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Governor Cuomo of New York required nursing homes to take back all patients (covid positive or not) until mid-May. Did unionized nursing homes have comparable i

Governor Cuomo of New York required nursing homes to take back all patients (covid positive or not) until mid-May. Did unionized nursing homes have comparable infection and re-admission rates? "Just days later [mid-March] the governor pivoted: Cuomo announced that New York state nursing homes were required to readmit patients that had been sent to hospitals because they were infected with the coronavirus. Moreover, under the March 25 order, nursing homes weren’t allowed to test incoming patients for COVID-19." Ref: https://www.realclearpolitics.com/articles/2020/09/10/nursing_home_scandal_undercuts_cuomos_covid_boasts_144163.html https://www.realclearpolitics.com/articles/2020/09/10/nursin...

newacct583 6y ago
Is there a reason to expect union membership would change the decisions of patients? Data can be wrong always, but I don't understand the confounding effect you're imagining. Generally chasing correlations like that leads to more noise, not less.
- caseysoftware 6y ago
  Not imaging, asking: - Were unionized nursing homes covered by the same orders? - Did they have separate/additional staff/patient safeguards that allowed for testing and/or redirecting patients elsewhere? - Did staff have quarantine/isolation policies as part of their contracts? - Did they send patients out to hospitals at the same rate? Did they accept them back at the same rate? If the mere existence of a union contract was key, that's beyond odd. I'd love to understand: WHAT about being unionized helped them?
  - ceejayoz 6y ago
    The study states: > Although labor unions may influence COVID-19 mortality rates in numerous ways, we hypothesized that two important mechanisms were successful demands for PPE and reduced COVID-19 infection rates. By increasing access to PPE, labor unions may reduce the spread of COVID-19 between health care workers and nursing home residents, thus reducing COVID-19 mortality rates for residents. and: > 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.
- skybrian 6y ago
  Correlations can happen by chance or via a common cause. If it's not a randomized controlled trial then you need to be wary of any correlations that might distort the data.
ceejayoz 6y ago
That last sentence is false reporting by RCP. The actual order reads as follows: https://web.archive.org/web/20200407103413/https://coronavirus.health.ny.gov/system/files/documents/2020/03/doh_covid19-_nhadmissionsreadmissions_-032520.pdf https://web.archive.org/web/20200407103413/https://coronavir... > NHs are prohibited from requiring a hospitalized resident who is determined medically stable to be tested for COVID-19 prior to admission or readmission. They were not forbidden from testing them. They were forbidden from requiring one be done as a precondition to come back to the home. These patients should've been assumed to be potentially infectious by their nursing homes, and placed in dedicated COVID wings with dedicated staff. Nursing homes should be able to practice basic infection control; after all, they have flu season to manage every year. (The likely reason for this order: limited testing availability, and overwhelmed hospitals in NYC needing beds for the unstable patients, not convalescing nursing home folks.)
- mistermann 6y ago
  > Nursing homes should be able to practice basic infection control; after all, they have flu season to manage every year. What is seems more important than what should be. Also, applying science, logic, and epistemology at the layer where decisions are made that affect multiple downstream organizations (who may not have the in-house expertise to make optimum decisions) seems like a sub-optimal approach to me. If nursing homes "should" be able to make such decisions competently, is it not fair to ask that those higher up the chain should be able to do the same? What is the best way to manage risk in scenarios such as this? Noteworthy is the wide variability of reporting in the media about the degree to which Cuomo did a good job on covid.
  - ceejayoz 6y ago
    As I noted, it's likely this order was issued because NYC hospitals were filling up, and testing was very limited. On March 25, NY saw 5,146 new cases, and 12,209 tests. (https://covidtracking.com/data/state/new-york; https://covidtracking.com/data/state/new-york; click "full range) They didn't have the testing capacity to test stable nursing home patients before sending them home, and they didn't have enough hospital beds to let them sit around for weeks for that to change. Having them convalesce back at the nursing homes seems like a reasonable move given that. March in NY was "which of these bad options kills the least people" time.
noozirul 6y ago
I would be one of the family members hit by covid in those nursing homes ill sue new york
mjangle1985 6y ago
Just very generally speaking, a friend of mine works in a nursing home and is part of a nursing union. They work in PA where we had the same kinds of orders. Generally their working conditions have been safer than I've read about in other homes and hospitals. They did not allow staff to interact with patients unmasked, as opposed to non-union work environments that required nurses to work unmasked or with insufficient PPE (often times forced to work with covid positive or suspected positive patients) They established isolation units for covid suspected patients and provided proper PPE for those units (as opposed to other nursing homes that did not do this and allowed covid suspected cases to interact with other patients). Additionally the union worked independently to attempt to acquire PPE for their union members above what nursing homes/hospitals provided. While that's only one example of a union environment my impression is that these things were not the norm during the start of the pandemic and existed primarily in union nursing environments. All that said it wouldn't surprise me at all if the effect found in the study was caused by having a union.
- caseysoftware 6y ago
  This is way more interesting because (if true at scale) it's an example of a union working to protect their members in real, practical, day to day ways.
  - rbg246 6y ago
    I don't know about US unions but work safety is the bread and butter of unions in Australia.
    - mjangle1985 6y ago
      Collective wage and benefit bargaining tends to be the main focus of many unions. I'd say in the instance of this particular Nurses Union the union also advocated well and often for the safety of their nurses. So yes they do ensure worker safety but I don't think it's thought of as much as collective bargaining.
      - 6y ago

newacct583 6y ago

Is there a reason to expect union membership would change the decisions of patients? Data can be wrong always, but I don't understand the confounding effect you're imagining. Generally chasing correlations like that leads to more noise, not less.

caseysoftware 6y ago
Not imaging, asking: - Were unionized nursing homes covered by the same orders? - Did they have separate/additional staff/patient safeguards that allowed for testing and/or redirecting patients elsewhere? - Did staff have quarantine/isolation policies as part of their contracts? - Did they send patients out to hospitals at the same rate? Did they accept them back at the same rate? If the mere existence of a union contract was key, that's beyond odd. I'd love to understand: WHAT about being unionized helped them?
- ceejayoz 6y ago
  The study states: > Although labor unions may influence COVID-19 mortality rates in numerous ways, we hypothesized that two important mechanisms were successful demands for PPE and reduced COVID-19 infection rates. By increasing access to PPE, labor unions may reduce the spread of COVID-19 between health care workers and nursing home residents, thus reducing COVID-19 mortality rates for residents. and: > 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.
skybrian 6y ago
Correlations can happen by chance or via a common cause. If it's not a randomized controlled trial then you need to be wary of any correlations that might distort the data.

ceejayoz 6y ago

That last sentence is false reporting by RCP. The actual order reads as follows: https://web.archive.org/web/20200407103413/https://coronavirus.health.ny.gov/system/files/documents/2020/03/doh_covid19-_nhadmissionsreadmissions_-032520.pdf https://web.archive.org/web/20200407103413/https://coronavir... > NHs are prohibited from requiring a hospitalized resident who is determined medically stable to be tested for COVID-19 prior to admission or readmission. They were not forbidden from testing them. They were forbidden from requiring one be done as a precondition to come back to the home. These patients should've been assumed to be potentially infectious by their nursing homes, and placed in dedicated COVID wings with dedicated staff. Nursing homes should be able to practice basic infection control; after all, they have flu season to manage every year. (The likely reason for this order: limited testing availability, and overwhelmed hospitals in NYC needing beds for the unstable patients, not convalescing nursing home folks.)

mistermann 6y ago
> Nursing homes should be able to practice basic infection control; after all, they have flu season to manage every year. What is seems more important than what should be. Also, applying science, logic, and epistemology at the layer where decisions are made that affect multiple downstream organizations (who may not have the in-house expertise to make optimum decisions) seems like a sub-optimal approach to me. If nursing homes "should" be able to make such decisions competently, is it not fair to ask that those higher up the chain should be able to do the same? What is the best way to manage risk in scenarios such as this? Noteworthy is the wide variability of reporting in the media about the degree to which Cuomo did a good job on covid.
- ceejayoz 6y ago
  As I noted, it's likely this order was issued because NYC hospitals were filling up, and testing was very limited. On March 25, NY saw 5,146 new cases, and 12,209 tests. (https://covidtracking.com/data/state/new-york; https://covidtracking.com/data/state/new-york; click "full range) They didn't have the testing capacity to test stable nursing home patients before sending them home, and they didn't have enough hospital beds to let them sit around for weeks for that to change. Having them convalesce back at the nursing homes seems like a reasonable move given that. March in NY was "which of these bad options kills the least people" time.

noozirul 6y ago

I would be one of the family members hit by covid in those nursing homes ill sue new york

mjangle1985 6y ago

Just very generally speaking, a friend of mine works in a nursing home and is part of a nursing union. They work in PA where we had the same kinds of orders. Generally their working conditions have been safer than I've read about in other homes and hospitals. They did not allow staff to interact with patients unmasked, as opposed to non-union work environments that required nurses to work unmasked or with insufficient PPE (often times forced to work with covid positive or suspected positive patients) They established isolation units for covid suspected patients and provided proper PPE for those units (as opposed to other nursing homes that did not do this and allowed covid suspected cases to interact with other patients). Additionally the union worked independently to attempt to acquire PPE for their union members above what nursing homes/hospitals provided. While that's only one example of a union environment my impression is that these things were not the norm during the start of the pandemic and existed primarily in union nursing environments. All that said it wouldn't surprise me at all if the effect found in the study was caused by having a union.

caseysoftware 6y ago
This is way more interesting because (if true at scale) it's an example of a union working to protect their members in real, practical, day to day ways.
- rbg246 6y ago
  I don't know about US unions but work safety is the bread and butter of unions in Australia.
  - mjangle1985 6y ago
    Collective wage and benefit bargaining tends to be the main focus of many unions. I'd say in the instance of this particular Nurses Union the union also advocated well and often for the safety of their nurses. So yes they do ensure worker safety but I don't think it's thought of as much as collective bargaining.
    - 6y ago