The nursing home industry has long struggled with staffing shortages, a problem exacerbated by the COVID-19 pandemic. To fill gaps in their workforce, many facilities turned to agency nurses. However, a new study published in Medical Care suggests that this reliance on temporary staff may be linked to lower quality ratings in the Center for Medicare & Medicaid Services (CMS) Five-Star system.
Researchers analyzed data from over 80,000 U.S. nursing homes between 2017 and 2022 and found that the use of agency registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs) decreased a facility’s chance of achieving higher star ratings.
“Agency nurses have less familiarity with residents’ specific needs and facility protocols, potentially impacting continuity and consistency in care,” explains Rohit Pradhan, health services researcher at Texas State University. “Their presence may also create issues for permanent nursing staff who may feel that they have to ‘guide’ the agency nursing staff.”
This finding is supported by anecdotal evidence from nursing home professionals. In the 2024 McKnight’s Long-Term Care News Mood of the Market survey, over 36% of respondents cited reduced reliance on agency staff as a positive development. One survey-taker commented, “I truly feel for the first time that we are getting back to normal. This is evidenced by us filling our existing vacancies and utilizing temp agency staffing much less.”
The financial burden of agency staffing
Beyond quality concerns, the high cost of agency nurses is another factor driving nursing homes to seek alternative solutions. According to a 2023 report by the American Health Care Association/National Center for Assisted Living, the average hourly wage for agency RNs was $48, compared to $32 for employed RNs. This significant cost differential puts a strain on already tight budgets.
Shifting away from the gig economy model
While acknowledging that agency nurses play a role in addressing staffing shortages, Pradhan argues that the gig economy model is not the best fit for the nursing home industry. “Turnover among both nursing staff and administrators is very high, and constant staffing changes can disrupt residents’ care,” he says. “Nursing homes need to focus on retaining and recruiting staff by offering competitive wages – especially since nursing home wages are significantly lower than hospitals – good benefits and clear career paths.”
This shift away from agency staffing is gaining momentum. Many nursing homes are implementing strategies to attract and retain permanent employees, such as:
- Increased wages and benefits: Offering competitive salaries and comprehensive benefits packages can help attract and retain qualified staff.
- Career development opportunities: Providing opportunities for professional growth and advancement can incentivize employees to stay with the facility.
- Improved work environment: Creating a positive and supportive work environment can boost morale and reduce turnover.
The study’s findings highlight the need for nursing homes to prioritize long-term staffing solutions. By investing in their workforce and creating a stable and supportive environment, facilities can improve both the quality of care and their bottom line.