Echoes of Care: How Unions and Ownership Shape Resident Voice

To examine whether unionized nursing homes in New York State show different levels of resident voice-measured through formal complaints-and how ownership relates to these patterns.

Cross-sectional analysis of 2022 facility-level data.

A total of 511 New York State nursing homes categorized by union status and ownership type.

Resident voice was defined as complaints per 100 residents submitted to the New York State Department of Health Complaint Hotline. Key predictors were union status and ownership, with covariates including facility size, payer mix, occupancy, hospital admissions, and quality rating.

Of the 511 facilities, 361 (70.6%) were unionized. Unionized homes had fewer complaints on average (57.9 vs 64.4 per 100 residents; P = .04). Among unionized facilities, higher Medicaid (β = 0.885; P < .001) and Medicare shares (β = 0.567; P = .003) were positively associated with complaints and higher overall quality ratings were inversely associated (β = -6.77; P < .001).

Nursing homes with unionized workforces display distinct patterns of resident voice. These findings suggest that workforce organization may influence the institutional environment in ways that either facilitate or constrain residents' ability to advocate for improved care. Understanding how labor structures intersect with ownership and quality conditions can inform future policy efforts aimed at strengthening resident-centered care and guide research on mechanisms linking workforce organization to resident advocacy behaviors.