Mass General Brigham’s Hospital-At-Home Nurses Unionize, Home Care Segment Moves To Follow Suit

Nurses of Mass General Brigham’s hospital-at-home program have voted to unionize, and the clinicians at the health system’s home care segment are hoping to follow suit.

The efforts to unionize first started in February. On May 16, 80 of the health system’s home-at-hospital nurses voted to join the Massachusetts Nurse Association (MNA). That same month, the National Labor Relations Board certified the union to be representatives for the nurses. 

Currently, the union is collectively working on what issues to bring to contract negotiations.


Bridget Ellis, a registered nurse at Mass General Brigham’s home hospital program, said that one of the factors that led these nurses to unionize was feeling like clinicians should have greater input.

“With new policies rolling out and new procedures being formed, we felt that our input, being in the field, was extremely important to be able to maintain patient and nurse safety,” she told Home Health Care News.

Ellis hopes that hospital-at-home nurse unions become more common as more programs continue to launch across the country.


“I see this as a sort of health care of the future, and I don’t think it’s going anywhere, anytime soon … so if the nurses and these programs get ahead of it, and they unionize at a time that is really pressing, I think it’s going to benefit the program overall,” she said.

As of June, there are more than 331 hospitals and 136 health systems across 37 states delivering hospital-at-home care through the Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home waiver. Health systems are also delivering that level of care outside of the waiver program, through other payment mechanisms.

Mass General Brigham is one of the big players in the hospital-at-home space. The health system originally rolled out its hospital-at-home program in 2016, which predates the CMS waiver.

Over the next couple of years, Mass General Brigham is looking to expand the hospital-at-home program from 50 to 200 patients. This also somewhat contributed to the decision to form a union.

“There is a way to expand to 200 patients in a safe way, but when our opinions and experiences aren’t being taken into consideration, the number seems very scary, going to 200 patients,” Ellis said. “We thought if we can give our input and talk about our experiences — what’s working, what’s not working — it is a manageable thing to do. You need to hear from the people who are doing the job and who are seeing the patients.”

Mass General Brigham expressed dissatisfaction with the result of the vote to unionize.

“While we are disappointed with the outcome, we recognize that this election is part of a continuing national trend among health care providers seeking collective bargaining through union representation,” a Mass General Brigham spokesperson told HHCN in an email. “As an organization dedicated to providing safe, high-quality care to our community, we recognize the importance of working collaboratively with our nurses, physicians, and other health care providers to address the needs of our patients and community. We remain focused on that critical mission.”

Hospital at home isn’t the only way that Mass General Brigham is serving patients in the community.

Home health care, palliative care and other home-based care services are also part of Mass General Brigham’s service offerings.

In addition to the health system’s nurses, clinicians at Mass General Brigham’s home care segment are also in the process of voting on whether to unionize.

Karen Estey, a speech language pathologist at Mass General Brigham Home Care, said that things like changing productivity expectations and wages, among other factors, contributed to the decision to vote on unionization.

About a year ago, clinicians at Mass General Brigham Home Care were informed that the health system would be rolling out some changes. These policy changes were not uniform across the agency, and not equitable, according to Estey.

“As a speech pathologist, we have a very large territory,” she told HHCN. “Some of the speech pathologists were told that we needed to be seeing 25 to 27 patients a week, just like OT and PT, who have a smaller territory, and the nurses as well. It was not something that was going to be feasible for us. I was told 20 patients, another therapist was told 24 patients, and they work fewer hours than me. The messaging just wasn’t the same. They tend to try to keep us in silos without us really being aware of what’s going on.”

Clinicians at Mass General Brigham Home Care are also seeing more higher-acuity patients, which is more challenging to manage.

“I love working in someone’s home because it’s treating them where they’re most comfortable,” Estey said. “We’re able to do really functional tasks, so there’s some real benefits to being able to see someone in their home environment. There’s also been a real push to keep people out of hospitals. We have more and more patients coming home quickly out of hospitals, and sometimes opting to skip the rehabilitation portion, like a rehab hospital or a skilled-nursing facility stay. Our patients have become more acutely ill, and we’re now tasked with trying to keep them home, and keep them safe. That is incredibly hard to do when you’re being asked to see more people.”

Earlier this month, clinicians at Mass General Brigham Home Care received ballots, which will be counted at the end of June. This segment of the health system has over 400 clinicians.

Mass General Brigham Home Care have received support from their colleagues on the hospital-at-home side of the health system.

Estey thinks it’s likely that the vote to unionize will pass.

“There’s just such strong support,” she said. “Typically, I know it can take like a year or so to unionize. We started working on this on Valentine’s Day.”

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