VNA caregivers are seeking staffing and wage enhancements needed to recruit and retain the staff required to provide care to increasingly complex patients being released by hospitals for more acute care at home
BOSTON, MA — In response to an increase in the complexity of care required for patients admitted for care at home, in conjunction with a lack of staff and resources to provide that level of care, the 60 registered nurses (RNs) and healthcare professionals (HCPs) who work for the Visting Nurses Association of Boston/VNA Care (BVNA), cast a unanimous vote to authorize a 14-day strike in an effort to move their administration to provide the staffing and wage enhancements they need to provide the care their patients deserve.
The nurses and healthcare professionals, who are represented by the Massachusetts Nurses Association, announced the vote result at a press conference held today outside the BVNA’s office in Dorchester. The press conference was livestreamed and can be viewed on the MNA Facebook page
The nurses and healthcare professionals, who have been attempting to negotiate a new union contract to address their concerns, have been meeting with their administration since September 7th, holding nine negotiating sessions to date, with little movement on a number of key issues they say they need to address a growing patient safety crisis, as well as to provide them with the time they need to provide the complex care their patients require.
“While no nurse or healthcare professional wants to strike, we have decided to take this step because the issues at stake are critical to our ability to fulfill our professional and moral obligation to provide the best and safest care for our patients,” said Joan Hurton, RN, chair of the MNA local bargaining unit for the nurses in the agency. “Unfortunately, our administration has failed to provide us with the resources we need to safely care for our patients, treating us more like workers in a factory, rather than highly skilled professionals caring for vulnerable human beings with complex health conditions.”
Established in 1886, the Boston VNA — which is owned by Worcester-based VNA Care — is the oldest organized VNA in the country. Its RNs and HCPs include physical therapists, occupational therapists, social workers, and speech therapists, and they provide essential in-home care and recovery services to thousands of patients across Greater Boston, out of offices located in Dorchester and Weymouth. The medical needs of Boston VNA patients are varied and complex. They include post-surgical conditions such as total hip or total knee replacements; stroke; Parkinson’s Disease; Multiple Sclerosis; Amyotrophic Lateral Sclerosis (ALS); Lymphedema, cardiopulmonary conditions; amputations; all types of cancer, and post-trauma care.
These professionals, unlike caregivers in institutional settings, such as hospitals and nursing homes, work alone, without the additional staff and resources found in those settings. They not only deal with medical issues of these patients, but also are there to assess social, environmental and familial issues that may impact a healthy recovery. As documented in a recent study, “Compared to nurses in acute care settings, home care nurses face unique threats to safety, including unsanitary conditions in homes, dangerous pets, firearms in the home, hostile patients or family members, high-crime neighborhoods, and motor vehicle accidents while traveling between patients.” In November, a 63 year old nurse in Connecticut was murdered by a patient while performing a home health visit to the halfway house where he was living.
While always challenging, home care professionals and experts in the field point to changes in the health care environment, especially since the COVID pandemic, which has resulted in more patients being discharged from hospitals sooner, patients who are more acutely ill with more complex care requirements, a situation that calls for VNA providers to have more time to deliver this care. It also demands access to more experienced staff who can provide this level of care.
For example, hospital stays have decreased from 7.5 to 4.5 days and one recent report found that the acuity level of patients being discharged from hospitals has increased by six percent since 2019 and referrals to home health agencies has increased by 11 percent since the pandemic, with the increases likely due to the rise in demand for care by an aging baby boom population and ongoing staffing shortages.
“For nurses and healthcare professionals, we have seen complex cardiac patients, who previously would be discharged to inpatient cardiac rehab facilities, now coming to us for care at home, or patients having undergone orthopedic surgery being discharged to home the same day instead of receiving care in short term inpatient rehab facilities,” explained Jennifer Beckwith, RN a long-time nurse at the agency who is certified in wound care. “Our nurses are expected to perform and monitor IV diuresis, a procedure to treat serious cardiac conditions in the home, a procedure that typically would be monitored in an inpatient setting.”
The RNs and HCPs also point to increased demand by Medicare for greater documentation and data collection, known as OASIS, a series of questions to be covered as part of an effort to track the effectiveness of patient outcomes. In recent years, Medicare has increased the number of issues or points to be covered from 107 to 169, a significant increase requiring more time to complete.
“So we are seeing patients with greater needs for more complex care, while also being required to spend more time documenting our care without an appropriate increase in allotted time with our patients to accomplish these goals,” Beckwith added. “It is simply not possible to do what we need to do for our patients under current conditions, which is why we are taking the step we are taking to get what we need to ensure optimum patient care for these vulnerable patients.
And in the face of these challenges, the agency has cut staff or is failing to do what is necessary to recruit the staff needed to allow nurses to provide appropriate care.
“On top of the increased acuity of patients and more complex care being treated at home, staffing is low which leads to poor morale and unsafe working conditions,” said Matthew Keleher, RN, a nurse in the agency’s Weymouth office. “Recently, an RN did not return from a leave and the position is not being filled by management. The RN covering that caseload was since moved to the Dorchester office, leaving Weymouth staff shorthanded and overwhelmed. When we have raised these concerns to management all they say is ‘we do not have any help, do the best you can.’ It is that type of callous response that has led us to call for a vote to strike.”
The other major issue is the lack of a competitive wage and benefits to allow the agency to compete with large hospital networks for the qualified and experienced staff needed to deliver this level of care. The RNs and HCPs at the BVNA, especially those with more years of experience are paid between $15 – $25 less per hour than their counterparts working in the hospital setting, and RNs and HCPs in those settings are now seeing significant increases in their wages, only exacerbating the discrepancy in pay with home care staff. In addition, RNs and HCPs working in hospital settings enjoy significantly better health insurance and retirement benefits, key benefits to entice BVNA clinicians to stay employed and build their experience over time.
“There’s a lot to be said about caring for patients who come home vulnerable and frail due to a faster hospital discharge. For example, a patient recovering from a stroke, now unable to stand with weakness on one side, or a patient who had a joint replacement and was discharged home the same day of surgery. These patients need physical and occupational therapy to help restore their mobility and independence, however it becomes very difficult to help these patients without adequate staff. Our ability to deliver top-notch care is hindered,” explained Joanna Donato, a physical therapist who has been with the agency for 8 years. “Taking care of our patients becomes much more difficult when the agency is reducing our access to physical therapy support staff without reducing our caseloads. As a result, on one day I had 20 patients on my schedule when an appropriate schedule would have been six, an unmanageable situation. It’s incredibly frustrating that our patients are requiring higher levels of care but our agency isn’t providing us with the competitive wages and working conditions to ensure we have the staff to support our patients in this changing landscape of healthcare.”
What the BVNA Nurses and Healthcare Professionals Need to Avert a Strike
- Productivity standards that ensure RNs and HCPs have the time to meet patients’ needs. VNA Care continues to refuse to agree to safer limits on patient care assignments that account for the complexity of care required.
- Wages and salaries necessary to recruit and retain qualified staff. The agency’s current wage offer leaves the BVNA clinicians far behind their counterparts in hospital settings.
- Retirement improvements that allow RNs and HCPs to retire with dignity, at a time when most hospital nurses are enjoying significantly better pension and 401k benefits.
- No increases to medical insurance co-pays and deductibles.
Should the RNs and HCPs vote to authorize the strike, which is expected, the vote does not mean they will strike immediately. The vote authorizes the RNs and HCPs negotiating committees to call for a strike if and when they feel it is necessary. Following the vote on Tuesday, the union will be back at the table with management for negotiations on Dec. 15th, 19th and 27th. The contact has been extended through the end of the month, which prevents the RNs and HCPs from calling a strike until at least Jan 1st, 2024 and if and when they call for a strike, they are legally required to provide the agency with ten days’ notice to allow for further negotiations to reach a settlement or to allow the agency to prepare for the work stoppage.
“It is our hope that our administration finally realizes how serious we are about these issues and finally takes a step to bargain in good faith for an agreement we all can be proud of,” said Hurton. “If not, we stand in solidarity as we take all steps necessary to protect our patients and secure a contract that adequately supports and empowers our clinicians.”
Founded in 1903, the Massachusetts Nurses Association is the largest union of registered nurses and healthcare professionals in the Commonwealth of Massachusetts. Its 25,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on health care issues affecting nurses and the public.