‘Price pricing’ leads more care homes to launch in-house recruiting agencies


Faced with skyrocketing agency rates, long-term care providers have decided to launch in-house agency services to meet a growing demand for flexibility among shrinking staff numbers.

Operators tout the industry as the “best of both worlds”, Eileen Caffey told Skilled Nursing News – extra pay, experience in different care settings and the stability and perks that come with working for a single organization are part of the advantages.

Caffey is the recruiting director for the Bethesda Health Group based in St. Louis, Missouri.

Bethesda created its emergency nurse program late last year as a way to bring people into the organization and think about their staffing model in a different way, she said. declared.

On the management side, Caffey added, in-house agency staff are cheaper than traditional agency use and “game changers” when regular staff call in.

“Obviously, like many long-term care facilities, we have seen our spending on agency nurses increase not only because we have a greater need, but also because the prices for these nurses continue to rise. astronomically compared to what we are used to paying,” added Caffey.

Georgian non-profit operator AG Rhodes is also creating its own internal staff pool to cut costs, with the new business line due to launch at the start of its next financial year in June.

AG Rhodes CEO Deke Cateau said his organization currently pays agency staff three to four times more than it can pay its own staff.

“It’s something we’ve been talking about for a while,” added Cateau. “There’s a lot of what I call price gouging with staffing agencies… our best way to control that would be to bring that staffing in-house.”

Expansion of the staff pool

Bethesda’s emergency nursing program works well with its six skilled nursing facilities, some of which are located in the St. Louis metro area and others in Illinois, according to Caffey.

Caffey initially hired 12 licensed practical nurses (LPNs), as it is the most expensive position Bethesda obtains through outside agencies—Bethesda does not use agency registered nurses (RNs). About 20 certified practical nurses (CNAs) and an emergency staffing coordinator are next for the program, Caffey noted.

LPNs were the “lowest fruit,” Caffey said, when the organization discussed its emergency nursing program, but they had to be licensed to practice in both states.

“We’re now aware and we’re, you know, able to program them into our facilities as needed and it’s worked out really well,” Caffey said. “We were able to rehire nurses who left us for an agency opportunity, so that was really exciting.”

Cateau said AG Rhodes’ pool of staff depends on the number of vacancies and agency workers they are currently using. If the nonprofit were to launch the line of business today, it would initially hire 12 professionals between CNAs and LPNs, as that is the number of agency staff used between its three campuses.

Another senior care operator, Indiana-based Majestic Care, grew its own in-house recruiting agency to more than 60 full-time professionals in six months. More than half of his agency’s staff are CNAs, followed by LPNs and 10-15% RNs.

“They are committed to traveling and going where needed within a certain mileage,” said Bernie McGuinness, CEO of Majestic Care. “There are enhanced pay rates if they go outside of a certain 50 mile radius to be able to meet the needs of our facilities.”

Currently, Majestic Care is focused on growing its float pool in four markets: Fort Wayne, Indiana, as well as Detroit, Livonia and Flint, Michigan. Staff from his agency also travel to Indianapolis as well as Columbus and Cincinnati, Ohio, McGuinness said.

“We really did a heavyweight campaign…targeting nurses across the Midwest, with improved pay rates,” McGuinness added. “We heard our [LPNs] especially and we have changed some of these pay rates; we’ve had some success, particularly in the Cincinnati market. »

Bethesda was able to recruit new LPNs through the program who would otherwise have applied for a traditional long-term care opportunity within the organization.

“Why do they like the agency? Obviously they like to be paid more, but a big part of it is also the flexibility of being able to have more control over their schedule,” Caffey said. “They also tend to like the idea of ​​moving around, going to different care settings and having the opportunity to develop their skills, perhaps in several different specialties in several different facilities.”

Caffey said staff at his agency wouldn’t be canceled at the last minute if they weren’t needed, a common frustration among workers at traditional recruiting agencies.

“They would also know that very well and would be trained on our electronic medical record system, on our policies, on our equipment, so that they would have some level of comfort,” Caffey added. “Like a [traditional] agency nurse, you are greeted with limited training and expected to work. »

Multiple and specialized care settings

This is one of the main reasons why Bethesda is more selective with staff to fill these floating roles – they need to be more experienced in a multitude of different contexts for the model to work well.

A good candidate for the program would be able to “get into any setting and be successful” with Bethesda’s emergency nurse training. Others, according to Bethesda, weren’t quite ready for the program, were hired full-time and dedicated to one location, Caffey said.

Cateau said the development of an in-house recruiting agency aligns with the nonprofit’s mission of person-directed care, with a focus on dementia and memory care settings. .

“We want to be able to provide the kind of home care that’s seamless,” Cateau said. “Similarly, we want to be able to staff our homes in any emergency or temporary situation with staff trained in person-directed care and trained in caring for people with dementia.”

An East Coast Continuing Care Retirement Community (CCRC) said it is currently weeks away from launching its equivalent of a staffing agency, echoing Caffey and Cateau regarding its staffing flexibility.

The organization chose not to be named until the official launch of its service.

Implementation of agency logistics

Lori Porter, CEO of the National Association of Health Care Assistants (NAHCA), said staffing agencies and operator-developed float pools need to be aware of travel logistics and staff demographics.

“We know the CNA demographics are mostly women, mostly single moms, mostly poor, not a good running car, maybe not good child care…that travel distance they can or not be able to do that,” Porter said.

Cateau is also still discussing worker compensation, liability and insurance implications for the planned separate business and existing business lines with AG Rhodes management, other logistical issues that need to be resolved before the nonprofit launches its staff pool in June.

“We’re talking with our lawyers right now, talking with the insurers…it’s a very thin line that you’re walking because you have to make the proper distinctions in benefits while following the proper labor and benefits laws in under the Affordable Care Act,” Cateau said.


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