Agency staff utilization in nursing homes: patterns and concerns.

BACKGROUND AND

OBJECTIVE

The persistent shortage of direct care workers across the long-term services and supports system has worsened since the onset of the COVID-19 pandemic. This shortage resulted in nursing homes (NHs) relying more heavily on agency staff to maintain a stable workforce. This study examines patterns of agency staff utilization and associated concerns reported by NH administrators.

RESEARCH DESIGN AND

METHODS

Data from the 2023 Ohio Biennial Survey of Long-Term Care Facilities were used to report utilization patterns and concerns related to the use of agency-provided certified nursing aides (CNAs), licensed practical nurses (LPNs), and registered nurses (RNs). Analyses included 513 NHs in Ohio reporting the use of agency staff.

RESULTS

Findings indicate that agency-provided CNAs and LPNs were utilized more frequently and for more extended periods than RNs. Agency staff were most often used for filling in last-minute call-offs, difficult-to-hire shifts, and vacancies following employee departures. Almost 90% of administrators identified cost as a severe problem with using agency staff, while two-thirds reported issues related to lack of dedication, accountability, or familiarity with facility policies and procedures.

DISCUSSION AND IMPLICATION: Agency staffing remains an important operational strategy for mitigating workforce instability in NHs. While agency staffing is an adaptive response to labor shortages, it also leads to financial and organizational strain. Addressing these challenges will require policy and organizational interventions through workforce investments aimed at strengthening the recruitment, retention, and support of directly employed staff to ensure sustainable and improved care outcomes in NHs.