Agency Staff Utilization in Nursing Homes and Assisted Livings: Patterns and Concerns

TL;DR

This study examines how nursing homes and assisted living facilities use agency staff due to worker shortages and highlights concerns like costs and staff morale.

Contribution

The study provides new insights into patterns and concerns of agency staff utilization in long-term care, particularly in assisted living settings.

Findings

68% of nursing homes and 38% of assisted livings used agency staff in 2023.

Agency staff were often used for hard-to-fill shifts and last-minute absences.

Over half of nursing homes used agency staff as substitutes for more than four weeks.

Abstract

Since 2020, long-term care providers have been faced with a shortage of direct care workers. As a result, many nursing homes (NH) and assisted livings (AL) have turned to staffing agencies. Agency staffing is believed to be associated with worse resident outcomes, but our understanding of how and why providers use agency staff, and the implications of their use is limited, especially in ALs. Using data from the 2023 Ohio Biennial Survey (> 90% response rate), NHs and ALs that utilized agency staff for nursing aides or personal care aides during the year were identified. Nearly 68% of NHs and 38% of ALs utilized agency staff. NHs and ALs are more likely to use agency staff for hard-to-fill weekend and overnight shifts (NHs: 77%, ALs: 60%), filling in for last-minute call-offs (78%, 67%), when an employee leaves employment (76%, 64%) or is vacationing (55%, 44%), and when there is an increase in occupancy (59%, 27%). Over 55% of NHs and 39% of ALs reported using agency staff as a substitute for a directly employed aide for over 4 weeks. The most common serious concern among administrators regarding agency staff are costs, lack of dedication to building, negatively impacting the morale of directly employed staff, inadequate time to know residents’ care plans, and lack of knowledge of building policies and procedures. Investment in the long-term care workforce is necessary to reduce the use of agency staff. This study provides important insights that help direct these investments.