Background

Temporary employment is widely used in eldercare to address staffing shortages, but heavy reliance on temporary workers may compromise continuity of care, staff workload, and quality of care. Managers are key to how staffing is organised and handled in daily practice. This study examined how managers at different organisational levels perceived the opportunities and challenges of temporary employment in municipal eldercare.

Methods

This qualitative study was based on semi-structured interviews with 16 managers across four organisational levels in Swedish municipal eldercare, including residential care homes, home care services, and higher-level management. The interview guide focused on managers’ experiences of temporary employment, staffing practices, care continuity, work environment, and perceived effects on care quality. Data were analysed using qualitative content analysis.

Results

Three themes were identified. Balancing staffing on a tightrope describes managers’ struggle to ensure continuity in a system that relies on short-term solutions and often prioritising shift coverage over competence. Leading with tied hands captures managers’ limited control over recruitment and workforce planning, which reinforced reliance on temporary employment. From rigidity to flexibility highlights managers’ suggestions for improving staffing stability. Managers across levels identified similar challenges, but their priorities differed. First-line managers focused on daily staffing, staff well-being, and quality of care, while higher-level managers emphasised long-term planning. Temporary workers helped cover staffing gaps, but also increased permanent employees’ workloads and complicated workforce planning. Managers expressed frustration with centralised staffing decisions that prioritised immediate coverage over long-term stability. Temporary workers were often treated as interchangeable rather than integrated team members, reflecting systemic problems in staffing practices.

Conclusion

Temporary workers are essential for keeping eldercare services running, but over-reliance on temporary employment may reinforce reactive staffing practices, increase pressure on permanent staff, and weaken continuity. Managers suggested better onboarding, greater local hiring control, and dedicated staffing pools. Addressing these issues requires both immediate measures to integrate temporary workers into regular teams and longer-term changes in workforce planning, staffing levels, and local managerial influence.