Skilled nursing facilities are reporting improved clinical staffing stability in mid-2026 — but underneath the headline, a workforce data point from Ziegler's CFO Hotline Survey tells a more complicated story: certified nursing assistant turnover remains at 39%, meaning nearly four in ten CNAs leave their SNF employer within any given 12-month period.
The dual picture — relative stability at the top of the care team, persistent churn at the bottom — is emerging from two concurrent reports in Skilled Nursing News: one examining how operators are building what analysts call a "shadow workforce," and another parsing Ziegler CFO survey data on persistent operating pressures.
The Shadow Workforce Strategy
The term "shadow workforce" describes a layer of clinical workers that SNF operators are cultivating outside their traditional full-time, direct-hire pipeline. According to reporting by Skilled Nursing News, the most common components in 2026 include:
- Retired nurses returning part-time: Facilities offering PRN and flex scheduling to nurses who left full-time clinical work post-pandemic. The draw is predictable hours, no on-call obligation, and hourly rates that frequently exceed what those nurses earned when full-time.
- CNA-to-LPN bridge programs: Operators sponsoring their own CNAs through state-approved LPN programs, creating an internal talent pipeline. These workers are significantly more likely to stay post-licensure because the employer co-invested in their credential.
- International nurse recruitment: Multiple regional chains have launched EB-3 visa pipelines targeting the Philippines, Nigeria, and Kenya. EB-3 nurses commit to 2–3 year employment agreements as a condition of sponsorship — creating a retention anchor that domestic hiring lacks.
- Cross-trained hospitality staff: A smaller but growing share of SNFs are training existing dietary and housekeeping employees as CNA candidates, with the facility covering state-approved program costs and testing fees.
What the Ziegler CFO Data Shows
The Ziegler CFO Hotline Survey — a quarterly pulse of SNF chief financial officers — identified workforce costs as the top operating pressure for nursing home operators in mid-2026, a position they have held for three consecutive quarters.
While RN and LPN vacancy rates have modestly improved from their 2022–2023 peaks, the CNA vacancy-and-turnover cycle continues to be the single most destabilizing force in SNF operations. CNAs account for the majority of direct patient care hours in nursing homes and are the most common workforce category cited in CMS deficiency citations related to understaffing.
Why CNA Turnover Remains Structural
Nursing home CNAs face a compensation ceiling that makes retention structurally difficult. The national median hourly wage for nursing assistants in nursing care facilities was $17.40 in the BLS OEWS May 2025 release, with a 90th percentile wage of $23.19. In most SNF markets, that pay competes poorly against:
- Home health aide roles, which frequently offer comparable wages with less physical strain and more scheduling autonomy
- Retail and food service positions that have closed the wage gap since 2021 state minimum wage legislation cycles
- Hospital patient care technician (PCT) roles, which carry higher institutional status and access to hospital benefit packages
The math is difficult: to meaningfully reduce CNA turnover, SNFs would need to raise wages to a level that either further compresses already-thin operating margins or requires Medicaid rate increases at the state level. Most states have not provided Medicaid SNF rate increases sufficient to fully fund the labor cost gap.
The Federal Mandate Pressure Multiplier
CMS's final minimum staffing rule added urgency to what was already a structural problem. The 24-hour on-site RN requirement — initial deadline May 2026 — has been the more tractable compliance challenge. RNs are more available than in 2022, and some facilities restructured supervisory coverage to meet it without new full-time hires.
The nurse aide hours requirement — 2.45 hours of aide care per resident per day — is the provision most directly tied to CNA supply. A 100-bed SNF at full occupancy needs roughly 245 aide-hours of care daily. At 8-hour shifts, that is approximately 31 CNA shift-slots per day before accounting for vacancies, turnover, or call-outs. With 39% annualized turnover, operators are perpetually onboarding replacement workers at a pace that consumes significant DON and HR bandwidth.
What This Means for CNA and LPN Wages
The silver lining of structural shortage is structural wage pressure. CNA wages in markets where SNF density is high and vacancy rates are elevated — Ohio, Michigan, and parts of the Southeast — have risen measurably since 2022. Several regional chains have moved starting CNA wages to $18–$21 per hour in competitive markets, compared to $14–$15 four years earlier.
For LPNs, the shadow workforce dynamic cuts differently: as SNFs invest in internal CNA-to-LPN bridge programs, new LPN graduates enter a market where their sponsoring SNF actively recruits them — and where they carry both a fresh credential and an employment history at the facility. LPN wages in SNF settings have risen roughly 12–15% since 2022 in the markets where bidding for licensed nursing staff is most intense.
If you are a CNA considering your options, or an LPN evaluating SNF employment against hospital alternatives, the wage trajectory in long-term care has shifted positively — though it still trails acute care in most markets. The operators showing the most retention traction are the ones offering visible upward pathways alongside the wage.
CNA turnover at 39% is a workforce-design problem masquerading as a retention problem. Raising wages helps at the margin, but as long as the advancement ceiling is low and the physical demands are high, the job competes poorly against alternatives with similar pay. The operators getting traction on retention are the ones creating visible upward pathways — CNA to LPN to RN — with the facility actively co-investing in licensure cost. That changes the psychological contract, and it shows in their turnover numbers.