There’s plenty of good news to go around in the year’s biggest salary report for skilled nurses.
For workers, the average rate of pay continues to decline upward at a decent, above-historic rate in many roles, especially for frontline nurses. Coupled with an expected rate cut that could help push down inflation, that would be doubly good news for those who need their paychecks to stretch further.
For providers, there is relief that those increases are finally starting to slow down a bit, after record gains for employees for several years in a row during the pandemic. These raises may have originally been funded by federal or state aid, but now require an annual investment well above the old normal for wages.
But the 47th Annual Nursing Home Pay and Benefits Report, which my colleague Jim Berklan covered this week, also confirms that there’s still plenty of bad news out there if you know where to look.
Most of you will find it on the schedule sheet when there is a big empty spot where a weekend CNA or RN is supposed to be, or in housekeeping, or most likely, on the therapy floor.
HCS, which surveyed nearly 1,000 operators nationwide this year, began including job vacancies in its survey last year. And despite some anecdotal gains in various markets, the 2024-2025 release found that vacancies across facilities still averaged 17% over the year.
This average was led by therapy jobs, which respondents said were available 27.6% of the year.
For a sector that not so long ago depended on therapy billing for its lifeblood—and for whom quality therapy outcomes remain critical to patients and referral partners—this is truly dire news.
But it is not just the providers who are to blame for this alarming absence. Federal tricks in the past few years have reduced how and how much some therapists can bill for services in nursing homes.
In the latest move last month, the Centers for Medicare & Medicaid Services proposed what basically amounts to another 3% rate cut for therapists who work in nursing homes under the Part B fee schedule.
As with other wage issues in the sector, all the administration’s talk about creating quality jobs has not really translated into actual action or investment in care or therapy. Congress, once eager to fix these Medicare physician failures, has been slow to address them in the past two years, creating financial and billing nightmares.
Payment policies that undercut efforts to attract and fairly pay workers across the board, and especially on the clinical and therapeutic side, are incredibly short-sighted.
Decisions that make practical patient roles supporting the elderly and disabled even less attractive to young workers and those so desperately needed in the midst of a demographic shift… Well, it makes it seem that anything beyond the nursing home jobs are “available”.
Empty ideas will continue to leave providers with empty jobs.