Three years on from the worst of it, turnover is still a third of the workforce and the underwriters are still asking
For assisted living operators, staffing trouble is old news. What changed around 2023 was that it became an insurance problem as well. When we first wrote this in September 2025 we had the numbers from the worst of the shortage. We now have a year of newer data, and the picture is better than it was and nowhere near good.
The numbers, then and now
Then. LeadingAge polled 891 senior living and care providers between February 21 and March 13, 2023:
- 70% of assisted living providers reported a significant or severe workforce shortage. Among nursing homes it was 92%.
- 64% of all respondents said the situation had not improved on the year before.
- Operators said it was not uncommon for 20% of positions to be open with no applicants, with overtime and agency staff filling the gap.
Now. Ziegler's July 2026 survey of senior living and care providers, mostly not-for-profit operators across 40 states, found:
- Total workforce turnover of 35.4%, down from 36.3% in 2025. Registered nurses turned over at 40.8% and certified nursing assistants at 39%.
- CNAs are the hardest role to recruit and keep, named by 65.4% of operators, with RNs close behind at 60%.
- Agency use is rising again. Operators who "often" use temp agencies for direct-care vacancies went from 16.8% to 24.8% in a year, and those who never do fell from 31.6% to 26.1%.
- 90% reported higher staffing costs in the past 12 months, 22.1% of them significantly. Wages and benefits now take 56.2% of the operating budget.
- The typical assisted living ratio reported was one caregiver for every 10 to 15 residents. Memory care runs one for every five to eight.
Argentum's June 2026 retention study adds the reason: 62.3% of senior living workers named uncompetitive pay as the top reason they would leave.
Why insurers care
From an underwriter's desk, a staffing roster is a claims forecast. Falls, pressure injuries, elopements and medication errors cluster where the floor is short, and the first document a plaintiff's lawyer asks for is the schedule. In particular:
- Lower staff-to-resident ratios raise the odds of a neglect allegation, and make it harder to defend.
- Burnout and turnover mean more errors, more accidents and more lapses in care from people who do not yet know the residents.
- Agency staffing leaves the carrier asking who trained the person on the floor last night, and who is accountable for them.
The premiums followed. In NIC's May 2023 survey, 65% of assisted living operators and 68% of memory care operators said their liability insurance cost had gone up in the past year.
What carriers are doing about it
- Premium surcharges for communities that cannot show stable staffing.
- Non-renewals in the worst cases, even where the claims record is clean.
- Tighter underwriting, with documentation of training and retention efforts now a standard request rather than a nice-to-have.
What to put in front of the underwriter
The communities that renew well are the ones that answer the staffing question before it is asked:
- Training records and protocols. Falls, elopement, medication administration and abuse reporting, with sign-off dates. This is your risk management plan in the form a carrier can read.
- Ratios by shift, actual rather than budgeted, and what happens when a shift runs short: who floats, who is called, and when agency is used.
- Retention, with numbers. Turnover by role against last year, what you pay against the local market, and what changed. An operator who can show CNA turnover falling has a story the carrier wants to hear.
- How agency staff are handled. Orientation before the first shift, supervision on the floor, and whether the agency carries its own liability cover. Our medical staffing agency page explains what the agency's policy should look like.
- The incident log and what changed after each entry. A community with incidents and corrections reads better than one claiming to have had none.
- A broker who knows the class and has carriers that will still write a community under staffing pressure, rather than one that shops the whole market and reports back that nobody wants it.
"At the end of the day, staffing is as much a risk management issue as a business one," said Ralph Schiller, Senior Broker at Homewood Insurance. "Operators who get ahead of this challenge will be in a stronger position when it comes time to renew coverage."
Our assisted living insurance page sets out current pricing and what the carriers we place with look for. The emergency evacuation rules by state are the other document an underwriter will ask about.
Associated Resources
- Assisted living facility insurance
- Assisted living regulations for resident evacuation
- Insurance for medical staffing agencies
Sources
