HR Support for Nursing Homes: Strategies, Hiring & More

If you run a nursing home, you know that patient care is only as strong as the team delivering it. But finding and keeping that team? That’s where things get complicated.

High turnover, staffing shortages, compliance headaches — HR in a nursing home is nothing like HR in a typical office. And when every delay or misstep in hiring impacts resident care, getting it right is essential.

In this article, we’ll cover:

• The biggest HR challenges nursing homes face

• How to recruit and retain top talent

• Ways to streamline nursing home HR support

• Strategies for HR support for nursing homes

What are common HR challenges in nursing homes?​

Running a nursing home means managing more than just patient care. You’re also responsible for building a reliable, skilled, and motivated workforce.

But between high turnover, staffing shortages, and complex regulations, keeping a facility fully staffed and compliant is a constant challenge. Here are some of the biggest hurdles for HR in care homes:

• High staff turnover: Nursing homes have some of the highest turnover rates in healthcare, which means administrators are always hiring, training, and trying to retain employees before they leave. When experienced caregivers walk out the door, it’s not just a staffing issue — it’s a disruption to patient care.
  
  

• Burnout and job satisfaction: Caregiving is physically and emotionally demanding. Long hours, high-stress situations, and the emotional toll of caring for residents lead to exhaustion. Without proper support, morale drops, job satisfaction plummets, and patient outcomes suffer.
  
  

• Compliance and regulations: Labor laws, licensing requirements, and evolving state and federal regulations add layers of complexity to HR management. A single missed update or incomplete record could mean fines, legal trouble, or even risk to the facility’s reputation.
  
  

• Workforce shortages: Skilled nurses and caregivers are in high demand, making hiring a constant battle. With increasing competition, attracting and retaining top talent requires strong benefits and competitive pay — which adds another layer of financial and administrative complexity.
  
  

• Payroll and benefits management: Offering fair wages and good benefits is essential for staff retention, but managing payroll in a way that meets both employee needs and budget constraints can be challenging.

These challenges create a constant balancing act: Keeping a facility staffed, ensuring compliance, and maintaining quality patient care all at once. It’s not easy, but the right strategies and tools can make all the difference.

Challenges in HR management within nursing homes

Managing HR in a nursing home requires keeping operations steady despite constant staffing changes, compliance demands, and financial constraints.

Unlike corporate HR, nursing home administrators must respond to fluctuating patient needs while ensuring their workforce stays engaged and properly trained. Here are some of the biggest operational HR challenges in nursing homes.

#1 Staffing levels don’t always match patient needs

Hiring enough staff to meet regulatory requirements is one thing, but ensuring the right number of caregivers for residents with varying levels of need is another. State regulations often mandate minimum staffing ratios, but these rules don’t always account for the complexity of care required. Plus, you could end up with a staffing surplus during an unexpected low census period when the number of patients suddenly declines.

#2 High turnover creates constant disruptions

Staffing shortages affect patient care, team morale, and operational stability. Many nursing homes experience frequent turnover among nursing assistants and caregivers, which means HR teams are in an ongoing cycle of hiring and training replacements.

#3 Compliance requirements are always changing

HR teams must stay on top of licensing, training, and certification requirements for every employee. Federal and state regulations frequently change, and missing an update can result in fines or legal issues.

With high turnover, compliance becomes even more complex. New hires need to be onboarded quickly, but rushing the process increases the risk of errors. Facilities that rely on manual tracking or outdated systems may struggle to keep up with the paperwork, putting them at risk for audits or penalties.

#4 Workplace tensions affect team dynamics

In a high-stress environment, disagreements happen. Nurses may feel overwhelmed by patient loads, caregivers might struggle with communication, and administrative staff may have differing views on policies. Without strong conflict resolution strategies, minor frustrations can escalate, leading to a negative work environment.

#5 Payroll and benefits must stay competitive despite tight budgets

Skilled caregivers are in high demand, and many facilities compete with hospitals, home health agencies, and private care providers for the same workers.

Offering competitive pay and benefits is necessary for retention, but nursing homes often operate on thin margins, especially those that rely heavily on Medicaid and Medicare reimbursements.

Effective recruitment strategies

Attracting and hiring the right caregivers requires a proactive approach. With high turnover and competition for skilled staff, nursing homes need to refine their recruitment process to bring in quality candidates quickly. Here are practical strategies to improve hiring outcomes:

Targeted recruitment campaigns

• Post on healthcare-specific job boards: Platforms like myCNAjobs, Nurse.com, and Health eCareers attract candidates with relevant experience, reducing unqualified applicants.
  
  

• Use social media for outreach: Running job ads on Facebook and LinkedIn allows nursing homes to target job seekers by location, certifications, and experience.
  
  

• Highlight workplace culture and career growth: Job postings should showcase meaningful work, flexible scheduling, and advancement opportunities to appeal to caregivers.

Competitive compensation packages

• Offer wages that reflect market demand: Researching local salary benchmarks ensures pay remains competitive without unnecessary overspending.
  
  

• Provide retention bonuses: Offering bonuses at six months or one year encourages employees to stay longer, reducing early turnover.
  
  

• Include non-monetary benefits: Tuition reimbursement, flexible scheduling, paid training, and shift differentials for nights and weekend, like a Baylor shift, can make roles more attractive.

Collaborations with educational institutions

• Partner with nursing schools and CNA programs: Establishing relationships with local schools helps create a steady pipeline of new graduates.
  
  

• Offer tuition reimbursement or scholarships: Supporting students who commit to working at the facility post-graduation ensures a reliable talent source.
  
  

• Host on-campus hiring events: Connecting with students early increases the chances of securing skilled employees before they enter the broader job market.

Employee retention: Strategies to reduce turnover

High turnover in nursing homes doesn’t just mean more job postings — it leads to staff shortages, increased training costs, and inconsistent patient engagement and care. Caregivers who feel valued, supported, and given opportunities to grow are more likely to stay. Here’s how nursing homes can improve retention.

How does staff satisfaction impact patient care?

When caregivers are overworked and underappreciated, it affects the entire facility. High turnover leads to staffing gaps, rushed care, and frustration for both employees and residents.

On the other hand, staff who feel engaged and supported build stronger relationships with residents, leading to better outcomes and a more positive work environment.

Recognition programs

Acknowledging hard work can improve morale and reduce turnover. Small, consistent gestures of appreciation make employees feel valued.

Programs like "employee of the month," peer-nominated awards, or shoutouts in team meetings highlight staff contributions. Plus, extra paid time off, small bonuses, or gift cards are simple ways to show appreciation.

Career advancement opportunities

A job with no room for growth quickly becomes a stepping stone to somewhere else. Nursing homes that invest in employee development see higher retention.

Covering costs for CNAs who want to become LPNs or RNs encourages long-term career growth within the facility. In addition to that, senior caregivers and nurses can benefit from management training that prepares them for supervisory roles.

Supportive work environment

Workplace culture plays a huge role in whether employees stay or leave. A stressful or unsupportive environment increases burnout and turnover.

Regular check-ins, feedback surveys, and open-door policies create an environment where staff feel heard. Team-building activities, even small things like monthly staff lunches or appreciation events, can also strengthen workplace connections.

Training and development: How to enhance staff competency

Ongoing training ensures staff feel confident in their roles and prepared for career growth. Investing in development improves job satisfaction, patient care, and retention.

Continuous education

Healthcare is always changing, and caregivers need regular training to stay up to date, so remember to:

• Provide ongoing skill refreshers. Monthly or quarterly training on patient care, safety protocols, and new regulations keeps staff informed.
  
  

• Cover costs for certifications. Offering reimbursement for advanced training encourages employees to expand their skills.
  
  

• Offer flexible learning options. Online training modules allow staff to complete education at their own pace.

Leadership development

Not every employee wants to stay in direct patient care forever. Leadership programs help prepare internal candidates for supervisory roles like these:

• Senior CNAs and nurses benefit from courses that develop management and leadership skills.
  
  

• Pairing newer employees with experienced staff helps with skill-building and workplace integration.
  
  

• Allowing staff to rotate through different roles builds a well-rounded workforce and improves engagement.

Mentorship programs

New hires are most likely to leave within the first few months if they feel unsupported. A mentorship program can help with retention, so follow these best practices:

• Having a go-to person for questions and support helps new staff adjust.
  
  

• A team that supports each other is more likely to stay together.
  
  

• Following up at 30, 60, and 90 days helps address early concerns before they turn into resignations.

Focusing on retention and training helps create a more stable workforce, improves patient care, and reduces the burden of constant rehiring. Small investments in employee development pay off in long-term staff satisfaction and facility success.

Compliance and regulatory considerations

Compliance plays a major role in human resources for the care home industry, affecting everything from staffing ratios to training standards. Falling behind on requirements can result in fines, legal issues, or restrictions on admitting new residents.

Regular audits help nursing homes stay compliant by reviewing employee records, licensing, and background checks. Missing credentials or expired certifications can lead to serious penalties, so frequent internal reviews prevent last-minute compliance issues. Proper documentation is also essential. Every employee’s training records, evaluations, and credentials should be easily accessible and up to date to meet regulatory standards.

Since regulations constantly change, staying informed about policy updates is critical. New laws can impact hiring, safety procedures, or reporting requirements. HR teams must review policies regularly, communicate changes clearly, and ensure staff follow updated guidelines.

How can technology support HR functions for nursing homes?

Managing HR manually in a nursing home is time-consuming and increases the risk of errors. When evaluating human resources for the care home industry, look for tools that include:

• Automated recruitment tools: AI-powered screening can filter candidates, match qualifications, and speed up the hiring process.
  
  

• Employee management systems: Centralized platforms track credentials, licensing, and performance evaluations, reducing compliance risks.
  
  

• Training modules: Digital learning tools allow staff to complete mandatory training on their own schedule while keeping records updated.
  
  

• Scheduling automation: Smart scheduling software prevents understaffing and reduces last-minute call-outs.
  
  

• Payroll and benefits management: Integrated payroll systems simplify payments, tax calculations, and benefits administration.

Reduce your HR workload with support from the right software: ExaCare

Managing HR support for nursing homes means juggling hiring, marketing, compliance, scheduling, and employee management — all while ensuring that patient care doesn’t suffer.

Software tools like ExaCare play a critical role in reducing administrative burdens by streamlining admissions and providing real-time insights into incoming patients.

When you have better visibility into changing patient needs, you can adjust staffing levels more efficiently and avoid last-minute shortages.

ExaCare transforms your admissions process by using AI to streamline referrals, automate document review, and help you make faster, more informed decisions. Our platform helps you modernize your operations while maintaining the quality of care your facility is known for.

Here’s what we offer:

• AI-powered referral screener that reviews hospital packets in minutes, enabling quick and accurate admissions decisions
  
  

• Centralized referral management that brings all your sources into one platform
  
  

• Built-in analytics to help you track performance and optimize your referral relationships
  
  

• Automated insurance verification, expensive med alerts, and reimbursement analyses to guard your bottom line.
  
  

• A unified communication hub to streamline decision-making with colleagues.

Ready to see how ExaCare can help your facility win more referrals? Talk with our team to learn more.

Schedule a demo.