Nursing Home Staff Turnover: What CMS Data Shows
The average American nursing home replaced 45.8% of its nursing staff over a year. In 28 homes, CMS recorded turnover above 100% — more departures than positions.
Every nursing home in the country reports this figure to CMS, and almost no consumer site shows it. Below is the national picture across 13,543 facilities.
Download the full dataset (CSV)Free, CC0. Every figure on this page, by state and operator.
Turnover falls at every step up the CMS rating scale
The pattern holds without exception. Homes CMS rates 1 star average 54.7% turnover; 5-star homes average 37.5%. Whether unstable staffing drives lower ratings or the reverse, CMS reports the two together for every facility.
The pattern is sharper among registered nurses specifically — the staff who assess residents and catch problems early. RNturnover runs 56.0% at 1-star homes against 31.3% at 5-star homes, a 24.7-point spread against 17.2 points for nursing staff overall.
For-profit homes report higher turnover than nonprofits
Across 10,107 for-profit and 2,617 nonprofit homes, total nursing turnover differs by 5.9 points. The gap is wider among registered nurses specifically — 45.1% versus 36.2%.
| Ownership | Homes | Nursing turnover | RN turnover |
|---|---|---|---|
| For-profit | 10,107 | 47.1% | 45.1% |
| Government | 819 | 44.3% | 38.1% |
| Nonprofit | 2,617 | 41.2% | 36.2% |
States with the highest nursing staff turnover
States with at least 20 reporting nursing homes, ranked by average total nursing staff turnover.
States with the lowest nursing staff turnover
Turnover by operator
Chains operating at least 40 nursing homes, with the average turnover CMS reports across their facilities. Averages describe a group of homes, not any individual one — each facility reports its own figure.
Highest average turnover
| Operator | Homes | Avg turnover | Avg CMS rating |
|---|---|---|---|
| Creative Solutions in Healthcare | 110 | 93.4% | 2.1 of 5 |
| Avir Health Group | 115 | 58.4% | 2.37 of 5 |
| James & Judy Lincoln | 55 | 56.8% | 2.45 of 5 |
| Opco Skilled Management | 65 | 54.5% | 2.29 of 5 |
| Hill Valley Healthcare | 42 | 54.1% | 1.74 of 5 |
| Lifeworks Rehab | 69 | 54% | 2 of 5 |
| Cascadia Healthcare | 44 | 52.7% | 3.19 of 5 |
| Evergreen Healthcare Group | 41 | 50.7% | 2.58 of 5 |
| Simcha Hyman & Naftali Zanziper | 82 | 50.5% | 2.59 of 5 |
| Nhs Management | 43 | 50.3% | 2.91 of 5 |
Lowest average turnover
| Operator | Homes | Avg turnover | Avg CMS rating |
|---|---|---|---|
| David Johnson | 47 | 33.9% | 3.19 of 5 |
| National Health Care Associates | 42 | 35.8% | 3.17 of 5 |
| Life Care Services | 42 | 37.8% | 4.02 of 5 |
| Foundations Health Solutions | 60 | 40% | 4.15 of 5 |
| Trilogy Health Services | 120 | 41% | 4.21 of 5 |
| Life Care Centers of America | 192 | 41.4% | 3.36 of 5 |
| North Shore Healthcare | 58 | 41.5% | 2.72 of 5 |
| Care Initiatives | 43 | 41.7% | 2.95 of 5 |
| Marquis Health Services | 89 | 41.9% | 3.06 of 5 |
| Pruitthealth | 97 | 41.9% | 2.86 of 5 |
Why this number matters when choosing a home
- Consistent caregivers learn a resident's routines, preferences, and early warning signs. That knowledge leaves when they do.
- Turnover describes daily life in a building in a way clinical measures don't. It is a reasonable thing to ask about on a tour.
- Compare it against staffing hours per resident per day. A home can report adequate hours while still cycling through the people filling them.
- Some turnover is normal and regional labor markets differ, which is why the state comparisons above are the fairer benchmark.
Methodology
Figures come from the CMS Care Compare Provider Information file, which reports Total Nursing Staff Turnover and Registered Nurse Turnover for each Medicare- and Medicaid-certified nursing home as the percentage of staff who left over a twelve-month period. This study covers the 13,543 currently-operating homes that report a turnover figure; homes CMS does not publish one for are excluded rather than counted as zero. State rankings require at least 20 reporting homes and operator figures at least 40, so small samples don't distort the order. Averages are unweighted means across facilities.
CareLens reports these figures as CMS publishes them and does not rate, rank, or score providers. Where this study describes a relationship — between turnover and star rating, for instance — it describes what appears in the data, not a causal claim.
Cite or embed this study
This research is free to reference. Journalists and researchers are welcome to cite the figures with a link back to CareLens.
CareLens. (2026). Nursing Home Staff Turnover: What CMS Data Shows. Retrieved from https://carelens.io/nursing-home-staff-turnover
<a href="https://carelens.io/nursing-home-staff-turnover" style="display:inline-block;border-left:4px solid #84cc16;padding:10px 14px;font:14px/1.4 system-ui,sans-serif;color:#0f172a;text-decoration:none;background:#f8fafc;border-radius:4px;max-width:520px"><strong>The average US nursing home replaced 45.8% of its nursing staff in a year</strong><br>Source: CareLens — Nursing Home Staff Turnover: What CMS Data Shows (2026)</a>
Source: CareLens — Nursing Home Staff Turnover: What CMS Data Shows (2026)