Recruiting and retaining qualified clinical staff continues to be one of the greatest operational and financial concerns for nursing homes and other long-term care providers, according to the July 2026 Ziegler CFO Hotline survey released Wednesday.
And although staffing conditions across all senior living segments have improved, maintaining workforce gains remains top of mind for many providers, the survey indicates.
Providers are increasingly shifting from short-term staffing solutions, such as wage increases and hiring bonuses, to longer-term investments in employee development, workplace culture, career advancement, flexible scheduling, technology and workforce sustainability, the survey indicates.
“[W]orkforce-related expenses remain among the most significant pressures on operating budgets, and providers are increasingly evaluating how demographic shifts, immigration policy, and changing employee expectations will shape their labor strategies in the years ahead,” the survey notes.
Participating CFOs represented a broad range of providers of primarily nonprofit providers, with nearly 80% offering the full continuum of care, including skilled nursing.
While overall workforce turnover declined slightly from 36.3% in 2025 to 35.4% in 2026, organizations are still replacing more than one-third of their workforce annually.
Clinical positions key to SNFs hard to fill
Clinical positions critical to Skilled Nursing Facilities (SNFs) remain the most difficult to stabilize.
Registered Nurses experienced the highest turnover rate at 40.8%, followed by Dining Services staff at 40.0% and Certified Nursing Assistants at 39.0%. Meanwhile, CNAs, RNs, and Licensed Practical Nurses (LPNs) were also identified as the most difficult positions to recruit and retain, underscoring persistent shortages in the licensed nursing workforce that is essential to skilled nursing operations.
The Midwest region experienced the highest turnover rate in the country.
Despite strides in cutting agency labor, temporary staffing remains an important component of workforce management, particularly among multi-site organizations, with more providers reporting frequent use of temporary staffing in 2026 than last year.
At the same time, many organizations are investing in strategies intended to reduce long-term reliance on agency labor through internal workforce development and stronger employee retention.
Staffing models continue to vary by care setting, with survey respondents reporting general staffing ratios of one caregiver for every 6 to 10 residents in skilled nursing, reflecting the higher acuity and regulatory requirements of SNFs compared with other senior living settings.
Labor remains the largest operating expense across the sector. Employee compensation accounted for an average of 56.2% of operating budgets, essentially unchanged from the prior year, yet 90% of organizations reported increased staffing costs. Wage increases, employee benefits, overtime, and agency staffing continue to drive budget pressures, while organizations increasingly focus spending on retaining and supporting existing employees rather than recruitment incentives alone.
Providers are responding with varied workforce approaches that extend beyond compensation. The most common initiatives include strengthening workplace culture, increasing wages and bonuses, expanding training and upskilling programs, creating career pathways, offering flexible scheduling, enhancing employee wellness and engagement, and improving benefits. Larger multi-site organizations are investing in initiatives focused on workforce technology, international recruitment and internal staffing resources, while single-site providers often emphasize localized culture and community partnerships.
Survey respondents pointed to immigration policy as having added additional pressures. About one-quarter of those surveyed reported staffing disruptions related to changes in work authorization, Temporary Protected Status (TPS), or visa availability, with impacts falling most heavily on frontline positions, including nursing, caregiving, housekeeping, and dining services. Many providers cited delays in recruiting international nurses, loss of existing employees, and increased uncertainty surrounding future workforce availability.
Providers expressed growing concern not only about filling current vacancies but also about the long-term sustainability of the healthcare workforce. Continued shortages of RNs, LPNs, CNAs and other frontline caregivers, combined with wage inflation, rising benefit costs, an aging workforce, fewer individuals entering nursing professions, leadership succession challenges, and uncertainty surrounding immigration policy, are expected to place ongoing pressure on SNFs.
“We have been forced to let go of multiple team members due to changes in immigration,” one survey respondent noted. “Our team members, who come from dozens of countries around the world, are concerned for their status and the status of their loved ones. We are deeply committed to supporting our team members.”
Others were experiencing delays of up to a year in recruiting RNs.
Of the 40 states represented, the largest number of responses came from Florida, Ohio, California, North Carolina, and Pennsylvania.
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