Staffing Agencies are the New Virus in Nursing Homes

It’s not hard to notice the hundreds, maybe thousands of hiring signs plastered on the windows of businesses everywhere. The words of the signs weigh on every manager, administrator, and CEO. They interest the job-hunting individual. They annoy the consumer who just wants their food now but can’t because of the lack of staff. They strike fear into those who are afraid of the COVID-19 virus but need money nonetheless. And many of these signs can be found on the front lawn of skilled nursing facilities.

According to the U.S. Bureau of Labor Statistics, the unemployment rate jumped from 3.7% to 8.1% from 2019 to 2020, the height of the COVID-19 pandemic. Besides anxiety from the virus, people aren’t working because a number of reasons including wanting a flexible schedule, a heightened sense of personal agency, not wanting a “bad job,” and the ability to haggle other companies.

Most, if not all these factors are heightened in a nursing home during a pandemic. The constant fear of getting sick or getting a patient sick, having a job that requires staff 24/7, the exhaustion of wearing PPE on top of the already exhausting job, and the fact that nurses and STNA’s aren’t getting paid enough. Although the CARES Act and the COVID-19 Public Health Emergency Funding were implemented during the pandemic, the funding wasn’t enough to counteract the costs of PPE, and the higher worker rates. In Marcum LLP Benchmark’s Analysis, they found that there was an $11 negative gap between the cost of a patient a day and the national average of funding. Administrators recognize that their employees are underpaid, but there just isn’t money to give.

The difficulty of the job caused burnout in some workers. But the lack of pay caused many others to look elsewhere to staffing agencies. A staffing agency is an organization full of workers anywhere from an RN to a CNA that are eligible to work at any nursing home if they pick up the available shifts that nursing home puts on their agency’s schedule. The two main pulls for workers to leave a specific nursing home for an agency is the flexibility of the schedule and the generally higher rates that agencies offer.

Nancy Ohman Milner, administrator of Ohman Family Living at Blossom (OFLB) in Huntsburg, Ohio, basically grew up in the nursing home industry. Her career started in 1987, under the guidance of her parents who started the business, in landscaping to laundry to the kitchen all the way up to administration. Throughout her years, Milner has seen the shift in staffing pre, during, and post COVID-19 and has dealt with the difficulty of staffing agencies.

“We are paying agency twice as more than our own staff because they aren’t regulated. There is no ceiling on their practices, on their rates. But all the money that comes into Blossom is capped, from Medicaid, from Medicare, from the residents. It’s not sustainable.” Adding on top of that, Milner observes that the agency workers often drop their shift right before it happens or don’t show up all together. When these temporary workers do show up, they are already at a disadvantage because they don’t know the building, they don’t know the other workers, and most importantly, they don’t know the residents. “The patient care we receive from agencies are often poor because they don’t know our patients,” said Milner.

In a facility that already lost revenue and workers from the pandemic, being forced to work with agencies further escalates the problem and ultimately puts the residents at risk.

President of the United States, Joe Biden, announced at his State of the Union Address on Mar. 1 that a set of reforms developed by the Department of Health and Human Services will be set in place this year to “improve the safety and quality of nursing home care, hold nursing homes accountable for the care they provide, and make the quality of care and facility ownership more transparent so that potential residents and their loved ones can make informed decisions about care.”

Milner is not in favor of more regulations set on the facilities themselves. “It’s basically requiring more for us to do with less people.” Instead, Milner and many other nursing homes across the country have been working with the American Health Care Association to put legislation in place for regulations on staffing agencies instead.