closeup of a pink stethoscope and a pile of fake US dollars, on a blue background
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Although assisted living communities in Tennessee tapped healthcare staffing agencies less frequently than nursing homes during the COVID-19 pandemic, providers in the sector collectively were on a trajectory to spend more than $4 million on such staffing in 2022, according to a new state report.

The number comes from the state Comptroller’s Office of Research and Education Accountability, which was required last year under Senate Bill 2463 / HB 2347 passed by the Tennessee General Assembly to coordinate a study with the Division of TennCare and the state Department of Health to determine the potential effects of the use of temporary staffing agencies by assisted living communities and nursing homes on state costs. The state annually provides $12 million for care provided at assisted living communities through TennCare, along with $1 billion for nursing facilities.

Costs soar during pandemic

Both settings contracted with staffing agencies most often for certified nursing assistants, followed by licensed practical nurses. 

Assisted living communities reported $4.5 million in spending for healthcare staffing agencies between 2020 and the first half of 2022. According to the study, 119 of the state’s 297 assisted living communities (40%) responded to the survey. Of those respondents, 45% (53 communities) indicated that they contracted with staffing agencies, and 60% reported expenditures for temporary staff. 

Of the assisted living community survey respondents, 77% indicated that they experienced a staffing shortage, whereas 23% said they did not. Overall, assisted living communities did not report staffing shortages as a high level of concern — only 20 communities reported limiting admissions at some point during the pandemic due to staffing shortages. 

Healthcare staffing agency spending by assisted living providers in the first half of 2022 exceeded those in all of 2021, according to the report. In 2019, assisted living communities reported expenditures to healthcare staffing agencies of $168,552. Spending increased to $737,791 in 2020 and more than doubled in 2021, to $1.7 million. In the first half of 2022, assisted living communities reported spending $2 million on staffing. 

“If spending levels remain the same for the second half of 2022, assisted care living facilities will have expended more than $4 million for temporary staff in 2022,” the report reads. 

In 2019, the number of hours assisted living communities reported for temporary employees was 6,683, rising to 7,642 in 2020. By 2021, that number nearly tripled, to 20,135 hours. For the first half of 2022, the number of hours increased to 31,979. 

Chances exist to up quality, reduce expenses

Among the policy options presented in the report include requiring healthcare staffing agencies to register with the state as well as expanding the state’s law against price-gouging to include direct care services provided by healthcare staffing agencies.

The report also suggested that the General Assembly consider providing state-funded grants equal to the pandemic relief that assisted living providers are receiving through the federal American Rescue Plan Act of 2021. Under ARPA, assisted living communities in Tennessee could apply for a total of $12.5 million in grants to cover pandemic-related expenses.