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How to Reduce Agency Spend in Skilled Nursing Facilities

A practical 30-day framework for reducing unnecessary agency dependency without risking resident coverage.

Agency staffing can serve an important purpose when skilled nursing facilities have exhausted their internal coverage options. But persistent agency dependency can also signal gaps in workforce visibility, internal staffing processes, and escalation practices.

The goal should not simply be to eliminate agency staffing. The better objective is to understand why agency hours are occurring, strengthen internal coverage wherever possible, and reserve outside staffing for situations where it is genuinely needed.

For operators looking to improve internal coverage before turning outside the organization, see how FindFill helps senior living organizations reduce agency reliance.

Start With Measurement, Not Assumptions

Facilities cannot meaningfully reduce agency spend until they understand where and why agency hours are being used. Start by tracking agency utilization by building, shift, role, day of week, and reason for use. Compare those hours against overtime, internal PRN utilization, open shifts, call-offs, and other internal coverage sources.

At minimum, leadership should regularly review:

The objective is to identify whether agency use reflects a true workforce shortage or simply a gap in how available employees are being identified and mobilized.

Identify the Primary Drivers of Agency Usage

Not all agency utilization has the same cause. Understanding the underlying driver is essential because each problem requires a different response.

Once leadership knows why agency hours are occurring, it becomes much easier to determine which hours are realistically preventable and which represent legitimate contingency needs.

Implement an Internal-First Escalation Model

Agency staffing should generally be the final escalation layer rather than the first response to an open shift. A simple coverage hierarchy might look like:

  1. Available employees at the building
  2. Internal PRN employees
  3. Eligible employees at nearby sister communities
  4. Overtime or other approved internal options
  5. Outside staffing resources

The precise order will vary by organization and operating policy. The important part is establishing a repeatable process that gives the existing workforce a reasonable opportunity to cover the shift before an external resource is requested.

See how FindFill makes internal shift opportunities visible before operators look outside the organization.

Strengthen Internal PRN Engagement

Building an internal PRN pool is only useful if those employees actually know when opportunities are available. Facilities should make it easy for internal employees to:

A facility may technically have enough employees to cover more shifts while still using agency because available employees never knew the opportunities existed. That is a workforce visibility problem, not necessarily a recruiting problem.

Look Beyond Each Individual Building

For multi-facility senior living operators, one building’s staffing shortage can exist alongside another building’s employee who wants additional hours. When every community operates independently, that employee may never know about the open shift.

Creating visibility across nearby sister facilities expands the internal workforce available to each building without requiring the organization to recruit another employee.

See how FindFill connects eligible employees across nearby sister communities.

Establish Clear Agency Governance Rules

Reducing unnecessary agency utilization requires clear operating rules. Organizations should define:

The purpose isn’t to make agency difficult to use when it is genuinely needed. It is to prevent outside staffing from becoming the default simply because it is operationally easier than identifying available internal employees.

Convert Strong Agency Clinicians Into Internal Opportunities

Facilities that repeatedly use the same high-performing agency clinicians may also want a defined process for evaluating whether those workers could eventually become internal employees or PRN staff, subject to contractual restrictions and applicable policies.

This can turn repeated external labor into a longer-term internal workforce opportunity. However, conversion alone does not solve the underlying problem if the organization still lacks a reliable way to activate and mobilize its internal workforce.

A Practical 30-Day Agency Reduction Plan

Week 1: Establish the Baseline

Week 2: Improve Internal Visibility

Week 3: Establish Escalation Rules

Week 4: Measure the Results

Compare:

Determine which interventions actually shifted coverage from external resources to the organization’s existing workforce.

What Realistic Agency Reduction Looks Like

Successful agency reduction does not necessarily mean reaching zero agency utilization. For many skilled nursing organizations, that isn’t realistic or even desirable.

Agency staffing can remain an important contingency resource for unexpected absences, unusual census changes, difficult-to-fill positions, and situations where internal options have genuinely been exhausted.

The better question is: How many shifts that previously required outside staffing can now appropriately be covered internally?

Every appropriate shift moved from external to internal coverage represents better utilization of the workforce the organization has already recruited.

Measure the Right Executive Metrics

Leadership should review agency reduction alongside the broader workforce picture. Useful monthly metrics include:

Looking only at agency spend can produce the wrong incentives. The goal is to improve workforce utilization without compromising coverage.

Agency Reduction Is a Workforce Utilization Strategy

The most sustainable agency-reduction programs don’t begin with the question, “How do we stop using agency?”

They begin with a better question: “Are we making full use of the workforce already available to us before we look outside?”

For multi-facility operators, better visibility across the organization can expose internal coverage opportunities that individual schedulers may otherwise never see.

FindFill is designed to make those opportunities easier to identify by connecting open shifts with eligible employees across participating sister communities.

Frequently Asked Questions

How can skilled nursing facilities reduce agency staffing?

Start by identifying why agency hours occur, improving internal PRN engagement, increasing visibility of open shifts, enabling appropriate cross-facility coverage, and establishing an internal-first escalation process before outside staffing is requested.

Should skilled nursing facilities eliminate agency staffing completely?

Not necessarily. Agency can remain a valuable contingency resource when appropriate internal options are unavailable. The objective should be reducing unnecessary agency utilization rather than pursuing zero agency use regardless of circumstances.

What is an internal-first staffing model?

An internal-first staffing model gives qualified existing employees and internal PRN staff an opportunity to cover open shifts before the organization turns to external staffing resources.

Can employees work across sister facilities?

That depends on organizational policies, employment structures, credentials, state requirements, and other operational considerations. Organizations that permit cross-facility work can benefit from making opportunities visible across participating communities.

How should nursing facilities measure agency reduction?

Track agency hours and spend alongside internal fill rate, PRN utilization, overtime, open-shift fill rate, cross-facility coverage, and unfilled shifts. This helps leadership determine whether lower agency use reflects better workforce utilization rather than simply shifting costs elsewhere.

Use More of the Workforce You Already Have

FindFill helps multi-facility senior living organizations expose open shifts to eligible employees across nearby sister communities, creating a more connected internal workforce before operators need to look outside.

SEE HOW FINDFILL WORKS

Explore how FindFill can help reduce agency reliance →

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