Nursing Homes Increasingly Rely On Staffing Agencies For Direct Care Nursing

John R. Bowblis, Christopher S. Brunt, Huiwen Xu, Robert Applebaum, David C. Grabowski

Research output: Contribution to journalArticlepeer-review


When nursing homes experience a shortage in directly employed nursing staff, they may rely on temporary workers from staffing agencies to fill this gap. This article examines trends in the use of staffing agencies among nursing homes during the prepandemic and COVID-19 pandemic era (2018–22). In 2018, 23 percent of nursing homes used agency nursing staff, accounting for about 3 percent of all direct care nursing hours worked. When used, agency staff were commonly present for ninety or fewer days in a year. By 2022, almost half of all nursing homes used agency staff, accounting for 11 percent of all direct care nursing staff hours. Agency staff were increasingly used to address chronic staffing shortages, with 13.8 percent of nursing homes having agency staff present every day. Agency staff were 50–60 percent more expensive per hour than directly employed nursing staff, and nursing homes that used agency staff often had lower five-star ratings. Policy makers need to consider postpandemic 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.

Original languageEnglish (US)
Pages (from-to)327-335
Number of pages9
JournalHealth Affairs
Issue number3
StatePublished - 2024

ASJC Scopus subject areas

  • Health Policy


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