Pleasant Hill Health Workers Strike to “Save the Heart and Soul of this Hospice”

There was chanting and music, and spirits were high at the Hospice East Bay picket line on July 29 in Pleasant Hill, as nurses, social workers, and bereavement and spiritual care counselors went on a one-day strike in pursuit of their first union contract.

Judy Fleischman, a spiritual care counselor, stood back and took in the scene and told me that all of this — the picket line winding along the sidewalk, the homemade signs, the coffee and the baked goods on the fold-out table — represented “the circle of care and community” that striking workers were fighting to defend.

“We’re here to save the heart and soul of this hospice,” Fleischman said. “It’s one of the last not-for-profit hospices. That really means something not only to those of us who serve here, but also to the community. And without a fair contract, we can’t do that.”

Workers at Hospice East Bay (HEB) see their workplace as one of the last holds of high-quality, not-for-profit, community-centered hospice care that supports terminally ill people and their families. Workers see their jobs as providing end-of-life care that puts “patients before profits,” in the words of their chants and picket signs. Since they first formed a union with the National Union of Healthcare Workers (NUHW) in 2023, they’ve been fighting for a contract that provides fair pay and benefits and guarantees the staffing ratios that they say are necessary for providing compassionate care.

“We’re in people’s homes while they’re dying. It’s really profound work, but it also has high rates of burnout. And [management will] praise us in a meeting or praise us in an advertisement, but then turn around and stab us in the back at the bargaining table.”

Management has taken a hard line from the beginning, workers told me. They said that HEB has made unilateral cuts to staffing and patient care, withheld merit-based pay-raises, and insisted on bargaining during the workday — when few workers are able to attend. Their union has filed several Unfair Labor Practice charges (HEB declined to comment on these accusations).

“It’s unfair labor practice after unfair labor practice. That’s why we’re here today,” said Jill Tobin, a registered nurse case manager and member of her union’s bargaining committee. “We’re in people’s homes while they’re dying. It’s really profound work, but it also has high rates of burnout. And [management will] praise us in a meeting or praise us in an advertisement, but then turn around and stab us in the back at the bargaining table.”

Every worker I spoke with mentioned this dissonance on the part of management: in public, a commitment to quality care, but at the bargaining table, a cynical refusal to guarantee the fair working conditions — especially staffing ratios — that make that care possible.

“We need safe staffing ratios to protect our community,” said Tobin. “If I don’t have enough time in my day to do the right thing, I’m in a terrible daily moral conundrum.” Workers understand their workplace conditions as synonymous with patient conditions.

Workers are concerned that HEB’s impending affiliation with Chapters Health System, a national chain of hospices, will lead to increased caseloads, reduced benefits, and compromised care — if they aren’t able to win a contract that protects their working conditions. Chapters, which is slated to take over in August (pending approval of the affiliation by the California Attorney General’s Office), is a “not-for-profit” organization, but, as NUHW recently noted in a press release, Chapters markets itself online as aiming to “maximize administrative resources and minimize expenses” at its hospices.

Workers on the picket line told me they had spoken to workers at other Chapters locations, who reported increased healthcare costs and cuts to staffing after their affiliation with the national organization.

“There’s a trend of monopolization in the hospice field,” said Tobin. “We’re facing an affiliation with Chapters, which is an out-of-state affiliation. We don’t know if they care about patient care. We don’t know if they care about our community.”

Even though the takeover hasn’t been formalized yet, workers said they’re already seeing increased caseloads and cuts to staffing. In December, HEB’s music therapy program was abruptly eliminated, leaving both staff and patients in the lurch. Fleischman told me that she saw this sudden cutback as “a betrayal of the trust of patients and their families” and “an example of what it means to lose the heart and soul of what [hospice] is about.”

In a phone call, HEB spokesman Rico Marcelli emphasized that Chapters is not-for-profit and said that HEB workers had recently spoken in support of the affiliation at a public hearing. That support, however, was conditional: transcripts of the hearing, provided to Current by HEB, show that workers expressed support for the affiliation on the condition that present-day staffing ratios and caseloads be maintained.

HEB workers aren’t alone in their predicament. In recent years, large conglomerates and private enterprises have snapped up huge numbers of formerly small and not-for-profit hospice centers across the country, cutting costs by firing staff and lowering standards of care.

But they also aren’t alone in fighting back: their strike follows a two-day strike at two hospice centers in Sonoma County — Memorial Hospice in Santa Rosa and Hospice of Petaluma — last month. Workers at these centers also formed unions through NUHW in 2023 and are fighting for their first contracts in the face of rising caseloads, reduced staffing, and an imminent merger between their parent company, Providence, and the private-equity-owned firm Compassus. In Oakland, healthcare workers at UCSF Benioff Children’s Hospital recently concluded a two-week strike that made similar demands and targeted a similar enemy: UCSF, a “public” institution that workers see as increasingly profit-driven.

Over 18 months of negotiations, HEB workers told me, the power of a strike has become very clear. “The only thing that seems to get the employer to bargain with us is if we threaten a strike,” said Rev. Claire Eustace, a chaplain and spiritual care counselor. Eustace explained that at several junctures, when management tried to stall or renege on its commitments, workers managed to jumpstart the process by credibly threatening to strike.

Now, with management refusing to agree to maintain current staffing ratios, offering only a 0.5% percent raise for next year, and insisting on its right to unilaterally slash worker benefits, workers have made the strike threat real. Of their bargaining unit of roughly 80 workers, 80% committed to participating in the strike.

In a clear sign that management was taking notice of the strike, a police officer showed up around 9 am, three hours into the picket, and threatened to declare an unlawful assembly if workers did not vacate a small strip of lawn between their workplace and the sidewalk. “We’re workers,” a worker at the food table sternly informed him. “This is where we work. We have the right to be here.”

“Our hearts feel lifted,” said Fleischman, “because we are stakeholders in a circle of care and community. To really care and to voice what’s really the trouble in our midst is important.” Dawn Torre, a children’s grief counselor, added. “This is my very first strike, so it’s sort of a learning experience for me. But throughout this whole process of trying to unionize, I’ve gotten to know so many more people, and we have so much more in common than we have that has separated us.”

In a clear sign that management was taking notice of the strike, a police officer showed up around 9 am, three hours into the picket, and threatened to declare an unlawful assembly if workers did not vacate a small strip of lawn between their workplace and the sidewalk. “We’re workers,” a worker at the food table sternly informed him. “This is where we work. We have the right to be here.” The officer left after several lawn chairs were moved from grass to pavement. The picket continued uninterrupted.

“What is to be accomplished by telling us that we cannot be on the grass?” Fleischman asked rhetorically afterwards. “What that’s saying is: we don’t see you as stakeholders.”

It remains to be seen whether HEB’s management will change their way of seeing things in the aftermath of the strike. Either way, workers say they're ready. 

“This is a one-day strike, but it’s not over today,” said Tobin. “We’re going to get a fair contract because our working conditions are intrinsically tied to patient care…. The union contract that we are determined to get will protect that patient care, today and in the future.”