Nursing Home Agency Staff and Temporary Nurses: What Families Should Ask
Nursing homes sometimes use agency, contract, or temporary staff to cover vacancies, census changes, leave, or hard-to-fill shifts.
Agency staffing is not automatically a sign of poor care.
The important questions are how much temporary staffing the facility uses, how those workers are oriented, whether they know resident-specific care plans, and how the facility preserves continuity across shifts.
CMS requires nursing homes to report direct-care staffing through the Payroll-Based Journal, including agency and contract staff.
Ask how often agency staff are used
Questions include:
- What percentage of nursing hours comes from agency staff?
- Which roles use agency workers most?
- Are certain shifts more dependent on them?
- Are the same temporary staff members returning regularly?
- Is usage increasing or decreasing?
A facility may use agency staff occasionally while maintaining a stable core team.
Another may depend heavily on unfamiliar workers every shift.
Ask about orientation
Before temporary staff care for residents, ask how they learn:
- emergency procedures;
- call systems;
- infection-control expectations;
- transfer equipment;
- medication systems;
- documentation;
- dementia-care practices; and
- facility policies.
A licensed nurse’s professional credential does not replace orientation to a specific facility.
Resident-specific information matters
Ask how agency staff learn:
- transfer method;
- diet;
- swallowing precautions;
- behavior triggers;
- skin risks;
- fall risks;
- communication needs;
- code status; and
- other care-plan details.
A temporary worker should not have to discover critical information after something goes wrong.
Ask who supervises temporary staff
Find out:
- who assigns residents;
- who answers questions;
- who checks competency;
- who monitors documentation;
- who handles medication-system access; and
- who evaluates performance concerns.
Temporary staff still work within the facility’s care systems.
Continuity can affect resident experience
Residents with dementia may be particularly sensitive to unfamiliar caregivers.
Frequent staff changes can also make it harder to recognize subtle changes in:
- appetite;
- behavior;
- mobility;
- skin;
- breathing; or
- cognition.
Ask how permanent staff support continuity when agency use is high.
CMS staffing data include agency and contract staff
CMS’s Payroll-Based Journal requires facilities to submit direct-care staffing information, including agency and contract staff, based on payroll and other auditable data.
CMS uses staffing data in public reporting and the Five-Star Quality Rating System.
Care Compare can help families review staffing and turnover trends, though it does not tell you everything about this week’s schedule.
Ask about the facility’s retention strategy
If agency use is high, ask:
- What positions are hardest to fill?
- What has the facility changed to retain employees?
- Are agency workers being hired permanently?
- How long have unit managers been in place?
- Has turnover improved?
Our guide What Does Nursing Home Staff Turnover Mean for Your Parent? explains how to review turnover alongside staffing levels.
A practical example
Facility A uses agency nurses for occasional weekend call-outs.
The same small group of agency nurses returns regularly and receives unit orientation.
Facility B relies heavily on different temporary aides every night.
Both use agency staff, but the continuity problem is very different.
The family needs more detail than a yes-or-no question.
Eight questions about agency staffing
- How much agency or contract staffing do you use?
- Which shifts depend on it most?
- Are the same temporary workers used repeatedly?
- What orientation do they receive?
- How do they access resident-specific care plans?
- Who supervises them?
- How do you preserve continuity for residents with dementia?
- What is the facility doing to improve retention?
Sources and review date
Sources checked October 12, 2026.
