After years of workforce instability, skilled nursing operators are finally seeing signs of progress in staffing – yet new policy developments and ongoing state level mandates threaten to complicate that recovery in 2026.
Sector leaders say declining agency use, stronger hiring pipelines, and expanded training programs helped stabilize staffing in 2025. However, regulatory pressures – particularly at the state level – remain a significant concern.
Laurel Lingle, vice president of talent acquisition at Journey Skilled Nursing, said the industry’s move away from agency staffing has been a major driver of improvement.
“As an industry, we’ve started to squeeze agency out,” Lingle said, noting that many agency workers are now seeking permanent roles that offer stability, benefits, and consistent schedules.
Journey has largely eliminated agency use across its portfolio since early 2025, even after acquiring facilities that relied on contract labor. That shift has helped convert agency workers into full-time staff, strengthening continuity of care.
At the same time, Gurwin Healthcare System CEO Stuart Almer said broader labor conditions have improved as the sector moves further from pandemic-era disruptions. Paid training programs – supported by state grants – have also expanded the pipeline of new workers.
“We’ve been able to bring people in, train them while paying them, and transition them into our workforce,” Almer said.
Both leaders highlighted changing workforce dynamics, including an increase in male employees and more mid-career professionals entering long-term care from other industries.
Gurwin, which tracks turnover rates quarterly by division, down to the building level, now has a system-wide turnover rate of 31%, which is 10% better than the industry average, and a significant improvement from over 50% in previous years, Almer said. And, in Gurwin’s largest and most challenging building, with about 750 employees, turnover dropped to 27% in 2025.
New York-based Gurwin is a non-profit which operates skilled nursing, assisted and independent living facilities across the state.
But even as hiring improves and turnover rates decline, policy challenges loom large.
While new funding such as that proposed through the Centers of Medicare and Medicaid Services (CMS) staffing campaign’s expanded funding is among the more positive approaches, state-level staffing mandates and the overall immigration policy has created hurdles for nursing home providers.
State-level mandates threaten to thwart gains
Workforce development funding is valuable, Almer noted, but warned that state-level staffing mandates could undermine those gains.
“It’s just not logical. There was no staff to be had, and now facilities are being penalized for that,” Almer said, referring to nursing homes being hit with penalties during the state’s workforce shortages. “Let us do our work. You can monitor our quality, which is fine, and I think you’ll see that we’ll staff well.”
New York State has begun imposing penalties for not meeting specific staffing requirements, including maintaining a minimum 3.5 hours of direct care per resident per day (HPRD).
Recently, over 20 facilities in the state have started receiving fines, which stem from staffing shortages that began in 2022, said Almer, who has been a past chairman of the board of LeadingAge New York. Despite good faith efforts to staff facilities, the state-level mandate remains difficult to meet, he said. The penalties are significant and will make it harder for facilities to manage, he said.
And yet, more penalties are expected for New York nursing homes, Almer said, creating additional financial strain for providers already dealing with tight margins and rising labor costs.
“The amount of dollars involved is extreme,” Almer said. “It will only make it harder for facilities to manage.”
Both leaders questioned whether rigid staffing mandates are the right approach, arguing that quality of care – not just staffing ratios – should be the primary focus.
“Just hiring someone to meet a metric doesn’t mean you’re hiring quality,” Almer said.
Geography further complicates compliance. While some facilities can attract staff more easily, others – particularly in competitive or rural markets – struggle to meet the same standards.
“You have the same mandate applied to all, and it’s not necessarily fair,” Almer said.
With the federal staffing mandate effectively repealed, providers are increasingly relying on internal benchmarks to guide workforce planning – and avert any fallout from state-level staffing mandates.
At Journey, that includes detailed staffing models, proactive hiring strategies, and contingency plans for call-offs and census fluctuations.
“We look at our staffing patterns, forecast needs, and make sure buildings are prepared,” Lingle said.
In states within Journey’s footprint that have state-level mandates, the organization is having to sweeten the pot even more to attract staff.
“We’re always looking at salaries and being [more] competitive in those markets,” Lingle said.
Journey operates more than 40 facilities across Georgia, Indiana, Kentucky, Maryland, Ohio, and West Virginia.
To add to these policy pressures, Almer noted state-level financial pressures. New York providers have gone for 14 years without a cost-of-living adjustment to their Medicaid reimbursement rates, even as wages and operational costs continued to rise, he said.
Immigration policy’s impact
Another policy pressure stems from the downstream impact of the Trump Administration’s immigration policy. Employers are wary of hiring immigrant workers, and have been monitoring workforce data to predict and prevent gaps in the workforce as a result, Almer said.
“Unless something changes in terms of immigration, how are we going to staff a unit, and where are we going to get people from? We don’t ever want to discriminate and we want to bring people in, but it could lead to [gaps] in organizations because people would be afraid to bring in staff who may have to then leave, right? So this has a tremendous ripple effect,” he said.
Keeping track of data has helped alleviate future problems for Gurwin for now, Almer said. This includes getting down to the granular level for Gurwin. Knowing the country of origin for immigrant nurses can be important, Almer said.
“We know that there were immigration challenges in this country … and that’s unfortunate because a lot of folks who are here legally are now needing to leave,” he said.
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