Agency staff utilization in nursing homes: patterns and concerns

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.