South Hills Health System Home Health Agency

National Labor Relations Board - Board Decisions

Feb 16, 2000

330 N.L.R.B. 653 (N.L.R.B. 2000)

SOUTH HILLS HEALTH SYSTEM AGENCY 653
Jefferson Health System, d/b/a South Hills Health
System Home Health Agency, and Family Hos-
pice, a wholly-owned subsidiary of South Hills
Health System and South Hills Home Care
Nurses Association/PSEA Health Care, Peti-
tioner. Case 6–RC–11756

February 16, 2000

ORDER DENYING REVIEW
BY CHAIRMAN TRUESDALE AND MEMBERS FOX AND
BRAME
The National Labor Relations Board has delegated its
authority in this proceeding to a three-member panel,
which has considered the Employer’s request for review
of the Regional Director’s Decision and Direction of
Election (pertinent parts of which are attached as an ap-
pendix). The request for review is denied as it raises no
substantial issues warranting review.1 See generally
Charter Hospital of Orlando South, 313 NLRB 951
(1994).

APPENDIX
DECISION AND DIRECTION OF ELECTION
As amended at the hearing, and in its posthearing brief, the
Petitioner seeks to represent in a single unit all registered
nurses including medical surgical nurses, mental health nurses,
IV nurses, rehabilitation nurses, and intake nurses employed by
the Employer at its Pittsburgh, Pennsylvania facilities and other
branch facilities located in Western Pennsylvania, excluding
guards, other professional employees, and supervisors within
the meaning of the Act. The Employer contends that the peti-
tioned-for unit is inappropriate in terms of composition, and
that the only appropriate unit is a unit composed of all profes-
sional employees, including registered nurses, and nonprofes-
sional employees employed by the Employer. In the alterna-
tive, the Employer argues that the only appropriate unit is a unit
composed of all professional employees of the Employer.
The Petitioner does not seek to represent the nonprofessional
employees of the Employer on any basis, and it would not pro-
ceed to an election in a combined professional-nonprofessional
employee unit.1 In the alternative, the Petitioner would seek to
represent all professional employees of the Employer, if that
unit was found to be the sole appropriate unit for collective-
bargaining purposes. There are approximately 200 employees
in the petitioned-for unit, and approximately 240 employees in
an Employer-wide all professional employee unit.2 There is no
history of collective bargaining for any of the employees in-
volved herein.

1 The only issue raised in the request for review is whether the Re-
gional Director erred in finding appropriate the petitioned-for unit of
registered nurses in a nonacute healthcare setting.
1 Sec. 9(b)(1) of the Act provides that professional employees may
not be included in a bargaining unit with nonprofessionals unless they
vote in favor of such inclusion. In Leedom v. Kyne, 249 F.2d 490 (D.C.
Cir. 1957), the District of Columbia Court of Appeals construed the
limitation in Sec. 9(b)(1) as intended to protect professional employees
and held that the professionals’ right to this benefit does not depend on
Board discretion or expertise and that the denial of this right must be
deemed to result in injury. The United States Supreme Court, at 358
U.S. 184 (1958), affirmed this ruling. The operative effect of Sec.
9(b)(1) is that a mixed professional-nonprofessional employee unit
cannot be found, as a matter of law, to be the sole appropriate unit for
collective-bargaining purposes. Otherwise, the statutory limitations set
forth in Sec. 9(b)(1) would be without meaning since professional
employees would either have to be represented as part of an overall unit
or not at all. In this case, no labor organization is seeking to represent
the Employer’s nonprofessional employees on any basis. Thus, the
question of whether a mixed unit of the Employer’s professional em-
ployees and nonprofessional employees is appropriate is not an issue to
be decided, and I therefore find it unnecessary to consider in any fur-
ther detail the Employer’s contentions in this regard. The Employer’s
reliance on the Board’s decision in Upstate Home For Children, 309
NLRB 986 (1992), in support of its mixed professional-nonprofessional
unit contention is misplaced. In that case, the Board found that separate
petitioned-for units limited to registered nurses and licensed practical
nurses were inappropriate since other professional and nonprofessional
employees shared a community of interest with the RNs and LPNs
respectively. The Board did not hold that if the petitioner desired to
represent the RNs, it had to do so only if the RNs were included in an
overall unit with nonprofessional employees.
SHHS is a Pennsylvania not for profit corporation and is a
large, complex health organization with a number of subordi-
nate entities, engaged in the provision of health care services in
the Western Pennsylvania area. Subsidiary nonprofit corpora-
tions of SHHS include Family Hospice, Long-Term Care Ser-
vices Corporation, Health System Service Corporation, Jeffer-
son Diversified Health Service Corporation, and JHS. SHHS is
under the overall supervision of Executive Vice President and
Chief Operating Officer Gary Perecko. Reporting to Perecko
are, inter alia, Judith Talbert, executive director of Family Hos-
pice and Gary Retone, executive director of Home Health.
SHHS is basically a management and service corporation
which provides a variety of services to its subsidiary corpora-
tions, including administrative services, management services,
and other support services.
The operations of SHHS and its subsidiary corporations are
primarily located on two campuses, commonly referred to as
the Jefferson Campus and the Homestead Campus. The Jeffer-
son Campus is located in Jefferson Borough, in the South Hills
section of Allegheny County, Pennsylvania. The main building
on the Jefferson Campus is Jefferson Hospital, which is a five-
story acute care facility. It appears that SHHS maintains its
offices on the Jefferson Campus.
The Homestead Campus is located in Homestead, Pennsyl-
vania, in the eastern section of Pittsburgh, Pennsylvania, ap-
proximately 12 to 15 miles to the northeast of the Jefferson
Campus. A number of buildings are located on the Homestead
Campus, including a five-story structure formerly known as
Homestead Hospital and now designated as Building 24. Home
Health’s administrative offices are located on the fifth floor of
this structure.3
In addition to its administrative office, Home Health main-
tains five branch offices located in the Western Pennsylvania
area, the Homestead branch office, which is also located on the

2 Although the record is not entirely clear, it appears that the Em-
ployer is one of a number of business units.
3 These administrative offices include offices for management and
administrative personnel, the central intake department, the utilization
review department, and the allied health department.
Other operations located at the Homestead Campus include, inter
alia, a primary care facility, an emergency health care facility, a skilled
nursing facility, and a personal care residence.
330 NLRB No. 107
DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD 654
5th floor of building 24; Robinson Township; Monroeville;
McMurray; and Pleasant Hills, which is located on the Jeffer-
son campus.
Family Hospice is not located at either the Jefferson or
Homestead campuses, but is rather located in Castle Shannon, a
suburban area adjacent to the southern part of Pittsburgh.4
Home Health is licensed by the Commonwealth of Pennsyl-
vania to provide health care, including nursing and allied health
services,5 to patients in their homes or residences. Home
Health is certified by Health Care Finance Administration
(HCFA) as a Medicare certified home health agency.6 Family
Hospice is a licensed Medicare hospice and home care provider
that provides health care services to terminally ill patients, and
a variety of “end of life” services to these patients and their
families. These services take place in patients’ homes, nursing
homes, hospitals, and hospices.7
Home Health
As noted, with respect to Home Health, although patient care
services are provided in patients’ homes, its administrative
operations are located in building 24 of the Homestead Cam-
pus. Reporting to Home Health Executive Director Gary Re-
tone are: Lynn Setar, Director of Client Relations; Susan Nav-
ish, Director of Administration & Managed Care Services; Jill
Johnson, Director of Clinical Operations; Christine Heasley,
Director of Quality Management; JoAnn Parzick, Consultant
for Special Projects; and Janet Rice, Financial Analyst. Report-
ing to Jill Johnson are the directors for each of Home Health’s
five branch offices. In addition, reporting directly to Johnson
are Donna Westerbeck, Manager of Rehabilitation; Jan
Muschar, Manager for Social Work/Mental Health Nursing;
Susan Keitzer, Manager of IV Therapy; and Patricia Ginsberg,
enterostimal therapy.8 Each branch office also has a clinical
supervisor and a manager of operations, or patient care man-
ager.9 The clinical supervisors are responsible for supervising
patient care and managing care delivery teams. The patient
care manager is responsible for managing authorization and
reauthorization of care from the payee’s standpoint. Each

4 Family Hospice was “formed” in the early 1970s by a consortium
of institutions including SHHS, Mercy Hospital, St. Clair Hospital, and
South Hills Health Ministries. It formally became a subsidiary of
SHHS in 1991. Family Hospice has its own Board of Directors which
includes the chief financial officer of SHHS, a representative from
Mercy Hospital, St. Clair Hospital and South Hills Health Ministries,
respectively, and 10 other “at-large” positions.
5 Allied health services include physical therapy, occupational ther-
apy, speech therapy, mental health nurses and social work services.
6 Approximately 3000 patients located in the Employer’s geographi-
cal service area receive approximately 270,000 visits from Home
Health personnel annually.
7 Approximately 10 percent of Family Hospice’s patients receive pa-
tient care services pursuant to Family Hospice’s home care license.
These patients are all terminally ill but receive home care health ser-
vices, rather than hospice services, because of the nature of some of the
services received, e.g., chemotherapy, which serves are not covered by
Medicare if an individual is in a hospice program.
8 The parties stipulated, and I find, that the aforementioned individu-
als, with the exception of Ginsberg, are supervisors within the meaning
of the Act, inasmuch as they possess one or more of the authorities
enumerated in Sec. 2(11) of the Act.
9 The parties stipulated, and I find, that the branch directors, clinical
supervisors and managers of operations are supervisors within the
meaning of the Act, inasmuch as they possess one or more of the au-
thorities enumerated in Sec. 2(11) of the Act.
branch office also has group facilitator, who is a registered
nurse and who is primarily responsible for providing care to
patients and coordinating care among care delivery teams, and
for performing certain other tasks, such as telephoning physi-
cians and laboratories.
Each branch office has assigned to it approximately 25 RNs,
approximately 8 nurses aides, and approximately 2 to 3 clinical
employees. There are a total of approximately 130 RNs em-
ployed at the various branch offices. These RNs are designated
as staff medical surgical RNs. In addition to these staff regis-
tered nurses, Home Health employs 5 or 6 IV RNs who report
to Suzanne Keitzer, manager of IV therapy; approximately 18
to 20 mental health RNs who report to Jan Muschar, manager
social work/mental health nursing; approximately 25 rehabilita-
tion nurses who report to Denna Westerbeck, manager of reha-
bilitation, and an enterostimal therapy RN, Patricia Ginsberg,
who reports directly to Johnson. Ginsberg, the IV therapy RNs,
the rehabilitation RNs and the mental health RN all perform
direct patient care functions and work in the geographical areas
serviced by one or more of the branch offices.10 In addition to
the aforementioned nurses, Home Health employs at its admin-
istrative offices five intake RNs who are responsible for proc-
essing new patient referrals, e.g., ensuring the referral is appro-
priate, obtaining information pertaining to each patient’s physi-
cian(s) and medications, processing insurance and assigning
patients to a specific branch office for care. These intake RNs
report to JoAnn Parzick, consultant on special projects.11 All of
Home Health’s RNs are paid at an hourly rate, between $16 and
$22 per hour.12
In addition to the RNs, it appears that Home Health’s profes-
sional staff consists of 2 salaried account representatives, who
report to Lynn Setar, Director of Client Relations,13 4 occupa-
tional therapists, 18 physical therapists and 4 speech therapists
who ultimately report to Denna Westerbeck;14 and 4 social
10 The parties are in agreement that the medical surgical staff RNs,
the IV therapy RNs, the mental health RNs, the rehabilitation RNs, and
the enterostimal RN should all be included in the unit.
11 The parties are in agreement that the intake nurses should be in-
cluded in the unit.
12 Two other RNs work at Home Health’s administrative offices at
the Homestead Campus. Suzanne Resetar is a specialist of clinical
systems who is responsible for developing education and training pro-
grams for Home Health’s staff, and Margaret Santoro is the utilization
review nurse. Both Resetar and Santoro report to Christine Heasley,
director of outcome facility management. The record is not clear,
whether the Petitioner seeks to include Resetar and/or Santoro in the
unit. Accordingly, I shall permit Resetar and Santoro to vote subject to
challenge in the election directed here.
13 The two account representatives perform marketing functions,
e.g., they are responsible for going to physician offices and other facili-
ties to speak about the services offered by Home Health. The account
representatives do not engage in direct patient care work.
14 The occupational therapists and physical therapists report to team
leader Lisa Simon, while the speech therapists report to team leader
Gerry Petro. Both Simon and Petro report to Westerbeck. The occupa-
tional therapists, speech therapists, and physical therapists, together
with the rehabilitation nurses, work out of Home Health’s Allied Health
Services department located at the Homestead Campus. Employees
occupying these positions receive patient care assignments in geo-
graphical areas covered by one or more of the branch offices. Home
Health also uses the services of a number of independent physical
therapists, occupational therapists, and speech therapists. The parties
are in agreement that these independent contractors should not be in-
SOUTH HILLS HEALTH SYSTEM AGENCY 655
workers who report to Jan Muschar, manager social
work/mental health nursing. As noted, the Petitioner, contrary
to the Employer, would exclude these positions from the peti-
tioned-for unit.15
Once a patient referral is initially processed at the Home-
stead Campus, it is assigned to a branch office nearest the pa-
tient. Each branch office has a number of delivery teams com-
prised of staff RNs, aides and, to the extent necessary, person-
nel from each discipline, e.g., the various therapist occupations
and/or social workers, and the specialized nurse occupations
(IV nurses, mental health nurses, rehabilitation nurses, and the
enterostimal nurse).16 The record reveals that each patient has a
designated primary service provider (PSP) who is responsible
for assessing the patient, developing and changing the plan of
care, making necessary references, completing the bulk of the
paperwork, and for facilitating interdisciplinary communica-
tions between the staff RNs and the other occupational
groups.17 Usually, the PSP is a staff RN, but in some cases the
PSP may be from another nursing occupational group or from
one of the therapist or social worker occupational groups. Each
discipline, however, is responsible for providing an assessment
of each patient receiving any specialized care, and for meeting
goals and communicating with the patient’s physician regarding
a plan of treatment.18 It appears that approximately 50 percent
of the patients receive care from multiple disciplines, with a
small number receiving care from all of the various disci-
plines.19

cluded in the unit. The independent therapists conduct between 30 to
40 percent of the therapy visits.
15 The parties stipulated that the account representatives, occupa-
tional therapists, speech therapists, physical therapists, and social
workers are professional employees within the meaning of the Act.
16 According to Home Health, the multidisciplinary team approach to
patient care is mandated by the Joint Commission on the Accreditation
of Health Care Organizations (JACHO) which requires that all of Home
Health’s services be coordinated, and that the services meet its stan-
dards.
17 In addition, each branch office also employs a group facilitator to
help coordinate care aspects of home care. For example, a group facili-
tator would call a patient’s physician to procure a walker or cane for the
patient as requested by physical therapy. By way of further example, a
group facilitator would call to request the use of an aide on behalf of
either a physical therapist or another RN for the purpose of bathing and
providing personal care.
18 The social workers, all of whom have master’s degrees in social
work, address the psycosocial needs of the patient and the patient’s
family. Mental health RNs deal with the psychiatric and psychosocial
aspects of patient care, e.g., depression which results after a major
change in a patient’s health condition.
When the PSP makes the initial assessment of a patient, it may be
determined by the PSP that employees from other disciplines are also
required to provide care. For example, if a patient has skin problems,
the enterostimal nurse would be included on the delivery team, or, if the
patient lives alone or appears to have been abused or neglected, a social
worker may become involved. A physician’s order is necessary before
such additional care can be added.
19 The patients who do not receive specialized care, approximately
50 percent of the patients, only receive direct care from the staff RNs
and the aides. In many other cases, only a social worker may be as-
signed to a patient in addition to a staff RN and aides. In this regard,
Margaret Reynolds, a staff RN, testified that of her 33 current patients,
only 4 are being seen by a physical therapist, and none are working
with an occupational therapist or a speech therapist. Similarly, another
staff nurse, LaVerne English, testified that of her current 20 patients, 3
The professional employees of the various disciplines do not
appear to interact with any degree of frequency on a day-to-day
basis. Usually, staff RNs visit the branch office each day, as do
the other professional nurses, therapists, and social workers,
who have patients in the branch offices’ geographical area. It
does not appear, however, that employees spend any significant
degree of time with one another at the branch offices. In addi-
tion, it appears that employees from the various disciplines are
discouraged from visiting the same patients on the same day.20
Further, the different care givers make their own scheduling
arrangements for patient visits.
The record reflects that the primary form of communication
among employees providing care to the same patient is the
Patient Interdisciplinary Communication Log (PIC Log) which
remains in the patient’s homes. This log provides a place for
caregivers to leave messages regarding the patient or plan of
care.21 In some instances, another form of communication
among the disciplines is the “case conference,” a meeting of all
employees giving care to a patient where particular problems
arise with respect to the patient, e.g., a patient is not reaching
the goals set by the individual team members.22 These confer-
ences are held for less than 25 percent of all patients.23 If a
team member cannot attend due to scheduling conflicts, the
team member must submit a verbal/written assessment of iden-
tified patient problems to their clinical supervisor prior to the
conference.
Family Hospice
Family Hospice employs approximately 14 RNs whom the
parties agree should be included in the unit. In addition, Family
Hospice’s professional staff24 appears to include 4 social work-
ers and 5 employees holding various administrative positions.25

or 4 require the services of a social worker and 4 require physical ther-
apy, while none require occupational or speech therapy.
20 There is a monthly schedule contained in the patient’s care folder
which is kept at the patient’s home. Each RN or other health profes-
sional is required to mark the calendar with anticipated dates of visits.
The calendar is also used to denote those times when physician ap-
pointments are scheduled and when any medical procedures (e.g., blood
work, chemotherapy) will be done.
21 Several staff RNs testified, however, that they do not use the PIC
Log on a regular basis.
22 For example, at one team conference held in December, 1999, at-
tended by a staff RN, an aide, a mental health RN, and an occupational
therapist, discussions ensued concerning the use of a glucometer and
about the patient’s medications because issues had arisen about the
patient’s blood sugar. As a result of the conference, the patient was
reassigned to a different PSP and a different staff RN.
23 For example, Lisa Simon, team leader for physical and occupa-
tional therapy, testified that she has not participated in any care confer-
ences in the last 12 months.
Each team conference is documented by a team conference record,
and is documented on the most recent progress note/flow sheet which is
contained in the patient’s care folder.
24 Family Hospice also employs two LPNs, six home health aides
and a number of clerical employees.
25 These positions include the development coordinator, a position
which is filled by Shirley Gautette, who is responsible for organizing
all special events such as golf benefits and for writing all of Family
Hospice’s publications. The person holding this position must possess
a bachelor’s degree. The parties stipulated that the development coor-
dinator is a professional employee within the meaning of the Act. The
parties also stipulated that two part-time employees, Tom Foreman and
Kirk Loadman-Copeland are professional employees within the mean-
ing of the Act. These employees provide spiritual care to patients and
DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD 656
As previously indicated, Family Hospice is a licensed Medi-
care hospice provider whose mission is to care for terminally ill
patients. Reporting directly to Executive Director Judie Talbert
are Michael Adametz, Manager of Business Services; Virginia
Valentine, Manager of Clinical Operations; Marty Tiani, Man-
ager of Development; Judie Speigel, Manager of Supportive
Service; and Kay Falkenham, Manager of Planning and Pro-
gram Development.26 Reporting to Manager of Clinical Opera-
tions Virginia Valentine is clinical supervisor Jo Ellen Deasy to
whom the RNs, aides, LPNs, and social workers report. Also
reporting to Deasy is Patty Hartman, a registered nurse who
acts as the intake coordinator for Family Hospice.27
At Family Hospice, services are also provided under a team-
based approach, with staff divided into two teams, with each
team having responsibility for patients within a specific geo-
graphical area. Unlike Home Health, an RN is always the pri-
mary care giver or care manager, and the team itself is com-
prised only of RNs, aides and at times a social worker.28 Be-
cause of the type of services rendered, volunteers and clergy
also assist staff members in providing palliative care in accor-
dance with Hospice Medicare benefits.29 More specifically, the
record reflects that when a patient is referred to Family Hos-
pice, an intake RN compiles as much information about the
patient as possible, including the patient’s condition, history
and family structure. The clinical supervisor, Deasy, then
schedules an RN case manager to make the initial patient visit.
The RN case manager will coordinate the care for the patient,
including spiritual care30 or volunteers, as needed. In this re-
gard, the case manager completes a series of paperwork includ-
ing paperwork to assist other RNs in dispensing medications, a
home health assignment form, and an initial spiritual assess-
ment form. Nursing flow sheets and pain assessment flow
sheets are also completed to document the patient’s condition
and are used by team members to coordinate and provide care.

their families and are required to possess a masters degree in divinity.
Finally, the parties stipulated that two employees holding community
liaison positions, Teresa Mervosh and Marjorie Wilder, and Marketing
Service Coordinator Michelle Dreyfus, are professional employees
within the meaning of the Act. Wilder is a registered nurse who also
functions as an intake nurse at Mercy Hospital. Dreyfus is responsible
for public relations for Family Hospice. The record is not clear
whether the Petitioner would exclude Wilder from the petitioned-for
unit. I shall, therefore, permit Wilder to vote subject to challenge in the
election directed herein.
26 The parties stipulated, and I find, that the aforementioned indi-
viduals are supervisors within the meaning of the act inasmuch as they
possess one or more of the authorities set forth in Sec. 2(11) of the Act.
27 It appears that the parties are in agreement that Hartman should be
included in the unit. Hartman works at Family Hospice’s administra-
tive office and performs all referrals and intake processing. There is
also a full-time RN, in addition to Wilder, who works at various hospi-
tals, primarily on the oncology floors, performing intake functions.
28 An interdisciplinary Group Care Plan is prepared for each patient
which has contributions from the Hospice medical director, RN case
manager, social workers, and attending physicians.
29 Much of the care Family Hospice provides occurs in acute care fa-
cilities, and Family Hospice is required to ensure that the plan of care is
being followed in the hospital. The care manager must coordinate the
services of Family Hospice with the hospital nursing staff, and other
staff, for those patients admitted to acute care facilities.
30 Social workers, in conjunction with clergy, provide bereavement
counseling to patients and their families.
Other Factors Relevant to the Unit Determination
SHHS’s Human Resources Department, which is located at
the Homestead Campus, serves all of SHHS’s operations, in-
cluding Home Health and Family Hospice. All personnel files
of Home Health and Family Hospice employees are kept there.
All employees of SHHS are subject to the same personnel poli-
cies which are set forth in SHHS’s employee handbook and
include such matters as timeclock/recordkeeping requirements,
orientation program, wearing of ID badges, and dress code and
attendance policies, codes of conduct, discipline program, work
reduction policy, uniform payroll periods, benefit programs, job
bidding, and transfer policies.
The record does not reveal any instances of Home Health
and Family Hospice RNs transferring between the two entities.
Further, the record does not reveal any instances of interchange
between RNs and other professional staff.
Analysis and Conclusions
The Petitioner, contrary to the Employer, contends that a unit
limited to RNs employed at Home Health and Family Hospice
is appropriate for the purpose of collective bargaining.
Neither Home Health nor Family Hospice are acute care
health care facilities. When determining the appropriate bar-
gaining unit for nonacute health care facilities, such as Home
Health and Family Hospice, the Board applies the “pragmatic
or empirical community of interest” test set forth in Park
Manor Care Center, Inc., 305 NLRB 872, 874–875 (1991). In
this regard, the Board will consider community of interest fac-
tors, and factors deemed relevant by the Board in its rulemak-
ing proceedings in collective-bargaining units in the health care
industry, the evidence presented during rulemaking with re-
spect to units in acute care hospitals,31 and prior precedent.
Specifically, the Board found during the rulemaking process
that RNs in acute care hospitals constitute a discrete group
because their distinctive interests warranted separate represen-
tation. The factors relied upon by the Board in making this
determination included: (1) unique work schedules, (2) unique
responsibilities, (3) common supervision by other nurses, (4)
separate labor market and distinct wages from those of other
professionals, (5) separate education, training and licensing
requirements, (6) interaction with other RNs, (7) lack of regular
and recurring contact with other professionals, (8) lack of inter-
change, and (9) history of representation and bargaining in
separate units. 53 CFR at 33911–33917, 284 NLRB at 1543–
1552.
Since Park Manor, the Board has not had occasion to con-
sider whether a unit limited to registered nurses at a nonacute
care home health facility, rather than a unit of all professional
employees, is appropriate for collective bargaining purposes.32
The Employer argues that a unit limited to RNs, apart from
other professionals of Home Health and Family Hospice, is not
appropriate because the RNs constitute only a segment of the
panoply of professionals interacting with one another to pro-
vide multidisciplinary team-based care to patients. Thus, the
Employer argues that this multidisciplinary team approach
31 See 53 CFR 33900 (1988) and 54 CFR 16336 (1989), set forth in
284 NLRB 1516, et. seq.
32 In Visiting Nurses Association of Central Illinois, 324 NLRB 55
(1997), the issue presented was whether a single facility, rather than a
multi-site unit of home health care registered nurses was appropriate.
The Board was not presented with the issue of whether other profes-
sional employees must be included in the unit.
SOUTH HILLS HEALTH SYSTEM AGENCY 657
demonstrates “an overwhelming degree of community of inter-
est” among the professionals at issue herein. More specifically,
the Employer argues that the utilization of PSPs, group facilita-
tors, and care managers to coordinate patient care, the PIC Log
process, and other forms of written communication and docu-
ments prepared for each patient clearly establishes the high
degree of functional integration of the work force.
For the reasons set forth below, I find that the petitioned-for
unit is appropriate for the purposes of collective bargaining. In
this regard, I first note that there are a number of professional
employees at Home Health and Family Hospice who the Em-
ployer seeks to include in the unit who do not provide direct
patient care services and are not part of any multidisciplinary
health care team.33 Further, unlike, the therapists and social
workers, RNs are paid by the hour and, generally, are the pri-
mary caregivers who are responsible for assessing the patients,
making necessary referrals, and developing and changing the
plans of care. Significantly, the record clearly establishes, as
set forth previously, that RNs are part of every delivery team,
while therapists and/or social workers are part of delivery teams
for approximately 50 percent of the patients. In addition, there
is little face-to-face contact between RNs and other profes-
sional groupings. There is little, if any, overlapping of time
spent with a patient.
Although social workers and therapists are part of the “team
approach” utilized by the Home Health and Family Hospice,
the argument made by hospitals during the rulemaking process
that a “team approach” compels a conclusion that RNs must be

33 E.g., the administrative assistants at Home Health, the mandatory
service coordinator, the development coordinator, and at least one
community liaison person employed at Family Hospice.
combined with other professionals was rejected by the Board.
Specifically, the background data reviewed by the Board in the
rulemaking process revealed that there are sometimes cross-
over duties between RNs and other professionals, the evidence
also established that licensing and other regulations clearly
prevent RNs from doing much of the work of other profession-
als—and other professionals from doing RN work. 53 CFR at
33912, 284 NLRB at 1544–1545. Thus, the Board concluded
the fact that some hospitals utilize a multidisciplinary team
concept did not “detract from the separate appropriateness of
RN units.” 53 CFR at 33913, 284 NLRB at 1546–1547. In this
regard, the Board emphasized that the utilization of a multidis-
ciplinary team approach is a process to ensure that the elements
of patient care are organized but that such a consideration did
not “alter each licensed professional’s responsibility for his or
her individual scope of practice.” Id. Additionally, the Board
noted that the participation of some RNs in team care did not
affect wages, hours, benefits, training, skills, or functions of
RNs on or off the teams. Id.
Based on the above, and the record as a whole, it does not
appear that to the extent Home Health and Family Hospice
provide multidisciplinary care, such a consideration compels a
conclusion that a combined unit of RNs and other professional
employees is the only unit appropriate for collective-bargaining
purposes. Accordingly, in accordance with the “pragmatic or
empirical community of interest test” set forth in Park Manor, I
find a unit of RNs employed by Home Health and Family Hos-
pice to be a unit appropriate for the purposes of collective bar-
gaining.
. . . .