Among 355 nursing homes in New York State for which data on COVID-19 mortality rates were available, the presence of a health care worker union was associated with a 30% lower mortality rate from COVID-19 among nursing home residents. The findings were robust to adjustment for a range of covariates and specification checks for bias from missing data. We also found that nursing homes with labor unions had greater access to PPE and lower COVID-19 infection rates, two important mechanisms that may link unions to lower COVID-19 mortality rates.

Specifically, unions were associated with a 13.8% relative increase in access to N95 masks and a 7.3% relative increase in access to eye shields. The study also identified that unions were associated with a 42% relative decrease in COVID-19 infection rates among nursing home residents.

As more than 40% of all COVID-19 deaths have occurred in nursing homes, there is an urgent need to understand factors that protect residents and staff. Amidst the COVID-19 pandemic, unions advocated for supplies and policies that protect staff and residents from SARS-CoV-2 infection. While the study design precludes causal interpretations, the results suggest that unions may have reduced COVID-19 deaths among nursing home residents by successfully demanding PPE for health care workers. These are especially important contributions given that early research on COVID-19 in nursing homes found that only facility size and location, rather than quality metrics, were associated with COVID-19 outbreaks.

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