Staffing shortages have led providers to limit admissions – most commonly in Skilled Nursing units – with 25% of single-site communities and 18% of multi-sites affected, according to the latest July 2025 Ziegler CFO Hotline survey.

The survey offers a glimpse into staffing trends, vacancy and turnover rates, reliance on agency staff, as well strategies aimed at stabilizing the workforce in long-term care communities across the U.S.

“Amid an evolving labor landscape, rising costs, and growing care demands, the senior living sector continues to face considerable obstacles in attracting, retaining, and supporting its staff,” the survey notes.

Vacancy and turnover remain core concerns among the CFOs polled. Certified nursing assistants (CNAs), licensed practical nurses (LPNs), and registered nurses (RNs) were named the most difficult roles to recruit and retain, with CNA turnover reaching 44.2% on average. Vacancy rates are highest in rural areas, especially among CNAs and LPNs, while multi-site sub-metropolitan organizations reported particular difficulty in filling RN roles.

Over 60% of respondents reported using agency staff in the past year, with multi-site organizations more likely to rely on temporary workers. Staffing shortages led some providers to limit admissions.

Nearly all organizations, or about 96%, saw staffing costs increase over the past year, with over one third of the providers experiencing a “significant” increase in labor costs. Compensation now consumes more than half of provider operating budgets, averaging 56.1%. One in six organizations reported that staffing challenges had a severe impact on their operating margin.

Providers surveyed said they were adopting a variety of approaches to attract and retain staff, with top strategies including promoting a positive workplace culture among 78% of respondents. About 77% said they were raising wages and offering bonuses, and expanding internal training and career pathways. However, fewer organizations said they were leveraging international recruitment, citing legal and visa hurdles, with only about 6% reporting successful international hiring efforts.

Participating CFOs represented a broad range of providers but primarily single-site communities, with the largest number representing independent living and skilled nursing, followed by a significant number who also offered assisted living. Almost half also offered home and community-based services (HCBS).

Of the 33 states represented, the largest number of respondents came from Pennsylvania, Florida, Virginia, North Carolina and Ohio.