The National Turnover Rate, Calculated From Every Home #
Half of the US nursing homes that report turnover lost at least 44.9% of their nursing staff over a year. That is the median across the 13,537 homes that report turnover in the August 2026 Centers for Medicare & Medicaid Services provider file, and it is our calculation from that file.
Put plainly, the typical nursing home replaces close to half of its nursing workforce every twelve months. In an industry where the staff are the service, that is the figure that shapes a resident's day.
Registered Nurses Leave Almost as Often #
Registered nurse turnover runs only slightly lower, with a median of 41.7% across the homes that report it. The licensed staff who supervise care and sign off on it churn nearly as fast as nursing staff overall.
That is the part of the figure with the sharpest operational consequence. Continuity in clinical oversight is harder to rebuild than headcount, and agency nurses brought in to cover gaps typically cost more per hour than the staff they replace.
It also narrows the range of explanations. If aide turnover were high and registered nurse turnover low, the story would be about entry-level pay and working conditions. The two moving together points at something that reaches the whole of the nursing structure in a home rather than one rung of it.
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Which Facilities Are Inside This Figure #
The industry Census calls Nursing Care Facilities, Skilled Nursing Facilities (NAICS 623110) is defined by its staffing. These establishments provide inpatient nursing and rehabilitative care, generally over an extended period, and they carry a permanent core staff of registered or licensed practical nurses who, with other staff, provide continuous personal care.
That definition is why turnover is measurable here and not in most industries. A nursing home is required to hold a licensed nursing establishment on site, so there is a defined population of staff whose presence and departure can be counted against a defined roster.
The same definition draws the boundary. Assisted living that provides room, board, supervision and help with daily living but no on-site nursing is a different industry, with a different staffing model and no comparable measure. A community providing the full range with an on-site nursing facility is a third. Turnover figures from those settings are not benchmarks for this one.
How CMS Measures It, and What That Misses #
CMS measures total nursing staff turnover as the share of nursing staff, registered nurses, licensed practical and vocational nurses and nurse aides, who stopped working at a home over a twelve-month period. It is counted by person rather than by position and built from payroll records that homes submit each quarter.
Building it from payroll rather than from a survey is what makes it unusually solid. Most industry turnover benchmarks are self-reported by the employers who choose to answer; this one is derived from the staffing data homes are required to file, for every home that files it.
We took the median across every home with a reported value in the August 2026 file, excluding homes CMS flags as not reporting. The middle half of homes sit between 35.4% and 54.9%, so a home inside that band is ordinary, and one outside it is not.
Three limits follow from the construction. Counting by person means a home that loses one worker twice registers differently from one that loses two, which matters most where short tenures are common. The measure covers nursing staff only, so departures among dietary, housekeeping and administrative staff are outside it. And homes CMS flags as not reporting are excluded rather than assumed, which keeps the figure clean but means it describes reporting homes, not every home.
Ownership Makes a Difference #
For-profit homes run higher turnover than non-profit homes, and government-run homes sit between the two, by our calculation from the same file. For-profit operators own the large majority of homes, so they set the national figure.
The pattern holds across a very large number of homes, which makes it hard to dismiss as noise, though it does not by itself say why. Pay, staffing ratios and the share of agency staff all differ by ownership and all plausibly contribute.
It also cuts the other way when benchmarking. A non-profit judging itself against the national median is comparing against a population dominated by a different ownership model, and will tend to look better than its own peer group would suggest.
Why Turnover Is the Number to Watch #
CMS publishes turnover alongside staffing levels on Care Compare, and the two answer different questions. Staffing levels alone can hide instability: a home can report adequate hours while running on a rotating cast of new and agency staff.
For an operator, turnover is also a cost line hiding in plain sight. Recruiting, onboarding and covering vacancies with agency staff all scale with it, and none of them appear under a heading called turnover.
It compounds with the other operating number in this industry. A home carrying empty beds has less revenue to absorb the agency premium that high turnover forces on it, so weak occupancy and weak retention are the same problem seen from two sides. The wider labor picture behind it is covered in our healthcare industry trends page.
Benchmarking a Home Against the Industry #
Any home's own figure is on Care Compare, measured the same way as the national median here, which makes this one of the few operating benchmarks in any industry where an operator can compare like with like.
The industry around it is Census territory: 18,126 nursing care facilities with paid employees, and an employment base of 1,426,754 (Census CBP, 2023). That base is the denominator behind every recruitment conversation in the sector.
| Benchmark | On this page | In the report |
|---|---|---|
| Staff turnover and occupancy rates, from CMS | Yes | Discussed, not measured |
| Facilities and employment, national | Yes | Yes |
| Facilities and employment by state | No | Yes |
| Industry receipts and five-year forecast | No | Yes |
| Market concentration | No | Yes |
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