Strike: News Releases

Visiting Nurse Association of Boston
MNA Registered Nurses’ Bargaining Unit
Contract Negotiations Talking Points

Position Overview

• The nurses of the Visiting Nurses Association of Boston are prepared to strike on Friday, Dec. 10, 1999 because of deteriorating working conditions; a 40 % increase in the number of patients we are expected to see each day; and demands that we freeze our salary for another two years and cut our benefits by 5 %.

• They demand these cuts after we have already forgone a wage increase in our previous two year contract, thereby giving up 8 % percent of our salary to the agency. On top of this, we will see a significant increase in our out-of-pocket costs for health insurance benefits in January 2000

• The agency’s management claims that these cuts are necessary for the agency’s survival under the Balanced Budget Act of 1997. Our analysis of the situation disputes this contention. In fact, the Federal Government has reinstated significant funding for home care services cut by the balanced budget act. With this infusion of new money, our analysis shows the agency can afford to manage its operations without forcing the nurses to make additional sacrifices.

• The nurses have voted by an overwhelming 96 % majority to authorize this strike. We are exhausted, we are angry and we are firmly committed to making a stand for the integrity of our nursing practice and for our personal dignity.

• The nurses are firmly opposed to any reduction in our salary or benefits. We have already sacrificed greatly to support the agency, and have paid a personal and professional price by working under highly stressful conditions. Management must take the benefit reductions and salary freeze off the table in order to avoid a strike.

What is the agency seeking from the nurses in these negotiations?

• The parties are far apart on the issues, with the key issue being the agency’s demand that the nurses accept a salary freeze and a significant cut to their benefits.

• Management came to the table demanding a 7% reduction in salary and benefits and the continuation of a salary step freeze. Their only movement form this original position is to change the reduction to 5% and have it come form benefits only. On top of this, the nurses will see a significant increase in their out-of-pocket cost for health insurance benefits in January 2000.

• The cuts in benefits include: taking away two holidays and a full week of vacation time; elimination of life, HIV insurance and tuition reimbursement, and decreasing reimbursement for mileage by 50% (travel is a major expense for visiting nurses). The agency is also eliminating its contributions to the nurses’ dental benefit,

What is the nurses’ position on these demands?

• During the last two-year contract (12/1/97-11/30/99) the MNA nurses agreed to a salary step freeze for the life of the contract thereby conceding a total of 8% in their salaries. We did get a 3% cost of living increase in the second year of the contract, thereby netting a total concession of 5%.

The nurses made this concession at the agency’s request, as the VNAB was seeking to offset problems they were expecting with reimbursements from both Medicaid and Medicare under the Balanced Budget Act of 1997.

• While nurses have forgone salary increases to support the agency, there has been a dramatic deterioration in our working conditions, and increased pressure from management to increase our productivity. For example:

• Nurses’ patient assignments have increased by 40%, rising from five patient visits per day to 7 per day.

• The acuity level of our patients has increased. Due to earlier discharges of patients from hospitals, the patients receiving home care are more acutely ill and in need of more intensive nursing care (at the same time that nurses are expected to see more patients each day).

• The nurses’ geographic areas of coverage have been expanded to include suburban populations outside of Metro-Boston, forcing nurses to travel farther distances in the same day. VNAB nurses service a client populations located in a number of surrounding communities including: Allston/Brighton, Brookline, Chelsea, Dedham, Everett, Malden, Medford, Melrose, Newton, Quincy, Revere, Saugus and Wellesley.

• Nurses’ paperwork has increased dramatically. This paper work is required in order for the agency to receive reimbursement for the care the nurses deliver. On average, 30 – 35 documents per patient must be filled out for reimbursement to occur, which adds to the time constraints placed on nurses, as they are required to fill out this mound of paperwork, while seeing more patients and traveling further to see those patients in a single day.

• We provide first-rate care to some of the poorest and frailest members of our society and to some of the most dangerous neighborhoods in the city.

• We want the agency to withdraw its demand for a salary freeze and benefits reduction from the table.

• The nurses are seeking strong language to create a diverse nursing staff to reflect the communities the VNAB serves, fair language involving the assignment of weekend work while respecting seniority and a cost of living raise in each of the next two years of the contract.

What about the agency’s claims about the severe impact of the Balanced Budget Act of 1997 on home care agencies?

• Our evaluation of their financial statements, as well as our recent review of developments in Washington to address problems with the BBA show us that the agency’s financial analysis is misguided.

• In October of 1999, the Health Care Financing Administration (HCFA) estimated the impact of the proposed changes in payments to home health agencies for their Medicare patients. The estimate was that agencies in the Northeast states would see an increase in their payment amounts of more than 20% above the interim payment system currently in effect. Since that estimate was published, the Balanced Budget Act of 1997, which called for a 15% reduction in payment limits, was amended by Congress. The amendment eliminates the 15% reduction, thereby increasing further the payments home health agencies will receive under the new system. If Northeast agencies were expected to do well under system excluding the recently passed 15% reduction in place, we can only expect they will do even better now that the 15% reduction has been eliminated.

• The nurses question many management decisions that have contributed to this crisis. Most glaring is the agency’s total lack of a commitment to fundraising over the last two years. The VNAB is a multi-million dollar private not-for-profit agency serving a number of underserved communities. Yet, in the wake of the passage of the Balanced Budget Act of 1997, a development that has threatened the financial stability of a number of agencies, the VNAB has failed to implement an aggressive fundraising campaign to offset their projected losses in revenue. Instead, they have turned to their own staff, and are attempting to use the nurses’ well deserved compensation to finance their BBA shortfalls.

What about the VNAB’s contention regarding Medicaid reimbursement rates?

• The Boston VNA has claimed that it loses $15-20 per visit on each visit its nurses and home health aides make to patients whose health care is paid for through Medicaid. However, the agencies are due for a rate increase. Already, so far as we can determine, $6 million is included in the state budget for that rate increase. Since the federal government matches state funds for Medicaid, altogether, $12 million should be available: $6 million from the state and the matching $6 million in federal funds. While the hearing on this rate increase was held only last week, November 29, the agencies have argued for the rate hike to be retroactive to April 1, 1999. In addition, the agencies have made a strong argument for a somewhat larger rate hike, totaling about $16 million.

• There is as yet no date set on which the rate hike will be announced and it is also not yet clear whether that increase will be retroactive. If it is and if the increase is close to what they have requested, it will cover a substantial part of the agencies’ losses for the current calendar year.

• According to the management of the Boston VNA, Medicaid represents just under 30% of its business, the rest being largely Medicare(close to 60%) and private insurance or self pay.

• While it may be appropriate for the agency to seek increased funding to compensate for the actual cost of care for Medicaid patients, we question the agency’s timing in pushing for this hike so strenuously at this time. The agency has gone as far as to threaten to no longer accept Medicaid patients as of Dec. 15th, unless the state increases its contributions to Medicaid for home care.

• The nurses can’t help but believe that the agency has proposed these drastic cuts from the nurses and pushed the nurses to strike as part of a strategy to force the state’s hand. Worse still, it leads to the unseemly prospect that the agency might use the ensuing strike as an excuse to drop its commitment to care for Medicaid clients altogether.

What do the nurses feel about the prospect of their patients no longer receiving necessary home care?

• Going on strike is the last thing nurses want to do. But we will in this case because we refuse to accept further cuts and sacrifices when our workloads are increasing so dramatically. Nurses cannot and will not continue under such oppressive conditions. It’s not fair to nurses, and its not fair to our patients.

• We are doing this for our clients. They deserve motivated, well-rested and enthusiastic home care nurses, who are satisfied in their practice, supported in doing their job, and with the workload and resources to provide the best care possible. Our clients will not receive this care under current conditions.

• Most important of all, there shouldn’t be any lack of services to our clients. If there is a strike, it is by management’s choice and their reluctance to negotiate a settlement. If the strike ensues, management has been given due notice to transfer our clients to alternative sites for care.

• We would hate to see our management exacerbate this situation to deprive services to Medicaid clients or potential clients. This agency has a long and distinguished history of providing first-rate care to the citizens of Greater Boston, no matter what their socioeconomic status. We would hate for mission to be changed.

• We at the VNAB are proud of the care we provide our patients in the city of Boston and surrounding areas and only wish to continue to do so. But we cannot accept, nor is it appropriate for the VNAB to ask us to cut our benefits. This is a matter of justice, dignity and respect.