Staffing constraints are the single greatest challenge to maintaining clinical excellence in 2025, followed by insufficient reimbursement, and then rising operational costs and regulatory burdens. Meanwhile, operators are split on building new specialty clinical services.

Workforce challenges are overwhelmingly top of mind for operators, with 45.5% saying these are hindering quality care, according to a survey conducted by Skilled Nursing News to uncover key insights about the trends, challenges and innovative strategies shaping the delivery of clinical care.

In terms of the clinical goals that held the highest priority for their organization in 2025, operators surveyed felt reducing hospital admissions was their highest priority, followed by meeting patients’ behavioral health needs at 42.4%, better medication management at 30.3% and enhancing dementia care at 24.2%.

Respondents were able to choose from various clinical goals, which included improving wound care, better infection control and meeting and exceeding staffing needs of residents as well as “all that apply” out of given options.

About a third of the 33 respondents own more than 20 nursing homes, according to survey results.

Readers can learn more about clinical trends, roadblocks and innovative solutions in the works at Skilled Nursing News’ CLINICAL conference, taking place Feb. 18 in Bonita Springs, Florida.

Recruiting, retention tech holds the most promise

More than 45% of those surveyed said that they expected staffing challenges, specifically in recruiting new workers, to only get harder this year. About 30% expect recruiting to get easier and 24% say it will stay the same. Retention, meanwhile, is expected to stay the same, according to 46.9% of the respondents.

Considering such a focus on recruiting and retention, it makes sense that operators said recruiting and retention technology platforms have the most promise to elevate clinical care in skilled nursing facilities.

Just over 33% of respondents said remote patient monitoring – tied to predictive analytics – has the most promise for nursing homes, while only 12.1% said telehealth had the most promise.

And, as staffing issues are expected to get worse in 2025, patient acuity will increase even more than it already has, according to 7.8% of respondents. It’s a concerning trend considering operators are already struggling to care for patients with higher acuity.

In terms of positions, registered nurses (RNs) posed the greatest recruitment and retention challenge for operators with 48.5% of respondents choosing the role, while 27.3% said certified nurse aides (CNAs) were the most difficult to bring on and retain.

One respondent cited the availability of quality staff as major constraint, saying it was difficult to find nurses who have been “trained at the bedside, can pick up on subtle changes in a patient and know how to adequately communicate such to a physician or nurse practitioner.”

The respondent was voicing what has been a common refrain heard since the pandemic, with many new nurses having less real-world experience. Many nurses graduating between 2020 and 2022 were unable to complete their clinicals on-site due to Covid, leaving nurses to learn through online skills labs and other solitary training.

Operators split on prospect of new services

Running in tandem with many obstacles to quality care, nursing home operators are split on adding specialty clinical services in 2025. About 42.4% said they wouldn’t be offering new services, 30.0% said they would, and 27.3% were on the fence.

For those that are launching new clinical services, specific offerings range from pulmonary and the Transforming Episode Accountability Model (TEAMs) diagnosis protocols, to vascular services and in-house dialysis. Others will be focusing on ventilator services, memory care, and outpatient therapy for residents prepped to go home. Still more are focusing on combating Candida Auris.

The Trump administration’s communications freeze muddies the waters when it comes to clinical goals, seeing as many are also measures implemented by the Centers for Medicare & Medicaid Services (CMS); data used to track measures, and in turn update the Five-Star Rating System, has been impacted.

Nursing homes were expecting an unfreezing of four quality measures on hold since April 2024, since measure adjustments were needed for the minimum data set (MDS).