Evidence map›Paper›PMID 39241851›Full record

SynthesisJournal of the American Medical Directors Association2024

The Impact of Unions on US Direct Care Workers in Long-Term Care Settings: A Systematic Review.

Kiran Abraham-Aggarwal, Daniel Spertus, Ariel Avgar, Andy Hickner, Joseph Spak, Russell Weaver, Heeeun Jang, Madeline Sterling

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of the American Medical Directors Association, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Kiran Abraham-AggarwalSchool of Industrial and Labor Relations, Cornell University, Ithaca, NY, USA; Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
Daniel SpertusDepartment of Medicine, Weill Cornell Medicine, New York, NY, USA.
Ariel AvgarSchool of Industrial and Labor Relations, Cornell University, Ithaca, NY, USA.
Andy HicknerSamuel J. Wood Library, Weill Cornell Medicine, New York, NY, USA.
Joseph SpakSchool of Industrial and Labor Relations, Cornell University, Ithaca, NY, USA.
Russell WeaverSchool of Industrial and Labor Relations, Cornell University, Ithaca, NY, USA.
Heeeun JangDepartment of Information Sciences, Cornell University, Ithaca, NY, USA.
Madeline SterlingDepartment of Medicine, Weill Cornell Medicine, New York, NY, USA. Electronic address: mrs9012@med.cornell.edu.

Funding

Leveraging Home Health Aides to Improve Outcomes in Heart FailureK23HL150160 · NHLBI · WEILL MEDICAL COLL OF CORNELL UNIV · PI STERLING, MADELINE R · 2020 to 2024
$921k
NHLBI NIH HHS K23 HL150160
6 · The paper itself

Abstract

objectivesTo meet a growing demand for direct care workers (DCWs) in the United States, structural, organizational, and policy-related solutions are needed. Unionization of the workforce may be one such mechanism; however, its impact on outcomes remains poorly understood. To examine the impact of unionization on DCWs' financial well-being and employment attitudes, as well as patient outcomes.

designA systematic search of AgeLine, CINAHL, PubMed, Scopus, and Web of Science from database inception through June 20, 2024. We included peer-reviewed empirical studies that used observational, quasi-experimental, and experimental designs. SETTING AND

participantsStudies pertained to DCWs who provided care in the home and long-term care settings. We focused on studies that illustrated the financial outcomes of DCWs (wages, compensation, benefits), employment outcomes (job satisfaction, turnover), and health-related outcomes of DCWs and their patients.

methodsCovidence was used to screen studies for inclusion criteria. Study characteristics were abstracted manually by prespecified domains. The Downs and Black tool was used for quality assessment. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed.

resultsA total of 19 studies met inclusion criteria; they were predominantly observational (94%), with local (47%) and national (53%) samples. Three studies focused on compensation and all found that unionization was associated with higher wages and benefits among DCWs. Seven studies focused on employment, finding that unionization was associated with greater job satisfaction, quality, and retention, particularly among nursing home staff and home health aides. Unionized workplaces reported better care quality and safety, including fewer injuries and better equipment provision. Unionization's impact on patient outcomes showed mixed results, particularly among nursing home residents. Overall, the quality of the research studies varied, with limitations in methodology and sampling affecting reliability. CONCLUSIONS AND IMPLICATIONS: Unionization among DCWs was generally associated with higher wages, benefits, and job satisfaction, as well as reduced turnover; however, its impact on worker and patient outcomes varied across studies. The overall quality of the studies was fair to poor, highlighting the need for more rigorous research in this area.

Indexed as

Labor UnionsLong-Term CareHealth PersonnelHumansJob SatisfactionNursing HomesPersonnel TurnoverSalaries and Fringe BenefitsUnited Statesbenefitsdirect care workerslong-term careoutcomesUnionization

Identifiers

PMID39241851
PMCPMC11658852

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.