Staff at Oahu Care Facility, a Honolulu nursing home, went on strike Wednesday to demand higher wages and better working conditions.

Approximately 30 union staff members represented by the Hawaii Nurses Association held signs in front of the Beretania Street facility on the first day of a planned seven-­day strike after failed attempts at mediation with management. They have been working without a contract since February.

“We’ve been at the table for a few months now, looking for fair wages, a fair contract, fair working conditions,” said HNA labor relations specialist Mandy Vega. “People are working double shifts all the time. They’re exhausted. Even after a double shift, they’ll go home for a few hours and then get called back in.”

Daniel Ross, HNA president, said staff at Oahu Care Facility are among the lowest paid in the state.

The facility’s certified nurse aides are paid $14.95 per hour, while registered nurses are paid about $33 an hour, when most facilities in the state are now paying in the mid-$20s and mid-$40s range for those positions. At acute care hospitals, registered nurses are paid $60 or more per hour.

The result of the low pay is a shortage of staff, with people unwilling to take open positions at the home, while others leave for better pay, he said.

“You can go to McDonald’s and make more than what they pay the certified nurse aides,” he said.

Those who stay on are invested because they have a relationship with their patients, having worked there for 10 to 20 years or more.

This, in turn, means mandatory overtime, which puts both worker and patient safety at risk and affects quality of care. One member, he said, crashed her car on the way home after working 16-hour shifts.

“When you’re working exhausted like that, doing back-to-back double shifts, you’re not on your game,” he said.

Oahu Care Facility is an 82-bed nursing home built in the mid-80s by the late Gordon Ito, founder of the Ito Healthcare Group. Last year, Pacific Skilled Healthcare LLC of Las Vegas acquired the group’s facilities and became the new employer.

Olivia Kim, nursing home administrator, said in a written statement that Oahu Care Facility has provided skilled nursing and intermediate level of care services to kupuna for 38 years.

“Currently our leadership team continues to negotiate in good faith, and we respect the right of our nursing staff to participate in the strike,” she said. “We hope to resolve the concerns of our nursing team and reach an amicable agreement so that we may move forward together to focus and continue providing excellent care to the residents we serve.”

Pacific Skilled Healthcare LLC also acquired Pearl City Nursing Home and Kulana Malama, a facility serving medically fragile children in Ewa Beach.

The union held an informational picket a month ago, but moved to strike after failure of management to bargain in good faith, he said, particularly when they put forth a best-and-final offer on the first day of mediation.

Management initially proposed increases in the range of 15 to 40 cents per hour, which was frustrating, he said, because, “We’re so far behind, you need to be talking in dollars, not cents.”

Management eventually offered a package deal bumping pay for certified nurse aides to about $17.50 per hour in the first year, followed by $18 per hour the second year. For registered nurses, management was offering about $37 per hour.

But Ross said the union wants a minimum of $20 and $40 an hour for certified nurse aides and registered nurses, respectively, which is still lower than other places. That might just be enough, he said, to attract new hires to ease the shortage and mandatory double shifts.

The strike comes amid a chronic shortage of health care workers that was pronounced during the height of the COVID-19 pandemic and which persists beyond the end of the emergency.

Hawaii’s hospitals today are full of more patients than they were pre-­pandemic, according to Hilton Raethel, president and CEO of the Healthcare Association of Hawaii.

The average census at Hawaii’s hospitals remains at about 2,400, which is 400 more than it was in 2019, resulting in an increased need for health care workers.

The fullness is due, in part, to patients awaiting placements at a long-term care facility such as a nursing home. The homes are unable to take more patients due to staffing shortages.

Raethel said a survey of members in October found more than 200 patients waited about 80 days for placement. Another survey in May found the waits for those patients got longer — to about 120 days.

While some training initiatives have brought in a new cohort of nurses, he said, ramping up the health care workforce will take time. The high cost of living in Hawaii continues to present challenges in attracting and retaining health care workers, and there are shortages in every industry.

At the same time, some nursing homes are also struggling financially. Some, such as Wahiawa General Hospital, have thrown in the towel. Last summer, Wahiawa General shut down its 115-bed, long-term care center, citing financial challenges.