COVID forced more facilities to rely on staffing agencies to maintain census and keep their doors open, but the underlying scarcity of caregivers led to higher pay.
Those costs put long-term care facilities at odds with the staffing agencies they needed, and now there’s a post-COVID backlash. People say the problem with agencies is how much they cost.
But I think there’s a different problem. I’ve seen facilities deliberately reduce their census and operate at a negative margin to avoid using agency staff. They would rather lose money than work with an agency.
The problem is deeper than price. Based on my work supporting facilities, I think it’s actually about trust. And trust is about care quality and risk.
Care quality
Long-term care facilities need staff that show up on time and step up to perform highly varied tasks, ranging from hard manual work to the diligence of charting care so that facilities can be reimbursed. You can’t have caregivers who fall asleep on the job, or get into disputes with their supervisors.
That kind of care quality isn’t guaranteed with agency, which can create a two-tier workforce where full-time in-house staff doing most of the work, and temps who may or may not fit the bill.
Late cancellations and no-shows disrupt smooth operations and force existing overworked personnel to scramble to fill the gap. So facilities feel like they are paying agency prices for work that doesn’t meet their standards, and their in-house staff is still exhausted, which was the problem they needed to solve in the first place.
Risk
When care quality varies too much, the real problem is risk. Who’s going to walk in the door today? How much can I count on them?
Facilities see agency caregivers’ work as less predictable. That’s partly because agencies are moving toward a 1099 contractor model, rather than a traditional employer-employee relationship using W-2s.
This creates a marketplace for mercenaries who don’t stay anywhere long, and fail to form relationships with both the in-house team and the residents. The more frequently caregivers move from one facility to another, the less context they have about any given site and its residents.
What’s more, because 1099 contractors cover their own payroll taxes and forego typical employee protections, the quality of caregivers who accept 1099s can be lower.
The less context that caregivers have, the more likely they are to make a mistake, which can range from neglect to failing to administer the right medications. Mistakes like that raise the risk of liabilities that most facilities want to avoid, which pushes to eliminate agency altogether.
What facilities can do
Facilities helped to create the problems they have with staffing agencies, and facilities have the power to solve those problems. They can increase care quality and reduce risk by doing the work of recruiting, hiring and training their caregivers in-house.
But that solution comes with a catch.
To eliminate agency, facilities need to master new skills and offer caregivers something different. The workforce they recruit has new requirements post-COVID. While healthcare facilities traditionally offered their caregivers rigid schedules, COVID changed the job market. Many caregivers worked on a flexible schedule that allowed them to choose their hours for the first time. That meant they could balance work with obligations like childcare.
Those caregivers are not coming back to facilities that give them no choice about scheduling. Facilities that adapt to caregivers’ needs will be able to recruit more staff in-house, and they’ll perform all the functions of an agency.
Facilities that don’t adapt will struggle to eliminate their reliance on external staffing. And that will leave them trapped in a cycle of distrust.
Matt McGinty is the Chief Revenue Officer of IntelyCare. As IntelyCare’s CRO, Matt is dedicated to empowering the long-term care industry to manage its workforce better through access to technologies such as PRN float pool management tools.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
