A state-by-state comparison of pay-rate disparities between agency nurses and their full-time counterparts is feeding the fury that disgruntled long-term care operators and other providers have felt during the pandemic.

Previously, largely anecdotal accounts of nursing agencies’ soaring pay rates and predatory recruiting tactics have fed providers’ anger. Now, they can see just how bad conditions are, and how differences exist among states.

The largest pay gap shows that agency rates nearly triple those of full-time nurses, while the smallest disparity is still one-and-a-half that of full-timers. South Dakota led the nation in the wage gap at 257%, while Hawaii had the smallest difference, at 151%.

Becker’s Hospital Review charted all 50 states late last week. The disparities likely are much wider in long-term care, which is suffering much worse continuing staff shortages, compared to all other healthcare sectors.

Long-term care shortages have caused providers to keep wings or services closed in some places, even when census levels have grown.

‘Shocking’ costs, implications

The pay disparity has angered nursing home advocates, who allege gouging in a time of crisis and decry the loss of regular staff to the higher-paying agency jobs. Providers also scorn the less familiar relationships with residents and staff that result due to agency use.

Nurses’ motivation can be understood, but agency owners deserve to be denounced, said Rachel Monger of LeadingAge Kansas.

“We know that the primary reason our nurses leave for staffing agencies is the higher pay,” Monger told McKnight’s Long-Term Care News Friday. “We have never faulted our nurses and nurse aides for seeking higher wages. They deserve every penny, and more.

“Our criticism lies with staffing agencies who have exploited the nurse shortage for higher profits and discourage market improvements with forced contract buyouts and non-compete clauses for nurses.”

Agency nurse use was a major factor in decreased sector margins, said accounting firm CliftonLarsonAllen in an October report.

The use of contract labor didn’t begin with the pandemic, CLA authors pointed out. It increased 19% between 2017 and 2018 and jumped 24% between 2018 and 2019 before skyrocketing the last three years. 

COVID and the ensuing inflationary economic environment significantly accelerated that trend, report authors noted. In 2021, 5.5% of all nursing hours were filled by contract labor, an 83% increase in median 2020 levels.

Approximately two-thirds of SNFs resorted to nursing contract labor in 2021, about a 50% increase compared to 2019, according to the report.

“This (pay-gap) chart also supports our plea to policymakers when it comes to increased reimbursement for staff wages, and the truly shocking number of dollars that will be required to meet new CMS staffing requirements if staffing agencies are allowed to run unchecked,” Monger explained.

Clif Porter, senior vice president of government affairs at the American Health Care Association/National Center for Assisted Living, echoed her sentiments.

“This alarming (Becker) report further demonstrates the need for government resources that will help long-term care providers offer caregivers more competitive wages,” Porter said in a statement to McKnight’s Friday. “We respect and value our travel nurses, but we need to be investing in full-time employees who know their residents intimately. It’s also time that Congress investigate predatory staffing agencies who have charged exorbitant rates during the pandemic and exacerbated our labor crisis.”