What elderly care facility caretakers deal with every day

I’m a Longtime Union Organizer. But I Had Never Seen Anything Like This.

The RawlinCredit…

By Vanessa Veselka

Photographs by Clayton Cotterell

Ms. Veselka is a writer and former union organizer.

  • Jan. 14, 2022

Last winter, workers at a memory care facility in western Oregon decided they were done watching the residents suffer. Conditions at the Rawlin at Riverbend, a 72-bed home in Springfield, were horrific because of critically low staffing and a lack of training. Elderly residents screamed from their rooms for assistance, and workers had to make the kinds of decisions that people are forced to make in war: Do you take precious time to do emergency wound care, even though you aren’t quite sure how, knowing that it means other residents might sit in their own feces for hours or trip and fall in the hallways? Do you stop to feed a resident who has trouble swallowing, knowing that others may not be fed if you do?

According to workers, Onelife, the company that operated the Rawlin, did not provide enough staff to properly care for the dozens of residents with dementia and other serious health problems. Around 20 residents died in about two months, from mid-November 2020 to mid-January 2021, only six of them from Covid. Many of the other deaths, caregivers believe, could have been prevented with better treatment.

Families of the residents, who often serve as a second pair of eyes on an industry prone to neglect, were mostly unable to enter the Rawlin for months because of Covid, so the added pressure to staff the home properly disappeared. After the facility lost its on-site registered nurse, Onelife temporarily replaced her with a regional nurse who visited the premises a few days a week and otherwise had to be reached by phone.

Experienced staff members watched their colleagues throw in the towel and walk out, wondering if they should do the same. Jenn Gregory, who had been at the Rawlin for more than two years, was one of the few more seasoned workers who stayed, trying to hold everyone together. She was making $12.40 an hour, just above Oregon’s minimum wage at the time, alongside new hires making $13 and $14. They were mostly young — some fresh out of high school with no experience.

Jenn Gregory
Jenn Gregory
Eric Holmes
Eric Holmes

At one point, Ms. Gregory, who had recently recovered from Covid and had not yet regained her sense of smell, entered a room to find an elderly woman with large bedsores that had become infected. One of them was the size of a softball and deep enough to expose the bone. Ms. Gregory called a co-worker, 18-year-old Eric Holmes, into the room to help. When she left to continue rounds, the stench was so unbearable that the next resident she attended, a veteran, kicked her out of his room because she “smelled like Vietnam.”

(In an email to The New York Times, Zack Falk, the chief executive of Onelife, disputed the description of the woman’s wounds, writing that he believes she had arrived from the hospital with bedsores. He also challenged his former employees’ recollections of the circumstances surrounding the deaths of many of the residents. According to Mr. Falk, all workers received proper training, staffing never fell below state-mandated requirements and the death toll did not differ significantly from a similar time period in the winter of 2019.)

Caregivers at the Rawlin formed a traumatized family, which grew closer with each new death. They called the state. They pleaded with management for more workers and higher wages to retain them — at least something more than what they’d earn at a fast-food restaurant. Not knowing what else to do, they contacted the local union.

Ihad been with the union for a year and a half when we got the call about the Rawlin. As an organizer with Local 503 of the Service Employees International Union, I represented long-term-care workers across the state of Oregon, and I knew that the nursing home industry had been in disarray even before the pandemic.

When Covid hit, workers in some nursing homes had to walk around in garbage bags and use bandannas for masks long after the hospitals got proper personal protective gear. And in my experience, whatever is bad in standard nursing homes tends to be far worse in memory care. So I wasn’t surprised to get a call from memory care workers. What would be a surprise is how dedicated they would become to forming a union.

To form a union, employees are supposed to gather signatures from at least 30 percent of eligible workers and submit them to the National Labor Relations Board as a “showing of interest.” The labor board then sets up an election, which is decided by a simple majority. I’ve never seen workers win if they follow these instructions. If the workers have an outright majority on union cards, they can also ask the employer to voluntarily recognize the union. I’ve only rarely seen this happen.

Legally, private employers are not allowed to interfere with the right to organize. They cannot bribe, threaten, retaliate, surveil, give the appearance of surveilling or fire workers for organizing. My experience is that many employers do all these things. I was taught that to win a “boss fight,” union supporters need to organize underground until at least 70 percent of employees have signed union cards so that they can withstand a 15 percent to 20 percent drop in participation when the employer counter-campaign hits.

A megaphone used during the strike.
A megaphone used during the strike.
A window at the Rawlin.
A window at the Rawlin.

The crucial period is the time between filing for an election and voting. During the Trump administration, the labor board issued a rule that allowed employers to delay elections through legal maneuvers, and also permitted them to file postelection challenges, which can prevent workers from moving into the bargaining phase at a reasonable pace. Time is a white-collar weapon. People with resources can easily outwait people with none. The longer it takes to get to an election, the less chance workers have of winning their union.

At a place like the Rawlin, which had a small staff with high turnover, workers would never make it through that process. If the employer’s anti-union tactics didn’t get them, attrition likely would. Even if they did manage to eke out a victory, they would need to bargain a contract, giving employers another round of ways to stall. With a hostile employer, those negotiations could take a year, and workers might still have to strike to win anything.

Given the situation, we told workers the truth: If they wanted a union, and truly could not wait for change, they would have to get an undeniable supermajority on union cards and strike until the employer voluntarily recognized the union.

This is the route they chose.

By our count, 85 percent of the eligible workers signed union cards within a week, and they approached management to demand recognition of their union. They gave management 72 hours to respond. We uploaded videos to social media showing workers talking about the union drive, which meant that the campaign was immediately public. After the Rawlin said it would not voluntarily recognize the union, workers delivered notice of their intent to strike.

Astrike for recognition is a radical act. In all my years in labor, I had never been involved with one. My introduction to organizing had come more than two decades earlier, when I took a job at an Amazon warehouse in Seattle, hoping to unionize the work force.

Back then, in 1999, the company was poised to become the Walmart of the internet, opening distribution centers across the country. Already, Amazon appeared to be vehemently anti-union. Company policies made it difficult for people to congregate or talk to one another much. When rumors spread that the Seattle warehouse was organizing, management started searching us for fliers and other pro-union materials.

Despite the failure of that drive, my desire to organize remained. I had seen in unions what I had not seen in other kinds of activism: power. The ability to shut down a business seemed like the only check on the unbridled dash for corporate profit. So I took a job at an S.E.I.U. local, 1199NW, for health care workers in Washington, where I learned the fundamentals of organizing: Tell workers it’s their union and then behave that way; workers know the risks; never lie.

As we won union elections at hospitals around the state, I saw that organizing could lead to far more than the right to bargain collectively for wages and benefits. It can be transformative. People decide to go back to school. They finally make appointments to see an eye doctor instead of relying on “readers” from the grocery store. They leave abusive partners. In short, they begin to imagine a better future, one that includes them. I loved witnessing that.

But I also felt we were fighting an uphill battle. Union membership had been declining for decades. The labor board’s 1949 “Joy Silk doctrine,” the fair standard under which many members of the Greatest Generation unionized, held that when workers present union cards and request recognition, employers must recognize the union and begin the bargaining phase unless they have a “good faith doubt” in the union’s claim of a majority, making it unlawful to insist on an election simply to buy time to undermine the campaign. The Joy Silk standard was abandoned around 1970, and rules became more favorable to employers.

The assault on workers’ rights continued under Ronald Reagan, then George H.W. Bush, then Bill Clinton. With the rise of Fox News and Rush Limbaugh, I saw workers internalize anti-union sentiment. When most people think of the George W. Bush presidency, they think of the Sept. 11 attacks, or the Iraq war, or Hurricane Katrina. What I remember was the assault on labor. Overtime rights were stripped, federal safety standards were rolled back and many government employees lost important whistle-blower protections.

Over time, the hard-won victories of health care workers here and there began to look to me like skirmishes on the edge of an empire. These fights cost workers so much and the employer so little. Corporations can pour money into union-busting consultants who are trained to pit people against one another. I’ve seen email addresses of white workers used to send out racial slurs, and schedules suddenly shifted to hobble single mothers. In the words of one reformed union buster, the job was to break the collective spirit “to be sure it would never blossom into a united work force.”

Summer Trosko
Summer Trosko

I waited to see if Onelife would hire a union buster. Onelife was founded by a former doctor named Greg Falk and his son, Zack. In 2016, Greg Falk agreed to give up his medical license after the Oregon Medical Board found that he had engaged in “unprofessional or dishonorable conduct” and “gross or repeated negligence.” (Zack Falk said that his father “chose to retire rather than engage in a lengthy and expensive defense of his practice.”) In 2017, Greg Falk opened the Rawlin with Zack, who became the chief executive of Onelife.

I knew the Falks had money — Greg Falk and his wife had purchased a $6.25 million house the previous year — but Onelife was a relatively small operation, with four facilities in Oregon, all of which receive Medicaid funding. I had thought Onelife might be unwilling to spend big on a union buster. I was wrong.

Soon enough, a white catering tent popped up in the Rawlin parking lot. Inside the tent was a man who had come to “educate” workers about unions. He was sent by a national consulting firm renowned for its anti-union zeal. A form filed by the firm later showed that Onelife paid the company $3,500 a day plus expenses. The tent, free food for workers, hotel and rental car for the consultant could have added $1,000 more a day.

A union buster’s pitch is almost always the same: Unions are corrupt and will take your money. Nothing will change anyway. Unions were important back in the day, but we don’t need them now. Often a worker is trotted out to describe a bad experience they had with a union elsewhere. Sometimes there’s an email from the company saying an anti-union employee had their tires slashed, and that they respect employees’ right to organize but can’t condone violence, which is occasionally followed by a tearful female manager claiming to have received death threats at her home.

Over the last several years, our understanding of power imbalances in the workplace around sexual harassment has grown enormously; our understanding of such imbalances when it comes to organizing has not. In higher-wage sectors, where career opportunities hinge on recommendations, workers are held hostage through their reputations. In lower-wage industries, simple things like a schedule change can upend the life of an employee, particularly a single parent dependent on child care. Free food provided by union busters may not seem like much of an inducement to vote down a union, but for workers who live in poverty like some of those at the Rawlin, food insecurity was real.

As the strike approached, the influence of the union buster began to show. The first slip we saw was on days when most of the single moms worked. The next slips came among their relatives or closest friends. We lost just under 20 percent of our support in five days. Our campaign was in free fall.

With support hovering at around 60 percent, we met with workers to decide if we should move forward with the strike. We gathered in the parking lot of an empty pizza place by the Willamette River. As caregivers made picket signs, I moved off to the side to talk privately with Summer Trosko, a medical technician in her 40s with strong hands, thick black hair and olive skin.

There are always multiple leaders in a union drive, but often there emerges a leader of leaders. Ms. Trosko was that person. She had a moral core of quiet fury over what was happening to her residents paired with a deep compassion for her co-workers. I told her I didn’t think we could hold it together and strike with a majority. She thought we could. “When you step out and do the right thing,” she said, “the universe has your back.”

I’m always nervous the night before an action. All I want to do is eat lasagna and pace. In the days leading up to the strike, we’d continued to release videos that the workers had made about their experiences, but the next day we would be in a very different media environment. The first group that had reached out to support the strike was the local chapter of the Socialist Rifle Association, a left-wing pro-gun group. We thanked them profusely and begged them not to wear anything to the picket line that revealed their affiliation. Not only did we not need signs reading, “The Socialist Rifle Association Supports Memory Care Workers,” but we did not need the Proud Boys, who, in Oregon, would almost certainly follow.

Health care strikes are not like other strikes. Because of the nature of the work, caregivers, who are almost all women and often people of color, cannot just walk off the job. They must give 10 days of notice so that the employer has time to hire replacement workers from staffing agencies, frequently paying them double the wages of the employees they are replacing.

One great disadvantage for the strikers was how easily they could be replaced. Assisted living and residential care is an underregulated industry: Oregon requires no certification for caregivers in memory care facilities. Med techs like Ms. Trosko can be hired off the street with zero experience on a Monday and pass out Schedule II drugs like OxyContin and morphine by Thursday. And even if the Falks paid double for replacements for strikers, that meant only around an extra $12 to $16 an hour for roughly two dozen workers.

A local pizzeria was a meeting place for strikers.
A local pizzeria was a meeting place for strikers.
A blanket made by a deceased resident of the Rawlin.
A blanket made by a deceased resident of the Rawlin.

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The morning the strike began, a picket line formed in front of the Rawlin. At the last moment, Local 503 members had voted to support the strikers with picket pay at $100 a day, a figure that still amounted to a loss for many of the workers. People moved in a loose circle, made looser by social distancing. By midmorning, activists, church members and workers from other unions joined the picket line.

All day long, the striking workers cleared the driveway to make way for their replacements, many of whom wore union stickers as a show of support. Some members of the original staff also drove through, taking fliers and apologizing, unable to look the strikers in the eye. Zack Falk rolled back and forth through the picket line in a glossy sports car. A man who worked for Onelife appeared to videotape the picket line — just one of many actions taken by the company that workers believed were threatening. Employees reported being told they would not be able to return to their jobs if they went on strike, and two workers said they were cornered by management before the strike. (Mr. Falk denies these allegations.)

But protections around the right to organize are largely nonexistent. It’s extremely difficult to meet the labor board’s criteria for a ruling against an employer. In general, a complainant must first prove that managers knew that he or she was organizing and that their intent was to retaliate. As police-reform activists know, intent is very hard to prove. Even if you provide sufficient evidence in the form of a miraculous damning email, the process is slow and the remedies generally toothless — certainly not strong enough to stop an employer from doing it again.

We filed two charges against Onelife alleging coercion, among other things, but we did not expect either to stick and eventually withdrew them. Had they been affirmed, they may have resulted only in notices being posted inside the Rawlin.

On the fourth night of the strike, picketers organized a candlelight vigil for the residents who had died. Candlelight vigils sometimes irk me because so often that’s how women are forced to perform sainthood to wring change out of a public terrified of their anger. Put simply, I have never seen the union that represents street maintenance workers hold a candlelight vigil over traffic deaths. In this case, though, the vigil was an act in total earnest. The caregivers, who had been so close to the residents, in some cases closer than their families, hadn’t really had a place to come together and grieve.

People gathered on the wet grass, holding umbrellas. Under a pop-up tent were candles with the room numbers of the deceased written on them. Caregivers shared what memories they could, but since medical privacy rules prohibit the use of names and details, much of it was coded, a language only intelligible to the workers. In tones that rose and fell, they said, “That one was my best friend”; “he was a wonderful man”; “she was a feisty little thing”; “they are our family.”

Ms. Trosko told the crowd the workers would strike for 10 more days. I have often wondered what makes people fight when they suspect they aren’t going to win. Here, I knew. It was for the residents.

Iwish I could say that the Rawlin workers got their union, but they didn’t. The strike lasted for 14 days, after which many of the workers who were on strike decided to quit together. About 12 employees marched over to the facility and handed in their resignation letters in person. Ms. Trosko said it felt great.

Elizabeth Roby
Elizabeth RobyCredit…Clayton Cotterell for The New York Times

For reasons I don’t fully understand, the things that usually mark a loss after campaigns like these didn’t happen. All the things that come with winning did. One worker got her driver’s license, another left an abusive relationship and at least two more went back to school. Elizabeth Roby, who had moved from Panda Express into the care industry, decided to train to become a certified nursing assistant. Ms. Gregory refused to work for under $15 an hour at her next job, and later joined Mr. Holmes at the facility where he landed. They are now making $16 an hour.

Ms. Trosko and another med tech, Hermes Ochoa, traveled around the state talking to lawmakers and their constituents about the need for more transparency and oversight in the memory care industry. Thanks in part to their efforts and the media attention drawn by the strike, the Rawlin had to respond to queries about allegations of neglect and inadequate staffing from the Oregon Department of Human Services and the county’s Adult Protective Services unit, whose employees are members of S.E.I.U. Local 503, the union organizing the Rawlin. (Mr. Falk said Onelife was inundated with an unprecedented number of complaints during the strike, and believes workers were trying to tarnish Onelife’s reputation.) More than a dozen allegations of neglect were substantiated.

I have a list of things I would do differently next time, but I don’t regret the choice to strike for recognition. The retaliation that workers reported experiencing over the month of the campaign — harassment, threats, surveillance — would have likely taken place over two to six months if we had waited for an election, and, given the size of the staff and the rate of turnover, the workers still would have lost.

Labor law functionally ceased to protect the right to organize decades ago, and a simple reinstatement of the rules around “timely elections” is not going to fix that, but there is one change that might. In late summer, the new general counsel at the labor board put out a memo expressing interest in potentially returning to the Joy Silk doctrine, the standard discarded around 1970. If Joy Silk had been the law when subsequent generations tried to organize, Amazon, Starbucks and Whole Foods might have all gone union 10 to 20 years ago. And if Joy Silk had been the standard when caregivers at the Rawlin organized last winter, Ms. Trosko and her co-workers could have had their union soon after they turned in their cards.

Maybe the Rawlin campaign felt like a win because the workers held their majority and finally spoke out about things that bothered them, but I now think that it had more to do with having a choice. All along, Ms. Trosko and the others made choices about what their labor was worth and what they would do with it. They chose to organize together. They chose to strike together. They chose to quit together because they would not use their labor to support a facility that they felt did not care how residents lived or died. The memory care workers did not become a union, but they acted like one.

Vanessa Veselka is a former labor organizer and author of the novels “The Great Offshore Grounds” and “Zazen.” Clayton Cotterell is a photographer and director.

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