Nursing Homes’ Use of Contract Direct Care Staff Before and During the COVID-19 Pandemic

Low direct care staffing levels and high turnover rates are longstanding nursing home (NH) workforce issues that were further exacerbated by the COVID-19 pandemic.1,2 The use of contract direct care staff employed by third-party agencies has allowed NHs to meet their workforce needs during periods of increased demand or staffing shortages, including following COVID-19 outbreaks in facilities.1,2 Although using contract staff may be costly to NHs and has been associated with lower care quality,3,4 little is known about the extent to which contract direct care staff have been used by NHs before and during the pandemic.