Strike threat wins for nurses

AFTER THREATENING to strike last weekend, more than 3,500 home-care nurses in New York City won a new contract with raises and no significant concessions. The nurses, members of a division of the United Federation of Teachers (UFT), ratified the new contract on January 29, two days before the old agreement's expiration.

A week before, the UFT had filed the required 10-day strike notice, and rank-and-file nurses were feverishly preparing for the upcoming showdown.

The new two-year contract includes 2 percent raises in both years and increased education benefits, including paying for a doctoral education. The only negative change is a small increase in co-payments for doctor's visits from $15 to $40, and from $100 to $150 for emergency room visits.

Negotiations stalled a week earlier when their employer, the Visiting Nurse Service of New York (VNS), demanded that nurses begin paying 40 percent of their health care premiums. In addition, VNS threatened to convert nurses' defined-benefit pension into some form of a retirement investment account, to which they would also have had to contribute to out-of-pocket. VNS also demanded a wage freeze for the life of the contract.

Although the UFT hadn't reported the size of the "yes" vote for ratification as this article was being written, VNS nurses reported that support for the contract was overwhelming, and the mood was celebratory. At the same time, several nurses expressed frustration at the lack of preparation by the UFT and the mixed messages sent out in sporadic communications to the membership.

Last week, other UFT members who were preparing for possible picket line support were told that a strike was off because a tentative deal had been reached--yet VNS nurses had not had a chance to discuss or vote on any proposal at that point. Many nurses and other UFT members are vowing to be better organized the next time.

THERE WERE also several issues left unresolved by the contract fight. For the past two years, VNS nurses have been burdened with increasingly unsafe patient loads. They report having had to cut the amount of time spent with recovering patients, spend extra unpaid hours completing documentation, miss meals and rush through necessary patient education, all in order to make sure they are able to see all the patients that are assigned in a given day.

One nurse--speaking before the contract was ratified, and on condition of anonymity because VNS has a contractual ban on them speaking to the press--reported breaking out in hives from the stress caused by daily unsafe patient assignments. "Already they've been increasing our patient assignments over the past two years," said the nurse. "Now I have to worry about how I'm going to pay for health care and if I can retire? It's just too much."

Leading up to the contract expiration, VNSNY pleaded poverty, saying it was $70 million in debt. It claimed that recent alterations in Barack Obama's Affordable Care Act (ACA) have changed the way VNS is compensated for patients, particularly those covered by Medicaid.

The ACA, along with several years of reductions in Medicaid reimbursements coming from the state level, has in fact meant severe reductions in funding for health care in New York City, as evidenced also by the recent financial crisis for Interfaith and Long Island College Hospital in Brooklyn. Specifically, cuts in Medicare could total well over $800 billion over the next 10 years nationwide. Additionally, the ACA includes drastic reductions in programs that are designed to compensate health care providers who care for the uninsured.

But as Peter Rugh pointed out in an important investigative article for PolicyMic, VNS apparently has enough money for $177 million in unspecified "investments" in Central America and the Caribbean. Plus, the "non-profit" VNS pays its CEO over $1 million annually.

Some of VNS's purported poverty is self-inflicted. For example, VNS was forced to return more than $30 billion in Medicaid reimbursements to the state of New York after it was caught signing up healthy patients for its VNS-Choice social day care program, while denying treatment to sicker patients at the same time.

As Rugh also reported, in the wake of this scandal, which broke last October, more than 500 VNS employees were laid off, but the architect of the scheme, VNS executive Chris Palmieri, remained on the payroll.

Health care providers dumping sick patients and enrolling healthy ones could prove to become a trend in the era of Obamacare. More and more reimbursements are based not on services provided, but as part of a "bundle" based on the illness of the patient. The ACA has numerous incentives and programs that facilitate bundled payments. So with certain services, the incentive is to enroll the healthiest individuals who fit a certain diagnosis and avoid the most extreme, and therefore more costly, cases.

VNS IS a significant provider of home health care in New York City, with approximately 30,000 patients at any point. It's a critical component to ensuring the return to health for patients recovering from illnesses and dealing with chronic conditions. The daily self-sacrifice of VNSNY nurses was recently featured in a NY1 profile that showed nurses braving severe weather conditions to provide care for their patients.

Patients of VNS rely on nurses, social workers, occupational therapists, physical therapists and physicians. In the ongoing fight for better care, smaller nurse-patient staffing ratios, and defending health care worker standards of living, solidarity among these different healthcare workers needs be built in an ongoing way.

The fight of the VNS nurses could be just the opening battle of many more around health care in the coming year. Contracts for nurses in the four largest hospital systems in New York City will expire later this year. There's also an ongoing struggle for a moratorium on hospital closings and maintaining health care access in underserved communities.

In these upcoming battles, all NYC nurses could look to the founder of VNS, Lillian Wald, for inspiration. At the turn of the 20th century, Wald founded the Henry Street Settlement, which became the first visiting nurse service in the U.S. She spent the next several decades fighting against injustice and inequality. In 1903, she helped found the Women's Trade Union League and was also a founding member of the NAACP. She also participated in the struggles for racial integration, against child labor, against war, for women's suffrage and to try to get socialists elected to office.

Let's take her fighting spirit and political vision to the front-line health care struggles of today--and use the victory at VNS as lesson that when you at least begin a fight, you have a chance to win better conditions for New York City's nurses and patients.