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Agency staff utilization in nursing homes: patterns and concerns.

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Nursing homes heavily use agency staff due to worker shortages, facing high costs and dedication issues. Policy changes are needed to support direct care workers and improve long-term care.

Keywords:
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Area of Science:

  • Healthcare Management
  • Gerontology
  • Public Health Policy

Background:

  • The long-term services and supports (LTSS) system faces persistent direct care worker shortages, exacerbated by the COVID-19 pandemic.
  • Nursing homes (NHs) increasingly rely on agency staff to maintain operational stability amidst workforce instability.

Purpose of the Study:

  • To examine patterns of agency staff utilization in Ohio nursing homes.
  • To identify concerns of nursing home administrators regarding the use of agency-provided certified nursing aides (CNAs), licensed practical nurses (LPNs), and registered nurses (RNs).

Main Methods:

  • Analysis of data from the 2023 Ohio Biennial Survey of Long-Term Care Facilities.
  • Inclusion of 513 Ohio nursing homes that reported using agency staff.

Main Results:

  • Agency CNAs and LPNs were used more frequently and for longer durations than agency RNs.
  • Agency staff primarily filled last-minute call-offs, hard-to-fill shifts, and post-departure vacancies.
  • Nearly 90% of administrators cited cost as a major concern, with two-thirds reporting issues with agency staff dedication, accountability, and facility policy familiarity.

Conclusions:

  • Agency staffing is a critical strategy for managing NH workforce instability but presents financial and organizational challenges.
  • Policy and organizational interventions focused on investing in and supporting directly employed staff are essential for sustainable care.
  • Strengthening recruitment, retention, and support for in-house staff is crucial for improved care outcomes in nursing homes.