This story is part of your SHN+ subscription
Nurses and CNAs are in short supply in health care settings, imperiling growth and normal senior living operations in the years ahead.
Senior living providers in 2026 are taking steps to solidify staffing models with programs to cultivate candidates to fill future nursing and clinical roles, while improving pay and benefits for nursing positions.
Assisted living and memory care operators rely on licensed care staff, including registered nurses (RN) and licensed practical nurses (LPN), to help provide clinical care to residents daily. These employees have faced extreme burnout and stress, especially since 2020, and these conditions persist today.
In last year’s state of nursing report by Cross Country Healthcare (NASDAQ: CCRN) and Florida Atlantic University, 65% of nurses reported high levels of stress and burnout, and those top stressors include staffing shortages, inadequate pay, lack of support from leadership and patient abuse.
The Bureau of Labor Statistics reported that RN positions are expected to grow by 6% over the next decade, a projected increase of 177,440 nurses. But the Bureau shows a projected shortage of RN positions with 193,100 openings through 2032, fueled by nurse retirements and those leaving the health care workforce.
Nursing shortages also are projected to be worse in rural areas, an already difficult environment for senior living and other health care providers to attract and retain top clinical talent.
According to the Health Resources and Services Administration (HRSA), non-metro markets face a projected 11% RN shortage in non-metropolitan areas by 2038, compared to a 2% shortage in metropolitan areas.This comes as rural hospitals and community health systems “are already operating” closer to double-digit nursing shortages, HRSA reports.
By 2038, the report estimates a gap of 245,950 LP positions, at the same time that demographic shifts skew the U.S. population older.
The U.S. also faces a shortage of certified nursing assistants (CNAs), with projections showing the deficit could be 73,000 positions short by 2028, according to the American Organization for Nursing Leadership (AONL).
The senior living industry often competes and loses nursing staff to health systems, often capable of offering higher pay.
“The reality is the shortage is massive,” Trilogy Health Services Senior Vice President and Chief People Officer Todd Kiziminski told Senior Housing News.
The Louisville, Kentucky-based senior living provider developed an internal CNA training program with 190 employees currently enrolled in 2026. The program has helped improve CNA retention to 80% compared to those not in the program. Trilogy recently launched its own LPN school to focus on employee continuing career education and improve retention.
Other providers taking steps to address this licensed care staffing shortage include Anthem Memory Care, Goodwin Living and Masonicare.
Improving pay, creating culture of retention
Between 2019 and 2023, senior living hourly wages increased 30.9% on average, an annual increase of 6.2% in that time period, according to a five-year study by senior living trade organization Argentum.
Alexandria, Virginia-based Goodwin Living increased CNA wages $10 per hour, from $13.25 to over $23 per hour since 2019, while also establishing a student loan payment program for eligible staff, according to CEO Rob Liebreich. The student loan payment program is facilitated through the Goodwin Living Foundation, the nonprofit senior living provider’s charitable organization, with employees able to receive $5,000 in student loan relief annually without a cap.
“Those kinds of programs and thoughtfulness have been really intentional for us,” Liebreich said.
In nursing positions, Goodwin Living has reduced turnover below 25%, while turnover for CNA positions was below 15%.
This comes as demand for senior living in the Washington, D.C. area continues to rise. Last year, companies in D.C. added new projects to the market, increasing supply by 5.3% in 2025. Competition for staffing talent, nursing or otherwise, is fierce.
“There’s no question about it, holistically, all around our organization has taken the mindset that we don’t need to be less than that,” Liebreich said. “We need to be on par or better than the options that people have in the community. So we should be able to compete with hospital systems.”
Creating an environment in which nursing staff want to work starts with creating “consistency throughout the organization,” while layering in support like benefits and training opportunities, according to Anthem Memory Care COO Lewis McCoy.
The West Linn, Oregon-based provider, along with other providers, is “blessed and cursed” by the impending shift in demographics as the population skews older in years ahead. While demand increases for senior living, so too does the demand for qualified nursing talent to provide clinical care.
“We’re still dealing with burnout,” McCoy said. “The clinical complexity in assisted living requires nurses to have stronger assessment skills, manage multiplicity of medication issues, chronic disease management and oversight, more so than we’ve seen in previous decades.”
With 1,500 employees, of which 500 are clinicians, Anthem has stopped using agency workers to bolster its clinical staff. This comes down to “culture becoming the major differentiator.”
Using mentorship opportunities and offering “realistic job previews” to incoming nursing staff helps make sure that candidates understand the role they are starting. The company promotes a career ladder program for nurses to move up in their roles from resident care manager to assistant clinical services director and finally as a community’s clinical services director, McCoy said.
Career programs, recruitment to prevent poaching nursing talent
Competition between operators for top nursing and CNA talent remains tough in 2026, Kiziminski said.
Kiziminski said it’s important for providers to consider creating their own pipelines for developing talent, regardless of the department, to meet future demand.
Providers don’t stop giving tours if a community is near or at full occupancy and the same diligence must be applied to hiring and recruitment of nursing talent, Kiziminski added.
“Panic is not a strategy,” Kiziminski said. “If we’re going to continue to grow, you still have to continue to hire, retain, train, and get them to refer to their friends, so it’s a similar cycle.”
Trilogy focuses on the first 90 days after a new employee is hired, supporting staff with consistent check-ins from leadership.
Overall, Trilogy has a 44.5% turnover rate in 2026, which includes licensed care staff.
The company has also established the “Trilogy flex force” of full-time employees who can travel between communities as needed, preventing the need for outside agency nursing staff. That model has helped Trilogy convert 90 internal travel nurses into full-time campus employees, Kiziminski said.
Recruiting new nursing talent remains competitive, according to Masonicare President and CEO Jon-Paul Venoit. The Connecticut-based nonprofit senior living provider connects with potential nursing candidates quickly after they apply to make an early connection.
Today, nurses and operations staff want access to wellness programs that providers offer, not just typical benefit packages, Venoit noted.
“If you don’t go back to a nurse within 24 hours, they’ve already found another opportunity,” Venoit said.
Succession planning is also critical in maintaining top clinical talent, helping up-and-coming staff gain the credentials to work in a nurse manager position, associate director of nursing or director of nursing roles, Venoit said.
Later this year, Masonicare is rolling out a “career explorer” program where employees can assess their career paths independently, showing steps along the way that are needed to move up the organizational chart.
Retaining nursing talent comes down to flexibility in scheduling, while having a consistent workplace culture fostered by supportive and responsive leadership when problems arise, Venoit added.
Ongoing nursing shortage won’t be solved easily
To prepare for the incoming demographic demand, providers must take steps to address their talent pipelines, from recruitment to retention, Kiziminski said.
That’s because the shortage of clinical talent is not a “snap-your-fingers” type of problem to be solved. It takes intentional planning and progress over time, Kiziminski added.
Anthem’s outlook on licensed care staffing is cautiously optimistic but clear-eyed. McCoy expects staffing to remain its defining challenge for the rest of the decade, yet sees early results from a layered strategy that pairs culture with task realignment, technology and career education.
Addressing the clinical staffing shortage requires “intentional planning,” Liebreich said.
“Successful workforce development requires intentional planning rather than immediate results, and you need a multifaceted strategy to see progress over time,” Liebreich added.