Nursing homes more likely to report workplace injuries and illnesses after unionization

Reviewed by Megan Craig, M.Sc.Sep 5 2023

Nursing homes that unionize are more likely to report workplace injury and illness data to the Occupational Safety and Health Administration, a new study published today in the journal Health Affairs says.

Unionization led to a 78% increase in employer compliance with OSHA's requirement to report workplace injury and illness data. Reporting such information helps make nursing homes safer."

Adam Dean, lead author of the study, professor of political science at the George Washington University

Nursing homes have been shown to be among the most dangerous workplaces in America, yet only 40% comply with an OSHA requirement to report workplace injuries and illnesses, according to Dean and his coauthors.

Since the 1970s OSHA has required employers to record the number of injuries and illnesses that occur on the job and to post such information at the workplace. In 2016, OSHA issued a new regulation requiring many employers to report summaries of such data to the agency, which now posts the information up on a public website.

"Without such data, policymakers and public health officials are flying blind in their efforts to prevent injuries," said David Michaels, co-author of the study and professor of environmental and occupational health at GW. Michaels served as Administrator of OSHA from 2009 to January 2017 and under his leadership the agency issued the regulation that requires many employers to report their injury data to OSHA.

Previous research had shown that labor unions play a crucial role in improving workplace safety by educating workers, monitoring workplaces and coordinating with OSHA to increase the likelihood of workplace inspections.

But no other studies have looked to see if labor unions increase compliance with the OSHA rules on workplace injuries and illnesses. To do this first of a kind study, Dean and his colleagues examined data on 15,921 nursing home unions from 48 states during the period 2016-2021. In the study, the researchers focused on compliance with OSHA reporting requirements rather than reported injury rates.

Workers in non-unionized nursing homes may be afraid to report on the job injuries which would make the injury rate reported by the nursing home appear to be low. To avoid that bias, the researchers decided to look at nursing home compliance with OSHA rules rather than the artificially low workplace injury rates, Dean said.

The researchers found that two years after unionization, nursing homes were 31.1 percentage points more likely than nonunion nursing homes to report the required data to OSHA. This estimate represents a 78 percent increase in employer compliance relative to the average compliance rate among all nursing homes during the study period.

The results have implications for public health leaders, nursing home administrators, patients, workers and others. Dean and the authors note that the pandemic illustrated the broader public health consequences of workplace safety in nursing homes as previous studies linked worker COVID-19 infection rates to death rates among residents.

Labor unions can make nursing homes safer but as long as the vast majority of nursing homes are non unionized, this study suggests that OSHA may be missing injury and illness data from some of the most dangerous workplaces in the country, the authors say.