Concern with the quality of nursing facility care includes consideration of complaints about facility care and substantiation of serious complaints. Among predictors of quality are factors related to unionization of facilities. We report analysis that considered unionization and a local-market climate of unionization among predictors of serious violations. We report data on nonhospital nursing facilities in California in 1999 (N=1155 facilities for which all data could be matched). Receipt of complaints was treated as reflecting both (1) possible quality problems, and (2) monitoring and advocacy. By contrast, substantiation of serious complaints was considered indication of serious quality problems. Preliminary analysis showed that not only unionization but also a climate of unionization was important. Climate of unionization was measured by (1) whether any facilities in a county were unionized, and (2) the percentage of facilities in the county that were unionized. Findings showed that unionized facilities showed far more complaints than did nonunionized facilities, but no difference in serious violations. Considering the environment of unionization, counties with unionized facilities showed far fewer serious violations. More directly, unionized facilities in counties with higher proportions of such facilities showed fewer serious violations. Findings are interpreted to show that unionization enhanced report of quality problems and, under conditions of stronger union environments, reduced the incidence of serious quality problems.

Learning Objectives:

* Participants should be able to: identify issues in nursing facility quality, understand issues related to facility unionization, and learn possible implications of unionization on quality issues.

Keywords: Quality, Union