What one departure costs a 100-bed building

A typical building

Take a 100-bed building, the national median size. It has roughly 50 nursing staff. At 47% turnover, the average for buildings its size, about 24 of them leave in a year.

Those figures come from CMS’s February 2026 data. The staff count and the 47% are our calculations for buildings of 90 to 110 beds, and the national median turnover is 45.6%.

The conservative figure

The most cited figure for one departure is about $4,500, from LeadingAge’s Workforce Cost Calculator, which treats it as a minimum. Its direct-cost part dates to a 2004 review of long-term care in general, not skilled nursing specifically.

At $4,500, a typical building’s 24 departures cost $108,000 a year.

A fuller estimate, line by line

We couldn’t find a current, published study of what a departure costs a skilled nursing building, role by role. So we built our own estimate from public data: wages from the Bureau of Labor Statistics and AHCA/NCAL, agency rates from ASPE, and typical screening and orientation costs.

We start with a CNA because CNAs and other aides make up about six in ten of a typical nursing team. For one CNA, it comes to about $6,700:

Ranges run from a quick, easy hire to a long search covered by agency staff. Agency aides cost about 80% more an hour than employed aides.

About $4,300 of that is money that goes out the door: recruiting and bonuses, screening, extra pay to cover shifts, trainers’ time and the paperwork of a departure. The other $2,400 is wages paid while a new hire is still learning the job.

Nurses cost more to replace. We estimate $10,400 for an LPN and $17,100 for an RN. Their pay is higher, we assume their jobs take longer to fill (30 days for a CNA, 45 for an LPN, 60 for an RN), and some come through recruiters who charge a fee.

Over $100,000 a year, conservatively. About twice that by our estimate.

A typical mix is about 61% CNAs and other aides, 23% LPNs and 16% RNs, from CMS staffing data. We use one turnover rate for every role, because CMS publishes one for all nursing staff.

All three use CMS’s turnover rate, which leaves out many of the people who leave fastest. The real number is likely higher.

What doesn’t show up on a P&L.

Residents come to know the people who help them bathe, dress and eat. When nearly half of a typical building’s nursing staff leave in a year, residents keep starting over with someone new.

The people who stay pick up the open shifts and help each new hire learn the job, on top of their own work. In an average week, about 15% of nursing hours are worked by someone hired in the last 90 days.

A study of 13,826 nursing homes found that higher staff turnover was linked to lower quality of care, including more citations at health inspections.

And turnover counts toward your staffing star rating, which families see on Care Compare.

Run it with your own numbers

It’s an estimate, not a benchmark, and your own payroll, agency invoices and hiring records will be more accurate than any of it. Start with three numbers:

• Everyone who left in the last year, including people who left in their first weeks.
• What you paid to cover their shifts, in overtime and agency hours above normal pay.
• What you spent to replace them: recruiting, sign-on bonuses, screening, orientation and the time of the people who trained them.

Our calculator does the arithmetic with your own staff count, turnover rate and cost per departure: Estimate your turnover cost.