CHICAGO — A new analysis reveals that nursing homes across the United States are increasingly dependent on a shadow workforce of temporary and contract staff to maintain daily operations, raising questions about care continuity and regulatory oversight.
The study, published this week by a healthcare workforce research group, found that nearly one-third of nursing home shifts are now filled by agency nurses and certified nursing assistants rather than permanent employees. This represents a significant increase from pre-pandemic levels, when contract workers accounted for roughly 15% of staffing hours.
Industry executives say the reliance on temporary staff reflects persistent challenges in recruiting and retaining workers in a competitive labor market. Wages for direct care workers have risen steadily, but many facilities still struggle to offer competitive benefits and career advancement opportunities that would encourage long-term employment.
The findings come as federal and state regulators grapple with how to ensure quality care while acknowledging workforce realities. Some advocates argue that heavy reliance on agency staff can disrupt resident care relationships and contribute to higher turnover rates among permanent employees who feel unsupported.
However, nursing home administrators counter that contract workers provide essential flexibility, allowing facilities to maintain staffing ratios during unexpected absences or surges in patient acuity. Several large staffing agencies have reported record demand from long-term care providers in recent quarters.
The analysis suggests that without systemic changes to workforce development and compensation structures, the industrys dependence on temporary staffing is likely to continue, if not intensify, in the coming years.
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