The Impact of Sick Leave on Nursing Home Care: Challenges and Leadership Responses

Sick leave is more than a human resources issue in nursing homes—it’s a daily reality that affects the quality of care for residents and the stability of working life for staff. Leaders in nursing homes consistently report that managing sickness absence takes a significant amount of time and resources, and that its impact goes far beyond filling shifts. It affects continuity, competence, morale, and ultimately, the quality and safety of care.

In speaking with nursing home leaders, several clear themes emerged about why sick leave is such a persistent issue, how it affects care environments, and what is being done—or still needs to be done—to reduce its impact.

What Drives High Sick Leave Rates in Nursing Homes?

Many leaders identified multiple factors that seem to contribute to sick leave, including the age of employees, aspects of workplace culture, and national sick pay policies. While these observations were based on their own experiences, they reflect a common sentiment in the care sector: sick leave isn’t simply the result of illness. It’s also influenced by the nature of the job and how people perceive it.

Some leaders noted that the reputation of nursing home work itself may influence sick leave rates. They shared that this type of work is often described publicly as heavy, emotionally demanding, or unsafe. When a job is repeatedly talked down, it can affect not just how society views it, but how employees see themselves and their work.

The Challenge of Losing Continuity and Competence

One of the biggest challenges of managing sick leave in a nursing home is the loss of continuity. When experienced employees are absent, leaders are often forced to bring in substitutes—who may be unfamiliar with the residents, the building, or the routines.

Several leaders explained that during periods of high absence, they often had to hire temporary or unqualified staff just to keep the facility running. While this was often necessary to meet staffing numbers, it also meant risking lower-quality care, higher stress levels among permanent staff, and additional workload for supervisors.

This made it clear that sick leave doesn’t just disrupt schedules—it diminishes the collective knowledge and competence that high-quality care relies on.

The Connection Between Leadership Visibility and Sick Leave

One striking point raised by several leaders was the connection between leadership presence and sick leave rates. They felt that when leaders were not visible or engaged in day-to-day activity—whether due to administrative overload or lack of support—this often led to a rise in sick leave. Once that cycle began, it could quickly spiral downward: more sick leave meant more need for temporary help, which meant even less stability and more stress on the team.

This finding highlights an important leadership lesson: being present—physically and emotionally—can be a core part of supporting a healthy workplace.

Creating Flexibility and Supporting Return to Work

While managing and preventing sick leave was a challenge, many leaders described creative efforts to bring people back to work sooner. They sometimes adjusted work roles, lightened physical tasks, offered flexible hours, or even redesigned workflows so that recovering employees could return without endangering their health or the quality of care.

These accommodations worked well in many cases, especially when the need was short-term. But leaders also acknowledged that supporting employees with longer-term needs or limitations was much more difficult. For example, if several employees needed reduced duties or different working hours at the same time, it could leave departments stretched thin.

Still, the leaders agreed: when the work environment is strong, staff are more likely to stay connected, return to work faster, and stay engaged through difficulties.

How Leaders Are Responding: What’s Working, What’s Not

To reduce sick leave and its impact, leaders in the study shared several strategies they were experimenting with. These included:

• Increasing basic staffing levels to reduce pressure

• Improving rotation schedules to avoid burnout

• Reinforcing positive work culture and recognition

• Strengthening communication and support between staff and management

• Offering more flexibility for physical and emotional needs

But leaders also noted that even with these changes, there are limits. Some issues are systemic—like staffing shortages or aging workforces—and require broader policy or funding support. Many stressed the need for continued attention to work environment and staffing levels at municipal and national levels.

Why This Matters for Quality and Safety

Everyone agreed that sick leave not only affects daily operations but also impacts the quality and safety of patient care (QPS) in measurable ways. When regular staff are missing and temporary help is inconsistent, the risk of mistakes increases. When morale drops, so does engagement. And in the end, the people who suffer most are the residents.

Reducing sick leave, then, isn’t just an administrative task—it’s a key part of improving safety, strengthening care, and maintaining dignity for vulnerable older adults. Supporting leaders, building resilient rosters, and prioritizing well-being for staff are all crucial steps toward that goal.