In 2024, 90% of skilled nursing facilities raised wages, offered sign-on bonuses, and paid for training. And yet 99% still had open positions. CNA turnover stayed above 42% in 2025.
The industry collectively spent more on compensation than at any prior point. The retention problem did not go away.
That is not an argument against paying staff fairly. It is an argument that wages alone are not the lever operators think they are. Something else is driving people out the door — and something else entirely is keeping them in at the facilities that have figured this out.
That something is culture. And unlike wages, it does not show up on a line item in the budget.
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The Wages-First Strategy Has Been Tried. Here Is What Happened.
After the pandemic hollowed out SNF workforces across the country, the industry response was predictable and understandable: pay more. Sign-on bonuses. Referral incentives. Wage floors. Shift differentials. For a while, it moved the needle.
Then it stopped moving it.
CNA wages grew 2.53% in 2025 about half the growth rate of the prior year. Turnover dropped slightly but remained at 42.34% for CNAs still nearly half the frontline workforce leaving annually (AHCA / HCS, 2025). Facilities that raised wages the most did not consistently outperform on retention compared to facilities that raised wages less but built stronger team cultures.
The data pattern is clear. Competitive wages bring people in. Culture keeps them there. Facilities that focused exclusively on compensation as a retention strategy found that they had to keep raising wages to maintain even marginal stability because as soon as a competitor matched their rate, the staff had no other reason to stay.
At a median SNF operating margin of 1.8%, a wages-only retention strategy is also unsustainable financially. There is a ceiling on what facilities can pay. There is no ceiling on what culture can do.
What the Research Says About Why People Actually Leave
The industry’s intuition about why staff leave tends to overweight compensation. The research tells a different story.
According to Gallup’s State of the Global Workplace report, engagement and culture issues account for 69% of the reasons employees leave while pay and benefits account for only 16%. That ratio holds across industries and has been consistent across multiple years of data.
In a SNF context, that means for every staff member who leaves primarily because of pay, more than four are leaving because of how they feel about their workplace whether they feel valued, whether their work feels meaningful, whether their manager sees them, whether the team around them functions well.
The competitive threat is real too. 61% of employees across industries say they would leave their current job for a company with a better culture without necessarily requiring more pay (Built In Culture Report, 2024). That means a competitor facility with lower wages but a stronger team culture can recruit your staff without outbidding you. They just have to make people feel more valued than you do.
This is not a soft finding. It is a hard competitive risk.
What Culture Actually Means in a SNF Not the Poster on the Wall
Culture is not a mission statement. It is not the values listed on a laminated card in the break room. In a skilled nursing facility, culture is the daily experience of showing up to work and whether that experience makes a staff member feel like they matter or feel like they are just filling a slot on a schedule.
The facilities with the strongest retention have built culture through four very specific operational practices:
Consistent assignment. When a CNA works with the same group of residents day after day, something changes. They know those residents. They notice when something is off before it shows up in vitals. They build relationships that give their work meaning. Inconsistent assignment rotating staff across different units and residents based on whoever showed up destroys the relational fabric of care and leaves staff feeling interchangeable. Consistent assignment is a culture decision with a retention outcome.
Role identity and language. Some operators have moved from “CNA” to “Resident Care Partner” not as a branding exercise, but as a deliberate statement that the person in that role is a partner in care, not a task-executor. The philosophy behind it: nobody is just anything. A person who helps someone bathe, dress, eat, and navigate a medical system during the most vulnerable period of their life is not performing entry-level work in any meaningful sense. When leadership communicates that clearly and consistently and when it is backed by real investment in that person’s development it changes how staff see themselves and their future at your facility.
Leadership visibility and direct acknowledgment. Staff notice whether their administrator knows their name. They notice whether a supervisor stops by to say something went well, or only appears when something went wrong. They notice whether the director of nursing walks the floor or stays in her office. Leadership visibility is not about surveillance. It is about presence and presence communicates that the people doing the work matter to the people in charge.
Coaching from real interactions. Some of the best retention-building moments in a facility happen in real time when a supervisor hears a difficult resident interaction handled well and takes 90 seconds to acknowledge it. When a charge nurse uses a challenging documentation moment as a teaching opportunity rather than a citation. When staff feel like their daily work is being seen and developed rather than just monitored for compliance, they stay.
Training Investment as a Culture Signal
There is a direct and measurable connection between learning culture and retention that most SNF operators are not using.
Companies with strong learning cultures show a 57% retention rate compared to only 27% for companies with moderate learning cultures (LinkedIn Workplace Learning Report, 2024). That is more than double the retention rate achieved not through higher pay, but through consistent investment in staff development.
In a skilled nursing facility, that investment looks like certified medicine aide training programs. It looks like paying for a CNA’s LPN coursework. It looks like putting a promising floor nurse through a charge nurse development program before there is an opening, so she is ready when there is. It looks like bringing in an Eden Alternative trainer or a dementia care specialist and paying staff for the time they spend learning.
When a facility invests in a staff member’s development, that staff member receives a message: this organization sees a future for me here. That message changes the retention calculus in a way that a $1.50 per hour raise does not.
The raise says you are worth more to us this week. The training investment says you have a future here. Those two messages land very differently and they produce very different retention outcomes.
What This Means for Your Operations
Building a culture that retains staff requires operational infrastructure, not just good intentions.
Scheduling systems that support consistent assignment so the same staff members are working with the same residents across shifts are the mechanical foundation of relationship-based care. When scheduling is built around consistency rather than just coverage, the culture benefit follows.
Internal communication that reaches frontline staff before they hear things through the grapevine is another operational culture-builder. When staff are told about regulatory changes, policy updates, or facility news by leadership before they read about it somewhere else, they feel like insiders part of the team rather than the last to know.
HR documentation that tracks training completions, certifications, and internal promotion history is what makes a career development culture real rather than aspirational. Facilities that can show a staff member their documented development path what they have completed, what comes next, what they are being considered for create the kind of concrete visibility that keeps people engaged.
Frequently Asked Questions
Wages are necessary but not sufficient. Research from Gallup shows that culture and engagement issues account for 69% of the reasons employees leave while pay accounts for only 16%. In skilled nursing, 90% of facilities raised wages in 2024 and yet 99% still had open positions and CNA turnover remained above 42%. Competitive wages attract staff. Culture keeps them. Facilities that rely entirely on compensation as their retention strategy find they have to keep raising wages because without culture, there is no other reason for staff to stay when a competitor matches their rate.
It looks like consistent assignment so staff build real relationships with residents. It looks like leadership that is visible on the floor and knows staff by name. It looks like role language that communicates value not just job titles. It looks like training investment that signals the facility is committed to each staff member's future. And it looks like coaching moments from real interactions rather than supervision that only appears when something goes wrong.
Research shows companies with strong learning cultures retain 57% of employees compared to 27% for those with moderate learning cultures more than double. In skilled nursing, training investment certified medicine aide programs, LPN coursework support, leadership development sends a specific message to staff: this organization sees a future for me here. That message changes the retention relationship from transactional to relational.
Compensation sets a floor. Culture determines whether people want to stay above it. A wage increase keeps a staff member from leaving for a higher-paying competitor. A strong culture keeps a staff member from looking for one. The practical difference: 61% of employees across industries say they would leave their current job for a company with a better culture without requiring more pay. That means a competitor facility can recruit your staff without outbidding you on wages they just have to make people feel more valued.
The SNF facilities that have cracked the long-term retention problem are not the ones paying the most. They are the ones where staff feel seen, valued, and invested in where their daily work feels meaningful, their manager knows their name, their schedule is consistent, and their future at the facility is visible.
That is culture. And unlike wages, it does not depend on a margin that most SNFs do not have.
Wages bring people in. Culture keeps them. The facilities that understand that distinction and build their operations around it are the ones that stop cycling through the same positions every eight months.
If you want to see how LTC Apps supports the operational infrastructure behind culture-driven retention from consistent shift scheduling to staff communication and HR documentation request a demo and we will walk you through it.
