This article examines the increasing reliance of nursing homes on staffing agencies for direct care nursing during the prepandemic and COVID-19 pandemic era (2018–22). Initially, 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, covering 11% of 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. The study found that the share of nursing homes using agency staff increased from 22% to nearly half, and the share of hours worked by agency staff rose from 3.2% to 11%. Labor costs for both agency and directly employed staff increased, with agency staff costs growing at a slightly faster rate. The use of agency staff may be associated with lower-quality care, as agency staff are less familiar with residents and facilities, potentially leading to less personalized care. The findings suggest that policymakers need to consider the increased use of agency staff and their higher labor costs as part of nursing home reform.This article examines the increasing reliance of nursing homes on staffing agencies for direct care nursing during the prepandemic and COVID-19 pandemic era (2018–22). Initially, 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, covering 11% of 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. The study found that the share of nursing homes using agency staff increased from 22% to nearly half, and the share of hours worked by agency staff rose from 3.2% to 11%. Labor costs for both agency and directly employed staff increased, with agency staff costs growing at a slightly faster rate. The use of agency staff may be associated with lower-quality care, as agency staff are less familiar with residents and facilities, potentially leading to less personalized care. The findings suggest that policymakers need to consider the increased use of agency staff and their higher labor costs as part of nursing home reform.