In the past decade, our industry of long-term care has seen substantial job growth. And that’s a good thing! Unfortunately, we also have another little “gift”. The gift that will keep on giving if we don’t do something about it. And I’m talking about turnover.

In the past decade, our industry of long-term care has seen substantial job growth. And that’s a good thing! With an aging population, employment opportunities in our sector are expected to surpass those of other U.S. sectors.  Who doesn’t like job security, right?

Unfortunately, we also have another little “gift.” The gift that will keep on giving if we don’t do something about it. And I’m talking about turnover.

Despite the rosy picture of increasing demand, we also have workers leaving our settings at a rate that outpaces other industries – by a lot – with turnover rates ranging from 55% to 75% for nurses and aides and sometimes over 100% for aides alone.2

This graphic1 depicts the disparity between those who come into the field and those who are leaving. The delta between the blue and red spells catastrophe for our industry if we don’t do something about it. It’s not sustainable in the long term.


And this chart is for all working types in that setting.   For example, we have a high share of low-skilled workers, and many of our jobs are not associated with direct health care delivery in the traditional sense, particularly in assisted living and home and community-based positions. Many of those areas of our industry draw workers from leisure and hospitality.

And here’s another thing. Long term care leavers tend to report higher rates of work disability and to have higher rates of poverty.

The cost impact of this turnover can be upwards of 30% of each incumbent’s salary. So if your caregiver comp is set at $23,000 per year, each worker’s replacement cost could be nearly $7000….times however many turnovers annually and…you get the picture.

Another study found that if you could reduce turnover even by 10%, you could save nearly 3% of total costs, or north of $165,000 per facility.3

Eleanor Barbera’s article in McKnights recently alluded to our practice of “treating their staff like a never-ending supply of fast food workers and avoiding investment in training and retention practices.” I couldn’t agree more!

It is hard to train and support in order to keep staff. I get it. But when you look at the coming trends, we have to take this more seriously at the community level. Most C-level people we work with completely understand this dynamic, but at the community level, those leaders are still trying to balance time, resources and demands. I would challenge the C-Suite to really put their money where their ideas are and do the following:

  • Begin by really analyzing your problem. Here are a couple of resources that can help leaders think about their turnover and begin to chart the costs. You can’t manage what you don’t measure, so here are some avenues to get you started.

What’s the REAL cost of Turnover? From Go2HR

How Much Does Employee Turnover Really Cost Your Business?   A Cost Calculator


  • If you aren’t familiar with Job Embeddedness, find out all about it and begin to practice it. Here’s a link to our full white paper on the topic. Basically, it is analyzing your orientation and workplace practices from the view of the new hire. It is up to us to make sure they see the “fit” between themselves, the organization and the job itself. Illuminating stuff.
  • Employers, educators, and policymakers should consider investments in education and training. Well-crafted training programs can not only improve the job skills of direct-care workers but also reduce occupational injury rates and job turnover.
  • Look at your budgeted training hours. It’s surprising the mismatch between what new hires need and what budget hours allow, especially if you haven’t looked at them in years.
  • Think seriously about your management training and their role in supporting new hires and new hire TRAINING. That checkbox, fast food worker mentality can be alive and well at the local level and you will be smart to ferret that out. It can be simple things like asking them about their training. It teaches them that you will ask and that you care! Let them shadow and observe. Stacks of DVDs out of context does not make for a welcoming orientation. We can do better!
  • The ACA authorized funds to provide new training opportunities for direct-care workers who are employed in assisted living facilities, skilled nursing facilities, intermediate care facilities for individuals with developmental disabilities, and home and community-based settings. Investments in training for workers in these occupations will likely help to ensure an adequately trained workforce in LTC, as well as support improved retention of LTC workers.1 Here is a link to a document that provides an overview of all the different types of training funds available.
    See if you qualify: Click here.
  • Consider the expertise of training professionals when you design your training programs and approaches. They are experts in translating what workers need to know into terms they can understand and embrace. They are worth their money, especially if what you are doing is not working. Try another perspective.
  • Increase the number of workers per resident.  I know. I know. This one is a tough one. Consider this finding from a 2007 Donoghue and Castle study: Increasing the number of aides per resident from 33 per 100 to 41 per 100 reduced CNA turnover from 65% to 41% and also lowered LPN and RN turnover.4 And with competency based regulations that are being proposed5 for the future, staffing (and training that level of staffing) will come more closely into focus.

Henry Ford said it best: “If you always do what you’ve always done, you’ll always get what you’ve always got.” The stakes are too high. We must turn the battleship (and we are)…we just need to hurry!

You don’t have to go it alone. At Redilearning, all we do is senior care and our entire leadership team are senior care practitioners. Ask us how we can help you design learning to help reduce turnover. Request a meeting here or email us directly at


1 Frogner, Bianca, and Joanne Spetz, Entry and exit of workers in long-term care, University of California, San Francisco, Health Workforce Research Center on Long-Term Care, January 20, 2015
2Barbera, Eleanor, The keys to reducing turnover in long-term care, McKnight’s, February 6, 2014.
3 The costs of turnover in nursing homes, Dana B. Mukamel, Ph.D., Professor and Senior Fellow, William D. Spector, Ph.D, Senior Social Scientist, Rhona Limcangco, Ph.D., Ying Wang, M.S., Zhanlian Feng, Ph.D., Assistant Professor, and Vincent Mor, Ph.D., Professor & Chair, Med Care. 2009 Oct; 47(10): 1039–1045.
4Castle, Christopher, Nursing Home Staff Turnover and Retention, An Analysis of National Level Data, Journal of Applied GerontologyFebruary 2010 vol. 29 no. 1 89-106
5 CMS Engages in a Flurry of Rulemaking, Provider Magazine, August 2015, p. 9.