Study: Chronic worker shortages in nursing homes must be addressed to help lessen patient risk

The now chronic problem of more expensive agency staff and potentially lower quality care in nursing homes needs to be addressed as part of calls for increased oversight of the sector, according to a recent academic study in Health Affairs. 

Before the COVID-19 pandemic, approximately 23% of nursing homes in the U.S. used agency nursing staff, equivalent to about 3% of all nursing hours worked. By 2022, almost half of nursing homes used such staff, accounting for approximately 11% of all nursing hours worked, according to study data. 

In addition to the increasing numbers of temporary staff in the period studied, almost 14% of nursing homes were using agency staff every day by 2022 to help address chronic staff shortages. Not only were such agency staff up to 60% more expensive, many homes using such temporary staff had lower five-star ratings. 

Even with the public health emergency officially over as of May 2023, approximately 1 in 4 nursing homes continued to report staff shortages. The relatively attractive work options outside of nursing once lockdowns ended caused many qualified workers to leave the profession permanently, the study showed. 

“Policymakers need to consider post-pandemic changes to the nursing home workforce as part of nursing home reform, as increased reliance on agency staff may reduce the financial resources available to increase nursing staff levels and improve the quality of care,” the study authors wrote. 

Temporary staff are more expensive than full-time workers, and this trend was exacerbated during the pandemic, the study showed. 

In 2018, agency nurses cost $17.20 per hour more than permanent staff. That figure had increased to $23.93 per hour more by 2022. There were similar trends for licensed practical nurses and nurse aides. 

The trend toward using more temporary staff can also affect the quality of care. Not that overall quality ratings were necessarily affected by the use of agency staff, but such staff may not know the facilities as well as permanent workers and may not have the long-term care plans for patients as a top concern. Overall reliance on temporary staff can also encourage greater patient exposure to respiratory illnesses as more workers traffic in and out of facilities, the authors wrote. 

There are also problems of morale with permanent workers demoralized by the reality of agency staff being on higher pay at the same time as being less accountable for patient care, according to the study. 

“Without significant investment in the nursing home workforce and ensuring that nursing homes have adequate revenue to hire workers, nursing home residents may be at risk,” the study concluded. 

While overall figures rose, such use of agency staff in nursing homes varied across different states with some in the Northeast (Maryland, Pennsylvania, New York, and Vermont) among the highest users of temporary workers in 2022. Smaller, more rural states such as Oklahoma, Alabama, and Arkansas used agency workers in their nursing homes at a far lower percentage.