Most buildings use some mix of core staff, a float or per-diem pool, and outside agency staff to fill gaps. The mix evolved over time, usually in response to urgent needs. Few operators have ever stepped back and asked a simple question: which of these approaches is working best for our building, for our residents and for our budget?
With the right metrics, you can answer that with your own data.
Why the question matters
Each coverage option has tradeoffs. Core staff know the residents and the routines. A float pool offers flexibility but may be spread thin. Agency staff can fill urgent gaps but may be less familiar with the building and typically cost more per hour. Which option fits depends on the situation, and the right mix may differ between a rural single building and a multi-facility group.
Start with the cost side
Cost per worked hour by category
Calculate your all-in cost per hour for each category, including wages, premium pay, benefits where applicable, and agency markup. Keep the calculation consistent so comparisons are fair.
Agency hours as a share of total hours
Trend this weekly by role and unit. A slowly rising share often signals an unfilled vacancy that has become normal. A spiky pattern may point to seasonal demand or a specific event.
Cost of unfilled shifts
When a shift is not filled, someone absorbs the gap through overtime, short-staffing or missed breaks. Counting open shifts and how they were resolved makes this hidden cost visible.
Then look at the care side
Cost alone is not the full story. Pair it with indicators of how care is going:
- Call-light response times on shifts with heavy agency use compared with those with core staff.
- Continuity measures, such as how often residents see the same caregivers.
- Staff feedback on orientation and support for temporary workers.
- Any quality or incident indicators your building already tracks, reviewed carefully and without drawing conclusions from small numbers.
Be cautious about causation. If agency shifts coincide with slower responses, the cause might be the agency staff, or it might be that agency is used on the hardest-to-staff shifts, which would be difficult for anyone. A hypothetical building might find that its slowest response times were all on understaffed evenings regardless of who worked them, which points to the staffing level, not the staffing source.
Evaluate the float pool on its own terms
An internal float pool is only effective if it is used well. Useful measures include:
- Fill rate: the share of open shifts covered by float staff.
- Notice time: how far in advance float staff were scheduled.
- Retention: whether float staff stay, or leave for fixed positions or other employers.
- Satisfaction: whether float staff feel supported and have clear expectations.
If the float pool fills a large share of open shifts and agency use falls as a result, that is a good sign. If agency use remains the same while float pool hours sit unused, scheduling or communication may be the bottleneck.
Look for the pattern behind the gap
Often the persistent need for outside staff points to a specific shift, role or unit. Recruiting or retention work targeted at that spot can do more than adding general float capacity. Data on turnover by shift and by tenure can help show where people are leaving and why.
A simple decision review
Each quarter, bring your administrator, DON, scheduler and finance lead together to review:
- Total hours by source and cost per hour.
- Open shifts and how they were filled.
- Care-side indicators by shift type.
- Staff turnover by unit, role and tenure.
- One decision to test next quarter, such as increasing float pool hours on weekend evenings.
Then track the result.
A note on balance
The goal is not to eliminate agency use. It is to use it deliberately, with the information to know when it helps and when it is a sign of something to repair. Staff who are working extra to avoid agency use deserve attention too.
See it in your own data
CarePulse combines payroll, scheduling and operational data so these comparisons are easy to see in one place. If you would like to examine your own float, per-diem and agency picture, we would be glad to set up a demo.