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FIRST ON FOX: California nursing homes with unionized staff received lower average federal quality ratings than facilities without confirmed union presence, according to a new report.
“Union presence in a CMS-certified registered home appears to lower its CMS rating by almost 10 percent,” a new report published by the Center for Union Facts (CUF), a right-of-center organization critical of organized labor, reviewed by Digital found.
The Department of Health and Human Services, through its Centers for Medicare and Medicaid Services, scores nursing homes on a five-star scale based on how well they perform on health inspections, the number of staff present relative to patients, how much care patients are provided and the overall quality of care residents receive.
The CUF analysis of federal CMS nursing-home ratings found that California facilities with unionized staff received ratings roughly 10% lower on average than facilities without a union presence, even after the study controlled for median county household income.
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Members of the 32BJ SEIU union and their supporters rally on Park Avenue in New York City on April 15, 2026. (Seth Wenig/AP)
Non-union facilities averaged 3.17 stars, compared with 3.02 for unionized facilities, 2.96 for SEIU-unionized facilities and 2.86 for facilities represented by SEIU Local 2015, which represents long-term care workers in California nursing homes and home-care settings, according to the report. After accounting for the income of the surrounding area, CUF found that unionization corresponded to a rating decrease of roughly 0.3 stars.
CUF argued the ratings gap warrants scrutiny of the Service Employees International Union’s (SEIU) role in California long-term care, pointing to prior allegations about the union’s internal culture and workplace disputes as a possible explanation for the discrepancy in ratings.
The report does not establish that union representation caused the lower ratings. Some studies have found that unionization at healthcare facilities does improve patient outcomes.
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“Overall, it is difficult to say for certain that unionization is the direct cause of these lower ratings, but this is hardly an isolated trend,” the CUF report stated. “A previous, similar report by the Center for Union Facts found that hospitals unionized with the SEIU had a star rating that was almost a full star lower (out of five stars) compared to non-union hospitals.”
CUF identified unionized facilities by reviewing union materials, online publications and National Labor Relations Board union-election records dating back to roughly 2006, according to the report. Facilities with no identified evidence of unionization were treated as non-union during the analysis.
Unionized workers march in the 2012 Toronto Labor Day Parade in Toronto, Canada, on Sept. 3, 2012. (Getty Images)
The report pointed to California labor unions’ past “history of abuse of their members,” including Chaquan May, a former long-term care worker and plaintiff in a Freedom Foundation-backed lawsuit against SEIU Local 2015.
May alleged in a sworn statement that union representatives coerced her and other workers in 2023 into signing membership forms, including by keeping them in a room until everyone signed.
“We’re waiting for everyone to sign … no one is leaving until everyone signs,” May quoted one union representative reportedly saying at the time.
The SEIU did not respond to a request for comment when reached by Digital. Digital additionally reached out to May’s attorneys and CMS for additional comment.
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CUF also argued that the potential for union-led strikes could negatively impact care for nursing home residents.
An SEIU representative speaks at the May Day march in Los Angeles, Calif., on May 1, 2026. (LB for Digital)
“Bad policy ideas and bad leadership are a dangerous combination,” CUF communications director Charlyce Bozzello told Digital. “It’s not just workers who can pay the price — it’s our most vulnerable loved ones. This new data raises a serious question: would you trust your grandmother in an SEIU-organized facility?”
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The report comes as California’s long-term care system is under federal scrutiny. CMS deferred more than $1 billion in Medicaid funding tied to the state’s in-home support services program — a move California officials have condemned as unlawful and harmful to vulnerable residents but federal officials deem necessary to root out fraud.
The SEIU has historically been a major supporter of the Democratic Party. During the 2024 presidential election, for instance, the union spent tens of millions of dollars in independent expenditures and contributions to help Democrats win elections, in addition to spending a purported $200 million on internal voter mobilization efforts to support liberal candidates for that cycle.
A previous Center for Union Facts report found that SEIU-unionized hospitals in California also received lower ratings from CMS.
