Facilities with heavy short-term or contract staffing can post a low, CMS-compliant turnover rate while running through people on the floor the whole time. The CMS-reported turnover number excludes any staff member who doesn’t hit 120 hours worked in their first 90 days on the job.
Invisible staffing churn in nursing homes: CMS turnover metrics miss a growing short-term workforce
By 2022-2023, 45% of nursing hires were excluded under CMS’s definition. As short-term staffing increased, CMS-specification and inclusive turnover diverged (correlation 0.91-0.82). Associations with quality outcomes were modest and similar across definitions. However, facility rankings differed substantially: only 30% of facilities remained in the same turnover decile, with reclassification concentrated among NHs with high short-term attrition, greater contract use, and distinct ownership and payer mix.
— Health Affairs Scholar, April 18, 2026
Petterson, Stephen, et al. “Invisible Staffing Churn in Nursing Homes: CMS Turnover Metrics Miss a Growing Short-Term Workforce.” Health Affairs Scholar, vol. 4, no. 5, 2026, academic.oup.com/healthaffairsscholar/article/4/5/qxag094/8658564.
Why CMS may tighten your facility’s turnover reporting
If you believe your nursing facility turnover numbers look reasonably healthy, this might be a good time to ask yourself an uncomfortable question:
What if the Center for Medicare & Medicaid Services takes away the mulligans?
By 2023, the study found, nearly half of new hires in some facilities were falling outside the federal turnover calculation. In practical terms, that means a building could experience heavy staffing churn while still looking relatively stable on paper.
— McKnight’s Long-Term Care News, May 10, 2026
Study: CMS turnover metrics miss nearly half of newly hired staff, masking instability
A total of 45% of newly hired nursing staff fell below the Centers for Medicare & Medicaid Services’ threshold for inclusion in staff turnover metrics, potentially underestimating turnover and weakening the validity of the metrics.
“As NH staffing patterns have shifted toward shorter periods of employment and greater reliance on flexible and contract labor, the CMS turnover measure has become less aligned with the workforce dynamics it is intended to capture,” authors said. “In 2022-2023, nearly half of newly hired nursing staff fell below the 120-hour threshold and were therefore excluded from the CMS-specification turnover measure.
— McKnight’s Long-Term Care News, May 7, 2026
Nearly half of nursing home turnover going unreported: study
They noted that the CMS criterion excludes contract staff working intermittently and regular new hires who quit shortly after their start date.
As a result, facilities with a highly churning short-term workforce may paradoxically appear stable, reporting low turnover under the CMS definition despite frequent changes in the staff providing hands-on care to residents.
— McKnight’s Long-Term Care News, May 7, 2026
