that the South is content to work for less and under worse working conditions." 


They had a movie showing us the bad things of a strike. How unions mess up houses. Our tires would be slashed. All the stuff the union would do to us. One lady said she was a person you could talk to and trust. She even said she had an old car we could buy. She kept me in her office 30 minutes. They promised to get new shower chairs for the patients, a whirlpool and a washer and dryer for the laundry. But some people you can look at and see what they're like, and I didn't trust them. " 


"All I had was a bunch to gain. I'm not against the union. When I was living in Dallas I worked for a construction company. We did have a union and I would take home $350 a week. That was money! Anytime somebody says union, I'm gonna listen. It was a long struggle [to get a union here]. There was a lot of pressure. They were harassing us. The vote was 26 to 9 in favor of the union. Now they know they've got to treat folks right." 


The success of the unions' organizing campaign is largely due to their ability to show the direct relationship between working conditions and patient care. The issue of patient care is being used to mobilize community support for nursing home workers and to encourage patients' families to apply pressure on Beverly. 


In the past several months the SEIU and UFCW have successfully negotiated a number of their first contracts with Beverly. In March workers at 11 homes in Michigan negotiated agreements with Beverly. This was followed closely by agreements in the 4 organized homes in Georgia. And in Texas, 9 Beverly homes are likely to ratify contracts soon. 

In all those contracts negotiated, the issue of patient care has been thrust to the top of the workers' agenda, and this has been a sticky point with management. The unions maintain it has been hard work just to get Beverly to agree to the principle that employees, as the main providers of care to the patients, have the right to address the issue of patient care. The unions have also been keen on empowering workers and fighting racism. This has been particularly important in the South, where mostly white management personnel now sit across the table from mostly black bargaining units. 

Despite the obstacles, the unions have succeeded in getting some language on patient care included as part of each settlement. In the SEIU agreement in Georgia, "resident services" committees will be set up at the facility level and workers and management will sit down together and talk about patient care. In North Carolina the UFCW has successfully bargained for language in the contracts to ensure that employees are treated with respect and dignity by their bosses. Without this element of respect, the union argues, nursing homes cannot give patients good care. By making the issue of patient care part of the collective bargaining agreements, workers will be able to monitor patient care conditions and use them as an instrument for labor relations. 

In these negotiations the issue of staffing has also been important. Throughout the South the staffing requirements are rock bottom. In Texas, for example, the minimal requirement for staffing states only that there should be a "sufficient" number of nurses aides on at all times. With labor accounting for some 60 percent of Beverly's expenses, the company tries to shave labor costs as much as possible. Many workers work less than 40 hours a week and there is extensive use of part-time workers and casual workers. 

Because the nursing home industry is not highly regulated, workers often find themselves shortstaffed and unable to meet the demands of the job. 

The whirlwind of recent contract victories for Beverly employees comes after two years of union organizing. On January 27, 1983, the two service-oriented unions officially opened a "corporate campaign" against Beverly Enterprises. Charging that Beverly was using taxpayers' money — in the form of reimbursements from Medicare, Medicaid, and the Veterans Administration — to fuel its own growth while neglecting patient services, the SEIU and UFCW began pressuring Beverly to moderate its anti-union activities. 

Kicking off the campaign UFCW president William Wynn articulated what was to become a highly effective organizing theme: "Working conditions and patient care conditions are closely linked. Quality care is sometimes difficult to deliver in the best of circumstances. In the worst of circumstances, when discouraged workers are understaffed, under-equipped, and underpaid, it is impossible." SEIU president John Sweeney explained, "Beverly is important to SEIU not just because of its size, but because it represents what appears to be the future wave of health care in this country — corporate health care." Sweeney denounced this trend in health care, saying it "puts profits ahead of patients." 


Armed with questionnaires on patient care and working conditions, a thousand union organizers fanned out across 26 states approaching workers at 475 Beverly homes. The results of the survey revealed that 74 percent of the workers viewed patient care as only fair or poor, 68 percent thought patients' meals were substandard, and 88 percent said that understaffing made adequate health care impossible. These findings expanded upon a report released by the AFL-CIO Food and Allied Services Trades Department in January 1983. Entitled "Beverly Employees C.A.R.E. (Cooperative Action and Reform Effort)," that report included preliminary results of the unions' investigation into patient care conditions in Beverly homes in four states. The findings showed that the rapidly growing chain was spending far less on patient care than the average nursing home and was putting "significantly more money into profit, administrative fees, and facility charges." 

In a 1983 study of 361 homes, Iowa's top nursing home regulator, Dana Petrowsky, found that for-profit nursing homes had a patient care staff of only 8 per shift for each 100 patients, while not-for-profit homes maintained 11 staff members per 100 patients. 

Union research also revealed that Beverly Enterprises is at the forefront of attempts to corporatize the health care industry. Hospital Corporation of America, the nation's largest for-profit hospital chain, owns 18 percent of Beverly while Beverly is also in a 50/50 partnership with Upjohn Health Care Services, the nation's largest for-profit provider of home health services. 


Tactics used in the unions' corporate campaign to organize workers and bring Beverly to the bargaining table included: exposing substandard patient and working conditions, challenging Beverly's applications for certificates of need to build nursing homes, taking legal actions before government agencies, and coordinating protests from consumer and church groups. In addition, the unions launched a proxy battle in which labor organizations and churches holding Beverly stock tried to place a prominent senior citizen advocate on the corporation's board. In the second round of shareholder protests on patient care the unions won 10 percent of the proxy votes, including a large block from Chase Manhattan Bank. By March 1984, when Beverly negotiated with the unions to call off the corporate campaign in exchange for the company's agreement to encourage a "non-coercive" atmosphere during election campaigns, the unions had won 28 out of 41 elections in Beverly homes. 

The terms of the agreement to call a truce between Beverly and the Unions demonstrate that a well-planned, well-fought corporate campaign can have a positive effect. And this model of organizing is becoming a key element in labor's current strategy. 

Even though labor and management, in their own words, "reached an understanding that provides the basis for a more positive relationship between the company and the unions," they continue to do battle. While Beverly launches decertification campaigns and stalls at the bargaining table, "they understand," one union leader says, "that we are going to be doing more organizing at Beverly than ever."