U.S. Long-Term Care Providers Rebuild Their Workforce as Agency Staffing Declines

Nursing Facilities Added Approximately 40,700 Jobs in 2025

According to the U.S. Healthcare Staffing Market Growth Assessment: 2026 from Staffing Industry Analysts (SIA), nursing facilities added approximately 40,700 jobs in 2025.

This increase suggests that long-term care providers have continued rebuilding their permanent workforce after the staffing disruptions experienced during and following the COVID-19 pandemic.

Nursing facilities depend on a broad range of employees to maintain daily operations. Registered Nurses (RN) / Travel Nursing, licensed practical nurses, certified nursing assistants, rehabilitation professionals and support staff all contribute to resident care and facility operations.

Adding permanent positions can help facilities strengthen their internal teams and reduce the need to fill recurring staffing gaps through outside agencies. It may also allow employers to develop more consistent scheduling arrangements, improve staff familiarity with residents and support longer-term workforce planning.

Nevertheless, job growth alone does not establish that every facility has reached its required staffing levels. Hiring needs can differ considerably by state, facility size, resident population and local labor-market conditions.

Healthcare Agency Staffing Use Declined 44% From Late-2022 Levels

The SIA assessment also reported that agency staffing use in healthcare had declined by approximately 44% compared with fourth-quarter 2022 levels.

Agency personnel played a significant role in helping healthcare organizations respond to staffing shortages during the pandemic and its aftermath. Temporary nurses and other contract professionals provided additional coverage when facilities struggled to recruit or retain enough permanent employees.

As direct recruitment improves and employers adjust their staffing strategies, some organizations have been able to reduce their dependence on these arrangements.

However, agency staffing remains an important part of the healthcare labor market. Temporary personnel can still help facilities manage unexpected absences, seasonal demand, vacancies and short-term increases in patient or resident needs.

The decline therefore indicates a change in the balance between permanent and temporary staffing—not the disappearance of contract employment.

For healthcare professionals, this distinction matters. Agency assignments may continue to appeal to workers who prioritize flexibility, varied work environments or assignment-based employment. Direct-hire positions, meanwhile, may be attractive to candidates seeking a more established relationship with one employer.

Recruitment Challenges Remain Widespread Across Healthcare

Despite improvements in staffing levels, healthcare employers continue to face significant recruitment difficulties.

The SIA research, as cited by AHCA/NCAL, found that 90% of health systems still report recruiting difficulties.

This figure highlights an important distinction: a reduction in temporary staffing does not necessarily mean that employers can easily fill all open positions.

Healthcare organizations may be hiring more permanent employees while still competing for experienced nurses, licensed clinicians and other qualified professionals. Recruitment challenges can be particularly difficult in locations where the supply of healthcare workers is limited or where multiple employers are seeking candidates with similar qualifications.

Long-term care providers face additional workforce considerations. Their staffing needs extend beyond filling individual shifts. Facilities need employees who can build familiarity with residents, recognize changes in health status, communicate with families and contribute to ongoing care planning.

The ability to recruit and retain qualified personnel is therefore closely connected to the long-term stability of nursing facilities.

What the Staffing Shift Means for Nurses and Direct-Care Professionals

The changing workforce environment may create opportunities for several categories of healthcare professionals:

• Registered Nurses (RNs): RNs in skilled nursing and long-term care facilities may be responsible for resident assessments, care planning, medication oversight, clinical documentation and coordination with attending physicians and medical directors. Depending on the facility and position, experienced nurses may also take on charge nurse, supervisory or management responsibilities.
• Licensed Practical Nurses (LPNs): LPNs support daily nursing services, monitor residents, administer medications within their authorized scope of practice and communicate changes in residents' conditions to supervising clinicians. Skilled nursing facilities and rehabilitation settings are among the employment environments where LPNs may find opportunities.
• Certified Nursing Assistants (CNAs): CNAs provide essential hands-on assistance with activities of daily living, including bathing, dressing, mobility, meals and routine observations. Because these responsibilities are central to resident care, nursing assistants remain an important part of long-term care staffing.
• Rehabilitation and Therapy Professionals: Physical therapists, occupational therapists and assistants may work with residents recovering from illness, injury or surgery, as well as individuals who need help maintaining mobility and functional independence.
• Administrative and Support Professionals: Long-term care facilities also employ professionals in admissions, medical records, scheduling, human resources, dietary services and other operational functions. These positions support the delivery of care even when they do not involve direct clinical responsibilities. Additionally, expanding post-discharge outreach and hybrid coordination increasingly leverage Telehealth / Remote / Virtual Jobs for remote monitoring and nurse triage.

Actual qualifications, licensing requirements and job responsibilities vary by state, facility and position.

Permanent Employment vs. Agency Assignments: What Candidates Should Compare

As long-term care providers rebuild their direct workforce, candidates may encounter more opportunities to consider permanent employment. However, the choice between a facility position and an agency assignment should depend on the full employment arrangement rather than the advertised hourly rate alone.

Important factors include:

• Compensation: Compare base hourly pay, shift differentials, overtime eligibility and any disclosed bonuses. A higher hourly rate does not automatically mean higher overall earnings.
• Schedule: Determine whether the position offers fixed shifts, rotating schedules, weekends, nights or on-call responsibilities.
• Benefits: Review health insurance, retirement plans, paid time off and other benefits, where offered.
• Staffing conditions: Ask about typical patient or resident assignments, available support staff and how the facility handles short staffing.
• Orientation and training: Understand how new employees are introduced to facility procedures, documentation systems and resident-care expectations.
• Career development: Consider whether the employer offers continuing education, clinical training or opportunities to move into supervisory roles.
• Employment status: Confirm whether the position is permanent, temporary, contract-based or agency-employed, and clarify who the legal employer is.

For nurses and nursing assistants, the working environment can be just as important as compensation. A position with a competitive hourly rate may be less attractive if scheduling expectations, workload or staffing support do not match the candidate's needs.

Candidates should also verify that their licenses, certifications and other credentials meet the requirements of the specific role and state.

Why Workforce Stability Matters in Long-Term Care

Long-term care providers serve older adults and individuals with disabilities who may require ongoing assistance, nursing services and rehabilitation.

Unlike some healthcare settings where patient interactions may be relatively brief, long-term care often involves sustained relationships between residents and care teams. Employees may become familiar with residents' medical histories, daily routines, communication preferences and individual care needs.

A more stable workforce can support continuity, communication and familiarity with residents. It may also help facilities reduce the operational disruption associated with repeatedly onboarding temporary personnel.

However, lower agency use does not automatically demonstrate improved care quality or adequate staffing at every facility. Outcomes depend on multiple factors, including staffing levels, employee experience, management practices, resident needs and the ability to retain qualified workers.

For providers, workforce rebuilding is therefore not simply a matter of replacing agency hours with permanent positions. It also involves creating working conditions that encourage employees to remain with the organization.

AHCA/NCAL's Focus on Long-Term Care Workforce Development

AHCA/NCAL has highlighted the workforce recovery trend as part of its broader effort to strengthen the long-term care sector.

Its Caregivers for Tomorrow initiative focuses on workforce development and policy solutions intended to support the availability of qualified caregivers in nursing homes and assisted living communities.

The initiative reflects a wider industry concern: long-term care providers need a sustainable pipeline of workers to meet the needs of an aging population and individuals who require ongoing support.

Recruitment campaigns alone may not be sufficient to address these challenges. Long-term workforce development can also involve education and training pathways, support for credentialing, improved retention strategies and policies that help providers compete for qualified employees.

The effectiveness of these efforts will depend on how successfully employers and policymakers translate workforce initiatives into practical improvements in recruitment and employee retention.

Healthcare Hiring Outlook: Direct-Hire Opportunities Grow, but Competition Continues

The latest findings point to gradual progress in long-term care workforce recovery. Nursing facilities added approximately 40,700 jobs in 2025, while healthcare agency staffing use declined by around 44% from fourth-quarter 2022 levels.

At the same time, the reported recruitment difficulties among 90% of health systems show that employers continue to face substantial workforce challenges.

For healthcare professionals, this may be a useful time to explore direct-hire opportunities in skilled nursing facilities, rehabilitation centers and other long-term care environments. Candidates can compare permanent and agency positions based on compensation, scheduling, benefits, staffing support and opportunities for professional growth.

For employers, the figures reinforce the importance of turning workforce gains into sustainable retention. Recruiting additional employees is only part of the challenge; maintaining adequately staffed teams over time remains essential.

As long-term care providers continue rebuilding their workforce, qualified nurses, nursing assistants and other healthcare professionals will remain central to the industry's ability to deliver consistent resident care.