Nursing homes that use contract staffing to fill certified nursing assistant position vacancies are more likely to experience worse care quality than those that do not, according to the results of a study by PHI. 

The proportion of total CNA hours filled by contract CNAs in SNFs increased from 2% in 2017 to 11% in 2022, the study found.

“Contract staffing may offer higher hourly wages and greater flexibility for employers and workers, but the practice also raises concerns around rising labor costs, precarious employment, and lack of benefits and worker protections,” PHI Director of Research Lina Stepick said, noting that arrangements can take the form of gig work, travel nursing agency staffing or another model.

CNAs provide the lion’s share of direct care in SNFs, the report noted. Although the use of contract staff workers can boost the number of hours per patient per day, continuity of care is threatened by the overuse of such workers, PHI said. Retaining on-staff CNAs for more than a year is the key to improving resident and patient outcomes, the report noted.

“More competitive wages and benefits, supportive supervision, and safer working conditions — among other improvements — are necessary to attract and retain CNAs to nursing home jobs and, in turn, support continuity of care for residents,” Stepick said.

PHI recommended policy changes for SNF owners and operators, such as increasing the wages of regularly employed full-time workers to increase staffing levels. Owners and operators also can strengthen training standards, build workforce pipelines, and enhance career development opportunities to improve recruitment and retention of regularly employed CNAs, the organization said.

Outside of the study, one state agency is taking a step toward facing CNA workforce challenges head on. The California Association of Health Facilities recruitment program aims to attract thousands of new, young care workers with a variety of incentives that could create a sustainable pipeline into the long-term care sector.

“What makes this program unique is that we’re building a relationship between nursing homes and the workforce potential at large,” Claire Enright, executive director of CAHF’s Quality Care Health Foundation, which manages the CNA program, previously told McKnight’s.