Long-term care facilities added 40,700 jobs in 2025, averaging roughly 3,400 new workers per month, according to AHCA/NCAL's 2026 Workforce Report. On its face, that sounds like progress. The same report reveals that nine out of ten providers still find recruitment difficult. Adding workers and having enough workers are not the same thing — and the LTC sector is living that gap in real time.
The SNF workforce has been in recovery mode since the pandemic accelerated departures that were already underway. Facilities that relied heavily on agency labor in 2022 and 2023 have partially clawed back to in-house staffing, but rising wages have compressed margins in ways that constrain hiring ceilings. The math is difficult: facilities want more staff, the staff exists in the labor market, but the reimbursement rates that flow through Medicaid don't always support what it costs to hire and retain a competitive nurse at 2026 wages.
The CMS nursing home staffing mandate — the rule that would have required 3.48 total nurse hours per resident per day (HPRD) and 24/7 RN presence — was repealed via interim final rule in December 2025. The mandate's opponents argued exactly this: that it would impose requirements facilities couldn't meet given current labor market realities. The counterargument from advocates, including NNU, is that removing the floor eliminated accountability without solving the supply problem.
For SNF and LTC nurses, the workforce data creates specific leverage. If nine in ten facilities are struggling to recruit, that's a seller's market for nurses willing to work in long-term care. New-grad LTC positions at major SNF operators like Ensign Group, Genesis HealthCare, and Kindred have offered sign-on bonuses ranging from $5,000 to $15,000 in competitive markets. MDS Coordinators, Directors of Nursing, and Wound Care Nurses remain in particularly short supply relative to open positions.
The practical note for nurses considering LTC: the 2026 landscape is meaningfully different from 2019. CMS's $200M nursing home staffing campaign — launched in 2026 — offers loan repayment and stipends up to $40,000 for RNs and LPNs who commit to working in skilled nursing facilities. That incentive structure, combined with the shortage-driven compensation pressures, makes LTC worth a second look for nurses who dismissed it years ago. See our ICU Nursing Career Guide for a comparison of acute-care vs. LTC career trajectories.
The wage pressure issue deserves specific attention. SNF operators are caught in a structural bind: they need to raise wages to recruit, but Medicaid rates — which cover roughly 60 to 70% of SNF revenue in most states — are set by state legislatures on an annual cycle that lags market conditions. When a nurse's market wage increases 8% in a year and the Medicaid rate increases 2%, the operator absorbs the difference from margins that are already thin. Some pass it to Medicare patients through rate-shifting; others reduce staffing mix (fewer RNs, more CNAs); others close beds or wings. None of these are solutions that serve residents well.
The irony of the CMS staffing mandate repeal in this context is that it removed accountability pressure at the exact moment the workforce data shows facilities aren't meeting adequate staffing benchmarks anyway. The May 11, 2026 compliance date — when non-rural facilities were supposed to meet the 3.48 HPRD and 24/7 RN requirements — has come and gone without consequence. Advocates who opposed the repeal argue the mandate would have created market pressure to raise wages and improve conditions. Opponents argued it would have accelerated closures in financially fragile markets. The AHCA/NCAL workforce data — 90% still can't recruit — suggests neither side's prediction about labor market response has fully played out yet.
For nurses weighing LTC careers, the framing has shifted. The narrative that long-term care is a career step-down — lower pay, less acute, less interesting clinically — doesn't hold in 2026. MDS Coordinators with AANAC certification command $80,000 to $95,000 in most markets. Directors of Nursing at mid-size SNFs often break six figures. Wound care nurses with WCC or CWS credentials are actively recruited. The Float Pool Nursing Guide covers a related path — PRN work across multiple facilities — that many experienced SNF nurses use to supplement income while maintaining schedule flexibility.