Staff Agency Use Up as Staff Burnout Spreads

The vast majority of skilled nursing and senior living operators, 84%, are currently tapping agency and temp staff to help with staffing shortages, according to the National Investment Center for Seniors Housing & Care’s (NIC) most recent executive survey. 

Now in its 31st iteration since the COVID-19 pandemic began, responses were collected from 70 small, medium and large senior housing and skilled nursing executives from July 12 to Aug. 8. NIC’s survey data shows that while move-ins have accelerated, staffing challenges continue to force operators to look outside their facilities to hire staff.

“In my years in this industry, this staffing crisis is absolutely unprecedented,” Plante Moran partner Betsy Rust told Skilled Nursing News. “We see our clients paying significant signing bonuses for key personnel on top of overtime and agency costs because there is such a recruiting war for the talent that exists in the nursing home industry.”

Dan Suer, administrator at Cincinnati, Ohio-based Hillebrand Nursing & Rehabilitation Center, said in his 36 years in the industry he hadn’t used staff agencies until July 1.

“Agency has always been the same issue: not reliable, not good at the position and generally non-caring,” he said.

Mary Haynes, president and CEO of Louisville, Ky.-based Nazareth Home, addressed the industry’s increasing reliance on staffing agencies at the American College of Health Care Administrators Midwest Post-Acute Executive Leadership Summit last week.

“When we purchased Nazareth Home Clifton, they had agency staffing. On our other Nazareth Home campus, we hadn’t used agency staff in probably 15 years,” she told the crowd. “My belief at that time, and I’m not sure that my belief can be sustained or ought to be sustained, [was] that a quality experience for all stakeholders could not be achieved with a high ratio of agency staff.”

In learning more about what was attracting workers to staffing agencies over her facility, she found that the number one reason people want to work in an agency is daily pay. The second reason was no weekend commitment and third was general flexibility.

Haynes looks to contract in order to temporarily fill an open position rather than calling an agency to get backfill if someone calls in.

“That’s not very satisfying to anyone,” she told Skilled Nursing News in a follow-up conversation this week. “What we found is more successful, is for instance, if we have a night nurse who resigned, we would try to fill her position for six weeks, 12 weeks, whatever, with an agency person until we can recruit and get someone onboarded effectively. That’s worked for us.”

OT vs. agency costs

Some solutions are better than others as all of the respondents in the NIC survey indicated they are currently paying staff overtime hours.

While a common criticism from operators is that using a staffing agency is not cost-effective, Chris Caulfield, co-founder and chief nursing officer of IntelyCare, argues that paying OT can have worse adverse long-term effects on the overall health of the organization’s staff. 

“With overtime, eventually you will burn out your staff and you’re going to be short-staffed for a much longer time period,” he said.

Caulfield has seen an increase in IntelyCare services to fill-in short gaps in nursing home operators’ schedules.

“If it wasn’t for staffing providers and agencies continuing to staff, I think a lot of skilled nursing facilities out there would be in dire need,” he said.

Mark Woodka, CEO of Cleveland-based OnShift, agrees that agency usage has helped operators deal with staff burnout.

“In general agency is not perceived as a positive, it’s perceived as a negative because it’s very costly,” he told SNN. “Having said that, in the time of COVID, with staff members getting burned out, I think some of the agency usage is to give staff a break.”

A recent OnShift survey of 2,800 long-term care employees, 39% of whom worked in skilled nursing, showed that 59% of respondents indicated they are moderately, very or extremely burned out or stressed.

Staffing crisis holds industry back

The staffing shortage continues to be felt by operators across the country as Maine-based Pinnacle Group of the Hudson Valley CEO Israel Nachfolger described it as a flaming crisis in a recent conversation with SNN.

A June survey of 616 nursing homes found that one of the top costs incurred due to COVID-19 was additional pay for staff or hiring additional staff, according to the American Health Care Association/National Center for Assisted Living (ACHA/NCAL).  

“While there are some encouraging signs of increasing new admissions in certain parts of the country, many other facilities are struggling to stay afloat or find the necessary caregivers to support their residents,” ACHA/NCAL said in a statement. “Now as the Delta variant spreads rampantly across the U.S., our recovery remains in jeopardy.”

Despite delta’s emergence, move-ins are up for the majority of operators, the NIC survey indicates.

“Between roughly 55% and 60% of organizations report that the pace of move-ins accelerated in the past 30-days, and similar proportions report a corresponding increase in occupancy,” NIC senior principal Lana Peck wrote.

The NIC survey also indicated that one out of five of skilled nursing and assisted living operators, 21%, are hiring staff from other industries.

Haynes admitted that changes to the marketplace has made hiring staff from other industries more attractive.

“I think hiring from other industries is something that we need to be constantly open to doing because the marketplace has changed,” she said.