"I think our members are feeling a greater amount of pressure on the job. The work is getting more difficult, and the fight to improve wages and benefits is more challenging year in and year out," said Todd P. Hobler, vice president of Local 1199, Service Employees International Union United Healthcare Workers East, who represents nursing home workers in the area.
The healthcare workforce long has been a bright spot in the region's lackluster jobs market, and it is a rare source of good news for private-sector unions whose memberships have shrunk recently.
But many workers feel under siege today, because the state and federal governments are prodding the industry to provide better care at lower costs.
At some facilities, workers face contentious contract negotiations, job cuts and growing demands on those left on the payroll—the nurses and aides who take care of our sick and our elderly. Other institutions try to work with their union employees.
"Costs are so out of control, and there are so many opportunities for bringing efficiency in the delivery of healthcare," said Paul E. Tesluk, chairman of the University at Buffalo's department of organization and human resources.
Spending on healthcare in this country hit $2.8 trillion in 2012, a figure that rose by 70% from 2002 and that accounts for 17% of our gross domestic product. Experts say this country can't afford to continue to pay that much for care.
For all of that spending, however, the U.S. ranks poorly among the world's industrialized countries when measuring health outcomes.
"So we have a real problem on our hands," said Peter M. Lazes, director of the Healthcare Transformation Project at Cornell University's School of Industrial and Labor Relations.
Healthcare is a key piece of the economy, however, and the trillions of dollars spent on healthcare nationally support 18 million jobs in that sector.
In Buffalo Niagara, healthcare has seen steady growth even as overall employment has stagnated.
Any efforts to rein in healthcare spending put those jobs at risk, and that's why the healthcare sector is shaping up as a major battleground for private-sector unions.
At Eastern Niagara Hospital, the equivalent of 60 full-time workers there are likely to lose their jobs because the hospital on Friday ended inpatient care at its Newfane site. That location will remain open, for emergency and outpatient services, with the equivalent of 34 full-time employees, while inpatient services are transferred to the hospital's larger Lockport site.
Small community hospitals aren't alone in facing financial woes or the threat of closing. Five not-for-profit nursing homes in the Buffalo area have closed over the last five years.
Outside Erie County, county governments that have operated their own long-term care facilities are selling them to private operators, citing similar financial and regulatory challenges. When the nursing homes have a union, new operators often seek to reopen the existing contract to try to extract concessions from employees.
"When these nursing homes are sold, we are going in to organize these people, because these employers that are coming in are horrible. I mean, they want to pay minimum wage, they want to pay very little in benefit structure," said Florence Tripi, Western Region president for the Civil Service Employees Association.
Officials from the McGuire Group and Elderwood, two of the largest nursing home operators in the area, and the New York State Health Facilities Association, which represents the interests of the industry, all declined interview requests.
A few healthcare providers and their unions are trying to work together to confront the industry's stark financial and regulatory realities.
At Kaleida Health, Jody Lomeo, the new president and CEO, made building a better relationship with the system's unions a top priority. The day after his interim appointment was announced in January, he met with representatives of the unions at 1199 SEIU's offices.
Management and union leaders at Blue Cross and Blue Shield of Western New York stood side by side at a May news conference to announce that the region's largest, and only unionized, health insurer would move 40 jobs to its Buffalo headquarters from Pennsylvania.
The Economist magazine recently compared the 21st-century nurse to the 20th-century autoworker, and Cornell's Lazes has studied what the healthcare industry can learn from the auto industry. The short answer: Unions have to be viewed as adding value, not serving as a stumbling block.
Union members agree, and they say they believe they're well-positioned to weather this period of industry change.