title: California nursing facility quality and union environments.
abstract: OBJECTIVE
  Many studies have examined quality effects of nursing facility (NF) staffing, but few have examined effects of unionization. Concerned with possible effects of unionization on quality, we analyzed unionization and local market climate of unionization, predicting both complaints (reflecting either quality problems or better monitoring and advocacy) and the substantiation of serious complaints (indicating major quality problems).
  
  
  METHODS
  Data were analyzed on California freestanding NFs in 1999 (N = 1,155). OLS regression was employed to predict both quality complaints and serious violations, the latter both controlling and not controlling for numbers of complaints.
  
  
  RESULTS
  Unionized NFs showed more complaints than did non-unionized NFs. Non-unionized NFs had more serious violations, particularly when the proportion of other county facilities unionized was higher.
  
  
  CONCLUSIONS
  These findings suggest that unionization enhances problem reporting while, especially in stronger union environments, reducing the incidence of serious quality violations.
authors.affiliation: University of North Texas, Denton, USA.
authors.forename: James H
authors.initials: JH
authors.lastname: Swan
authors.forename: Charlene
authors.initials: C
authors.lastname: Harrington
mesh_terms: D002140:California; D006272:Health Facility Environment; D006801:Humans; D007750:Labor Unions; D009735:Nursing Homes / Q000458:organization & administration*; D011787:Quality of Health Care; D012044:Regression Analysis