New York, New York — For the first time in years, skilled nursing operators say they’re making real headway on staffing. Agency use is down. Turnover is dropping. New workers are coming through the door. And then come the fines.
The tension playing out across the country — and loudest right now in New York — pits a recovering nursing home workforce against state-level mandates that were written during a hiring crisis and are now being enforced even as that crisis eases.
“It’s just not logical,” said Stuart Almer, CEO of Gurwin Healthcare System, a non-profit operator in New York. “There was no staff to be had, and now facilities are being penalized for that.”
Progress, Then Penalties
The staffing picture has genuinely improved. Operators like Gurwin and Journey Skilled Nursing say they’ve largely cut out agency labor, converted contract workers into permanent hires, and built internal training pipelines — some backed by state grants — that are bringing in new people from outside long-term care entirely.
Gurwin’s system-wide turnover rate now sits at 31%, roughly 10 percentage points better than the industry average and a major step down from the 50%-plus numbers the sector saw during the pandemic. At Gurwin’s largest building — nearly 750 employees — turnover dropped to 27% in 2025.
Laurel Lingle, vice president of talent acquisition at Journey Skilled Nursing, said the move away from agency staffing has had a ripple effect: many former agency workers are now actively seeking the stability that comes with permanent positions.
“As an industry, we’ve started to squeeze agency out,” Lingle said.
State Mandates Aren’t Waiting
New York isn’t waiting for that progress to reach every facility. The state has begun issuing penalties to nursing homes that fail to maintain a minimum of 3.5 hours of direct care per resident per day — a threshold tied to staffing shortages that first emerged in 2022.
More than 20 facilities have already started receiving fines. Almer expects more to follow. The penalties, he said, are financially significant and come at a time when many operators are already managing tight margins and rising labor costs.
“The amount of dollars involved is extreme,” Almer said. “It will only make it harder for facilities to manage.”
The challenge is compounded by geography. Not every facility sits in a market where workers are available. Rural and competitive urban markets face staffing pressures that a single statewide number doesn’t account for.
“You have the same mandate applied to all, and it’s not necessarily fair,” Almer said.
Quality vs. Ratios
Both Almer and Lingle pushed back on the idea that meeting a headcount metric equals quality care. Just because a facility hits a number doesn’t mean it’s hired the right people, they argued — and penalizing providers before the workforce has fully recovered may undercut the very operators doing the work to improve.
“Just hiring someone to meet a metric doesn’t mean you’re hiring quality,” Almer said.
With the federal staffing mandate effectively shelved, the pressure is now state by state. New York’s approach — penalize first, let facilities catch up later — is one model. Other states are watching to see whether it drives improvement or just drives operators deeper into the red.
For nursing homes that have already been squeezed by proposed cuts to federal nursing education and training funding, adding fresh compliance penalties on top creates a difficult equation to balance.
Almer’s ask is straightforward: “Let us do our work. You can monitor our quality, which is fine, and I think you’ll see that we’ll staff well.”
