Nursing homes increasingly rely on staffing agencies for direct care nursing. This study examines trends in the use of staffing agencies among nursing homes during the pre-pandemic and pandemic periods (2018–2022). In 2018, 23% of nursing homes used agency staff, accounting for about 3% of all direct care nursing hours. By 2022, nearly half of all nursing homes used agency staff, accounting for 11% of all direct care nursing hours. Agency staff were increasingly used to address chronic staffing shortages, with 13.8% of nursing homes having agency staff present every day. Agency staffing was 50–60% more expensive per hour than directly employed nursing staff, and nursing homes that used agency staff often had lower five-star ratings. Policy makers need to consider postpandemic changes to the nursing home workforce as part of nursing home reform, as increased reliance on agency staff may reduce available financial resources to increase nursing staff levels and improve quality of care. The study used data from the Payroll-Based Journal (PBJ), Nursing Home Compare Archive, and Medicare Cost Reports. It found that the share of nursing homes using agency staff increased from 22.5% in 2018 to 49.1% in 2022. The share of hours worked by agency staff increased from 3.2% to 11%. Labor costs for both directly employed and agency nursing staff increased significantly during the pandemic. Agency staff was significantly more expensive than directly employed staff, with hourly labor costs 50–66% higher. The study also found that nursing homes using agency staff had lower five-star ratings, though the analysis did not establish causality. The use of agency staff has increased due to staffing shortages, which have been exacerbated by the pandemic. Agency staff may be less familiar with the facility and residents, leading to lower quality of care. The higher cost of agency staff may also reduce financial resources available for staffing and quality improvements. The study highlights the need for policy changes to address the challenges in the nursing home workforce, including ensuring adequate payment for nursing staff and improving staffing levels. The findings suggest that increased reliance on agency staff may have negative consequences for the quality of care and the morale of directly employed staff. The study also notes the potential for the spread of respiratory viruses in nursing homes using agency staff. Overall, the study underscores the importance of addressing the nursing home workforce challenges to ensure quality care for residents.Nursing homes increasingly rely on staffing agencies for direct care nursing. This study examines trends in the use of staffing agencies among nursing homes during the pre-pandemic and pandemic periods (2018–2022). In 2018, 23% of nursing homes used agency staff, accounting for about 3% of all direct care nursing hours. By 2022, nearly half of all nursing homes used agency staff, accounting for 11% of all direct care nursing hours. Agency staff were increasingly used to address chronic staffing shortages, with 13.8% of nursing homes having agency staff present every day. Agency staffing was 50–60% more expensive per hour than directly employed nursing staff, and nursing homes that used agency staff often had lower five-star ratings. Policy makers need to consider postpandemic changes to the nursing home workforce as part of nursing home reform, as increased reliance on agency staff may reduce available financial resources to increase nursing staff levels and improve quality of care. The study used data from the Payroll-Based Journal (PBJ), Nursing Home Compare Archive, and Medicare Cost Reports. It found that the share of nursing homes using agency staff increased from 22.5% in 2018 to 49.1% in 2022. The share of hours worked by agency staff increased from 3.2% to 11%. Labor costs for both directly employed and agency nursing staff increased significantly during the pandemic. Agency staff was significantly more expensive than directly employed staff, with hourly labor costs 50–66% higher. The study also found that nursing homes using agency staff had lower five-star ratings, though the analysis did not establish causality. The use of agency staff has increased due to staffing shortages, which have been exacerbated by the pandemic. Agency staff may be less familiar with the facility and residents, leading to lower quality of care. The higher cost of agency staff may also reduce financial resources available for staffing and quality improvements. The study highlights the need for policy changes to address the challenges in the nursing home workforce, including ensuring adequate payment for nursing staff and improving staffing levels. The findings suggest that increased reliance on agency staff may have negative consequences for the quality of care and the morale of directly employed staff. The study also notes the potential for the spread of respiratory viruses in nursing homes using agency staff. Overall, the study underscores the importance of addressing the nursing home workforce challenges to ensure quality care for residents.