Staffing and Workforce Stability in Long-Term Care
A guide for LTC leaders, advocates, and researchers
Staffing is at the core of quality in every long-term care facility. Residents depend on consistent, trusted caregivers. Families look for a stable team before anything else. Administrators and clinical leaders know staff stability is the strongest predictor of safety, quality of life, and overall organizational health. Continuity of care is really important to our residents.
Yet workforce shortages and turnover continue to shape daily operations across the country. Understanding what drives these patterns, how they show up in Centers for Medicare and Medicaid (CMS) datasets, and what leaders can do to create a more stable environment is essential for anyone responsible for resident care.
This guide helps explain the key elements of staffing and workforce stability, how CMS measures it, why it matters for quality outcomes, and practical steps facilities can take to strengthen their teams.
Why Staffing Stability is Important
Most residents in long-term care facilities rely on staff for nearly every aspect of daily life. Stability ensures caregivers learn each resident’s needs, preferences, routines, and early warning signs of decline. When staff members come and go, care becomes fragmented. Residents feel less secure, and clinical risks increase. Agency and temporary staffing are prevalent throughout LTC communities, and this is affecting resident care and well-being.
National studies have linked stable staffing to fewer hospitalizations, lower rates of pressure injuries, better infection prevention, and stronger customer satisfaction. Stability also supports a healthier work culture. When staff trust the team around them, collaboration improves and burnout decreases.
How CMS Measures Staffing
CMS collects staffing information through two main mechanisms.
Hourly staffing comes from Payroll Based Journal. Turnover indicators come from employee-level records submitted to CMS.
These measures reflect the consistency, continuity, and adequacy of staffing inside each facility. They include:
Total nurse staffing hours per resident day (HPRD)
This measures staffing intensity. CMS tracks HPRD for:
Registered Nurses
Licensed Practical/Vocational Nurses
Certified Nursing Assistants
Contract and agency personnel included in PBJ
Facilities with strong HPRD values tend to have better quality outcomes. Low HPRD levels can signal staffing shortages, difficulty retaining workers, or heavy reliance on overtime and agency staff.
Weekend staffing
CMS compares weekend staffing levels to weekday levels. Significant drops on weekends may reflect uneven access to clinical oversight and direct care. Weekend patterns can also signal operational stress or scheduling challenges.
RN on-site hours
Federal regulations require an RN to be present at least eight hours per day. Consistent RN coverage improves assessment quality and supports clinical decision making.
Staff turnover measures
CMS tracks annual turnover for key roles:
Total nurse staff turnover
RN turnover
Administrator turnover
Licensed nurse turnover
CNA turnover
High turnover indicates instability that affects resident care. Low turnover shows strong retention practices, better teamwork, and a more predictable care environment.
What the Data Tells Us About the Workforce
Across the United States, staffing stability remains one of the biggest operational challenges for nursing homes. Many states continue to see:
Persistent CNA shortages
High dependence on agency staff
Increased turnover among RNs and leaders
A rise in burnout due to post-pandemic stress
Competitive pressure from hospitals and home health agencies
These workforce challenges directly affect resident outcomes. They also affect regulatory performance. Facilities with high turnover often experience more deficiencies, more enforcement activity, and weaker quality measure scores.
How Staffing Stability Shapes Quality and Safety
Staffing and quality are very closely linked. Strengthening the workforce has downstream benefits across nearly every operational metric.
Consistency reduces medication errors and improves clinical monitoring
Teams with low turnover manage change more effectively
Experienced staff recognize early warning signs before conditions worsen
Resident and family trust increases when staff remain familiar and dependable
Facilities often see stronger survey results over time
Workforce stability is not only an operational priority. It is a resident safety priority. It reduces risk, protects continuity of care, and supports better outcomes across the board.
What Leaders Can Do to Strengthen Workforce Stability
There is no single solution, but progress often begins with smaller, consistent steps. Leaders can improve retention by creating predictable routines, supporting staff well-being, and addressing the root causes of turnover.
Below are strategies that have shown meaningful impact across LTC settings.
Create a Culture That Values Staff
Recognition programs that feel genuine
Transparent communication about facility goals
Leadership visibility on all shifts
Support for emotional safety and respect in the workplace
Staff stay longer when they feel seen, supported, and included in decisions that affect resident care.
Improve Scheduling and Workload Balance
Predictable schedules reduce burnout
Cross-training helps balance workload during peak times
Smart use of part-time pools can reduce agency dependence
Facilities that adopt more flexible schedules often see better retention, especially among CNAs.
Strengthen Clinical Support
Provide meaningful preceptorship for new staff
Offer ongoing clinical education on infection prevention, dementia care, and early warning signs
Ensure charge nurses and supervisors are available and prepared to guide teams
Clear expectations and accessible support improve confidence and retention.
Reduce Reliance on Agency Staffing
Agency use often increases turnover and weakens team cohesion. Gradually lowering agency hours by building internal float pools, developing strong retention pathways, and improving recruitment pipelines helps restore stability.
Build Internal Career Pathways
Promote CNA-to-LPN and LPN-to-RN training partnerships
Provide leadership training for charge nurses
Create advancement opportunities for long-tenured team members
Long-term care facilities with structured advancement pathways report significantly lower turnover.
Support Staff Well-being
Breaks that are truly protected
Access to mental health resources or peer support teams
A work environment that prioritizes physical and emotional safety
Workforce stability improves when staff feel cared for as people, not just employees.
Where to Explore Staffing Data
The CMS Care Compare datasets, PBJ staffing files, and turnover metrics provide detailed insight into facility staffing levels and workforce consistency. These public datasets allow administrators, researchers, and advocates to monitor trends and identify areas needing attention.
The Staffing and Workforce section of each LTC Intel report translates these complex datasets into clear, visual intelligence that supports more informed decisions. Facilities can see how their staffing compares statewide and explore turnover patterns that affect quality outcomes.
Moving Forward
Staffing stability is not an isolated operational concern. It is the heart of long-term care. Residents experience the effects of staffing decisions every day. Families look for consistency and trust. Care teams rely on each other for safety, communication, and support.
Strengthening the workforce strengthens the entire care environment. With clear data, better transparency, and practical strategies, facilities and policymakers can work toward a more stable future for long-term care.