Unionized staff at Providence Hospice of Sonoma County in California have reached a labor agreement with their employer. The deal marks another instance of growing union activity in the hospice space.

Unionization is uncommon in hospice, but local media reports in some communities show that the movement has gained some ground. Hospices that are affiliated with larger health systems, like Providence, may be more likely to see staff participate in labor unions.

The Providence hospice workers include 130 registered nurses, social workers, and other staff who joined the National Union of Healthcare Workers (NUHW) in January 2023.

“This is a big step toward making our work sustainable and making sure that members of our community get the care they deserve during one of the most difficult times of their lives,” an unidentified Providence worker said in a press release. “Now we can see the power we have as union members, and we have to keep fighting to win our first contract and make Providence keep care in our community.”

According to NUHW, their agreement with Providence includes:

• Clear caseload limits for RN Case Managers (12-13 patients) and social workers (26 patients)
• A fair process for assigning excess case management duties on a volunteer basis, along with offering overtime before any supervisors do case management
• An additional 5% pay increase for anyone who takes on additional case management duties
• Backpay for nurses who took on additional case management duties during the past year, ranging from $1,500 to $5,000, along with a $1,000 bonus for all social workers in recognition of their caseloads
• An agreement that Providence will post and email all workers a notice of their legal rights as union members

Home health employees at sister organization Providence Sonoma HomeCare also recently voted to unionize with NUHW, adding to the number of the health system’s workers who have joined. A number of the system’s hospital employees also belong to the union.

Workers from Oregon-based Providence Home Health and Hospice, also part of the Providence Health System, decided to unionize in March 2023 with the Oregon Nurses Association (ONA).

This is the latest in a series of unionizations among hospice and palliative care workers, particularly in California and Oregon.

Labor pressures have haunted hospice and palliative care providers nationwide for several years running, only to be exacerbated by the COVID-19 pandemic. But these pressures also put strains on employees trying to keep up with demand. Increasingly, clinicians are moving towards unionization.

In January, palliative care physicians at Providence St. Vincent Medical Center in Oregon voted to join the Pacific Northwest Hospital Medicine Association (PNCHMA) labor union. This followed the unionization of more than 70 doctors at another Oregon health system, Cedar Mill Hospital.

In late December 2023, home health and hospice nurses at Oregon’s PeaceHealth Sacred Heart health system threatened to strike unless they receive wages that are comparable to the hospital’s inpatient teams.

Also last year, about 1,500 hospital workers at Sharp Grossmont Hospital in California voted to unionize with the Service Employees International Union, and employees from the affiliated Sharp HospiceCare followed suit in April.

Also in Oregon, nurses at St. Charles Home Health and Hospice in Bend joined ONA in late 2022 to negotiate for improved working conditions, compensation and other issues.