Staff turnover in long-term care refers to the rate at which employees leave a nursing home, assisted living community, home care organization, or long-term services and supports setting within a defined period. Reducing turnover requires leaders to identify why staff are leaving, strengthen onboarding, support managers, address workload pressure, improve training, and create career pathways that make employees more likely to stay.
Turnover is not just a workforce metric. In long-term care, every departure can affect resident relationships, staffing stability, team morale, and the consistency of daily care.
Key takeaways
- Staff turnover in long-term care affects residents, employees, managers, and facility performance.
- AARP’s 2023 LTSS Scorecard reported U.S. nursing home staff turnover of 53.9%.
- Research in JAMA Internal Medicine found that within-facility variation in staff turnover was associated with decreased nursing home care quality.
- Turnover should be measured by role, shift, unit, manager, tenure, and first-90-day retention.
- Retention improves when leaders combine better onboarding, manager training, career pathways, workload review, recognition, and ongoing education.
- Training alone will not fix turnover, but the right training can help managers and staff feel more prepared, supported, and connected to the work.
What is staff turnover in long-term care?
Staff turnover in long-term care refers to the percentage of employees who leave an organization, facility, unit, or role during a specific period. It may include voluntary departures, involuntary separations, retirements, transfers, and early-tenure exits.
In nursing homes, CMS publicly reports nursing home staffing and turnover data for total nursing staff, registered nurses, and nursing home administrators. These turnover measures are reported on Care Compare and included in the staffing rating.
Long-term care leaders should look beyond one annual turnover number. A facility may have acceptable overall turnover but serious problems in one role, shift, unit, manager group, or new-hire cohort.
Why is staff turnover high in long-term care?
Staff leave long-term care jobs for many reasons. Some are personal and unavoidable. Others are tied to working conditions, leadership practices, training gaps, scheduling, and career growth.
Common drivers include:
- Heavy workloads
- Chronic understaffing
- Burnout and emotional strain
- Limited career advancement
- Inconsistent manager support
- Weak onboarding
- Safety concerns or workplace injury risk
- Scheduling pressure
- Compensation and benefits gaps
- Lack of recognition
- Training that feels disconnected from daily work
- Poor fit between job expectations and the reality of care
The daily work of long-term care is personal. Staff support residents with bathing, dressing, eating, mobility, memory loss, behavioral symptoms, chronic illness, and end-of-life needs. When employees do not feel prepared or supported, the work can become harder to sustain.
That is why turnover prevention must start before someone resigns.
How staff turnover affects residents, staff, and facility performance
Turnover disrupts more than the schedule. It changes the rhythm of care.
Residents often depend on familiar staff who understand their preferences, routines, communication patterns, and early signs of change. Research has connected staff turnover with nursing home care quality, making turnover a quality issue as well as a workforce issue.
For remaining staff, turnover can mean extra shifts, heavier assignments, less predictable teams, and more time helping new employees learn the basics. For managers, it means more hiring, more schedule repair, more performance coaching, and less time for proactive leadership.
For the organization, turnover can affect:
- Recruiting and onboarding costs
- Overtime and agency staffing use
- Care continuity
- Staff engagement
- Resident and family experience
- Quality improvement efforts
- Survey readiness
- Leadership stability
The cost is not only financial. In long-term care, turnover can weaken the relationships that help residents feel known, safe, and respected.
Proof points: Why turnover needs executive attention
These proof points show why staff turnover belongs on the leadership dashboard, not just in HR reports.
- AARP’s 2023 LTSS Scorecard reported S. nursing home staff turnover of 53.9%.
- A JAMA Internal Medicine study found that within-facility variation in staff turnover was associated with decreased quality of care in nursing homes.
- A Health Affairs study on high nursing staff turnover in nursing homes found mean and median annual turnover rates for total nursing staff of roughly 128% and 94%, respectively.
How to measure staff turnover in long-term care
A single turnover rate can hide the problem. Leaders need a more specific view.
Track turnover by:
- Role
- Shift
- Unit
- Location
- Manager
- Tenure
- Full-time, part-time, and per diem status
- Voluntary and involuntary separation
- First 30, 60, and 90 days
- CNA, RN, LPN, administrator, and department leader groups
- Rehire eligibility
- Exit reason
- Agency and overtime trends
Also track leading indicators that often appear before resignations:
- Missed shifts
- Schedule changes
- Training delays
- Declining engagement survey scores
- Manager conflict
- Increased incident reports
- Unfilled positions
- Delayed competency completion
- Rising overtime
The goal is to see where turnover starts, who is most affected, and which actions are working.
Staff turnover metrics long-term care leaders should track
The most useful retention dashboard combines turnover, staffing, training, and manager data.
| Metric | Why it matters |
| Overall turnover rate | Shows broad workforce stability. |
| Role-specific turnover | Identifies whether CNAs, nurses, administrators, or other groups need targeted support. |
| First-90-day turnover | Reveals onboarding and job-fit issues early. |
| Turnover by manager | Shows where leadership support may need attention. |
| Turnover by shift or unit | Helps identify workload, culture, or scheduling pressure points. |
| Vacancy rate | Shows how many roles remain unfilled. |
| Time to fill | Measures hiring speed and labor market friction. |
| Overtime and agency use | Signals staffing strain and burnout risk. |
| Training completion | Shows whether staff are prepared for role expectations. |
| Stay interview themes | Reveals what keeps people and what may push them out. |
A strong dashboard should lead to action. If the data show that new CNAs leave within 60 days, the answer may be better preboarding, mentorship, schedule clarity, manager check-ins, and realistic job previews. If turnover is concentrated on one shift, the answer may be workload, supervision, communication, or staffing mix.
How to reduce staff turnover in long-term care
Reducing turnover starts with a clear plan. Leaders need to know where staff are leaving, why they are leaving, and which changes will make the work more sustainable.
Use this retention playbook:
- Measure the problem: Identify turnover by role, unit, shift, tenure, and manager. Look for patterns rather than averages.
- Listen before staff leave: Use stay interviews, pulse surveys, manager check-ins, and exit interviews. Ask what helps staff stay, what makes the job harder, and what would improve the next 30 days.
- Strengthen onboarding: The first 90 days should include role-specific orientation, mentorship, competency validation, workflow support, and scheduled check-ins.
- Train managers to retain: Frontline managers shape the employee experience. Train them to coach, communicate, resolve conflict, recognize good work, and support new hires.
- Build career pathways: Give CNAs, nurses, and other employees visible ways to grow. Some organizations also build their own nurse aide training program to strengthen the talent pipeline, support role readiness, and create clearer entry points into long-term care careers.
- Reduce daily friction: Address the problems that make good employees leave: unclear expectations, missing supplies, inconsistent schedules, documentation burden, safety concerns, and preventable communication breakdowns.
- Recognize work that matters: Recognition should be specific and timely. “Thank you” matters more when leaders name the behavior, the impact, and the value it supports.
- Review results monthly: Retention work should be measured. Track whether interventions improve early-tenure retention, reduce vacancy pressure, lower overtime, or improve manager-level trends.
Retention improves when leaders stop treating turnover as a single problem and start treating it as a set of fixable conditions.
First 90 days: Where long-term care retention is won or lost
Many employees decide whether they can stay before they finish orientation. The first 90 days should help new hires feel prepared, connected, and clear about what success looks like.
A stronger first-90-day plan includes:
- Preboarding communication before day one
- A realistic job preview
- A structured first-week schedule
- Role-specific training
- A mentor or buddy
- Competency validation
- Weekly manager check-ins
- Gradual workload ramp-up when possible
- Early discussion of schedule concerns
- A 30-day and 60-day stay interview
- Support for required training completion
- Clear guidance on who to ask for help
New hires do not only need information. They need belonging, practice, feedback, and a manager who notices when something is not working.
Why manager training matters for retention
People often leave jobs because the work becomes too hard to sustain without support. In long-term care, the frontline manager can either reduce that pressure or make it worse.
Managers influence retention through:
- Communication
- Coaching
- Schedule fairness
- Conflict resolution
- Recognition
- Psychological safety
- New-hire support
- Accountability
- Workload escalation
- Team culture
A manager does not need to solve every staffing challenge alone. But managers do need the skills to listen early, respond consistently, and help employees feel respected.
Manager training should be practical. It should prepare leaders for real conversations, for example: a CNA who feels overwhelmed, a nurse who is frustrated by schedule changes, a new hire who is unsure about expectations, or a team member who is disengaging.
Retention often improves when managers learn to catch problems while they are still small.
Staff turnover checklist for long-term care leaders
Use this checklist to identify where your retention strategy needs attention.
- Do we know turnover by role, shift, unit, manager, and tenure?
- Do we track first-30-day, first-60-day, and first-90-day turnover?
- Do new hires receive structured onboarding and mentorship?
- Do managers hold scheduled check-ins with new employees?
- Do employees have clear career pathways?
- Are training requirements relevant, accessible, and tied to daily work?
- Are scheduling practices sustainable?
- Are workplace safety concerns tracked and addressed?
- Are we using stay interviews, not only exit interviews?
- Are managers trained to coach, recognize, and support staff?
- Are turnover trends reviewed with operations, HR, nursing, and quality leaders?
- Are retention goals connected to resident care continuity?
If several answers are “no,” the issue is not only turnover. It is a system that needs better support around the employee experience.
Where long-term care retention strategies often break down
- Treating turnover as only an HR problem.
- Fix:Make retention an operations, quality, clinical, and leadership priority.
- Measuring only annual turnover.
- Fix:Track early-tenure turnover, role-specific trends, manager-level patterns, and shift-level risk.
- Overloading new hires too quickly.
- Fix:Use structured onboarding, mentorship, and progressive responsibility.
- Assuming training alone will solve retention.
- Fix:Pair education with manager support, workload review, career pathways, and recognition.
- Ignoring frontline feedback.
- Fix:Use stay interviews and act on recurring barriers.
- Waiting until exit interviews to listen.
- Fix:Build regular check-ins into the employee experience.
- Promoting strong clinicians into management without leadership training.
- Fix:Teach new managers how to coach, communicate, schedule fairly, and resolve conflict.
How training supports long-term care retention
Training cannot fix every reason people leave, but it can reduce confusion, improve confidence, and help staff feel prepared for daily work.
Effective training supports retention when it is:
- Role-specific
- Easy to access
- Connected to daily work
- Reinforced by managers
- Paired with mentorship
- Updated when policies or regulations change
- Measured for completion and competency
- Designed for both clinical and leadership skills
For direct care staff, training can strengthen confidence in resident care, dementia support, infection prevention, safety, communication, and documentation. For managers, training can improve coaching, feedback, conflict resolution, team communication, and new-hire support.
The best retention strategies do not separate training from operations. They use education to help staff do the job well and help managers create a workplace where people can stay.
Staff turnover in long-term care FAQs
What is staff turnover in long-term care?
Staff turnover in long-term care is the rate at which employees leave a facility, organization, role, or department during a defined period. It can include voluntary departures, involuntary separations, retirements, and early-tenure exits.
Why is staff turnover high in long-term care?
Staff turnover is high in long-term care because the work is demanding, staffing can be tight, and employees may face burnout, scheduling pressure, safety concerns, limited advancement, and inconsistent manager support. Turnover is usually caused by several connected issues rather than one factor.
How does turnover affect nursing home residents?
Turnover can disrupt care continuity and resident relationships. Research has found that within-facility variation in staff turnover is associated with decreased nursing home care quality.
How is nursing home staff turnover measured?
CMS reports staff turnover measures on Care Compare and includes total nurse, registered nurse, and nursing home administrator turnover in the staffing rating. Long-term care leaders should also track turnover by role, shift, unit, manager, and tenure.
What is a good staff turnover rate in long-term care?
A good turnover rate depends on the setting, role mix, labor market, and baseline performance. Leaders should compare their rate against available benchmarks, but the most important goal is steady improvement in high-risk roles, shifts, and early-tenure groups.
