The Increase in Contract CNA Staffing in U.S. Nursing Homes and Associated Care Quality Outcomes

Higher levels of certified nursing assistant (CNA) staffing are positively associated with improved care quality outcomes for nursing home residents, but low wages and other job quality concerns drive high turnover and job vacancies within the CNA workforce. Evidence suggests that nursing homes have addressed workforce pressures by increasing their reliance on contract CNAs from staffing agencies in recent years, particularly during the COVID-19 pandemic. This trend raises concerns about staffing quality and continuity in nursing homes, with pre-pandemic research indicating that adding contract CNA staffing does not improve care quality outcomes.