While still under siege due to departures at top administrative levels, nursing homes nonetheless have seen the huge salary rises of the pandemic years continue to moderate, according to the largest yearly US nursing home survey.
Nursing home administrators’ average salary was $135,744 in 2024 after a tempered 3.8% annual rise, while directors of nursing hit $117,754 due to a 3.75% climb. Their respective assistants saw pay rates rise slightly slower.
Meanwhile, hourly rates for nursing positions saw their pay rate rises moderate by 40% or more in most instances, an even stronger sign of a cooling off among the ranks. Registered nurses’ average hourly pay rate rose to $39.74, LPNs’ to $31.21 and CNAs to $19.81.
“Actual increases have continued to decline, along with turnover rates,” said Rosanne Zabka, director of reports for Hospital & Healthcare Compensation Services (HCS), which released its 47th Annual Nursing Home Salary & Benefits report Friday. “It seems to be good news for nursing homes, though I hesitate to say it out loud, lest I jinx anything. Sign-on bonuses continue to be used and increased slightly again this year. Since salaries aren’t going up astronomically now, we’ve actually seen an increase in the shift differentials, which is unusual. Nothing insane, but more than their usual annual increase.”
The nursing titles mentioned above rose between 4.59% and 5.12%, a far cry from the 9.4% to 11.5% range a year earlier. Meanwhile, DONs saw the rise in their average rise drop from 4.67% to 3.75%. (See chart)
“The No. 1 thing is salary increases are moderating. That’s the biggest takeaway,” affirmed Matt Leach, a senior consultant with Total Compensation Solutions. “When you look at year-over-year data, most titles are around 3.5%. That is what we’re seeing from other sources, too. CNAs are a little higher and some of the others a little lower.”
Chief financial officer ($169.819), director of information technology ($111,075), Controller ($103,391) and director of therapy/Rehabilitation ($103,230) were the other top-earner categories in the survey findings.
HCS gathered results on nearly 101,000 long-term care employees from 914 facilities for the 319-page report. It covers 47 management and 55 non-management positions and was produced in cooperation with LeadingAge and with support from the American Health Care Association.
New status for nursing homes
Leach, a veteran compensation and benefits analysis, said he was fascinated by the way nursing home salaries are now so competitive with their counterparts at continuing care retirement communities.
“For years, CCRCs pay well above nursing homes, and were more profitable and considered a better place to work, from an employee sense,” Leach said. “There are some jobs reporting higher wages for nursing homes than CCRCs. It takes in the current environment where providers have to compete with each other because they will go where they can get paid.”
While CNAs at nursing homes and CCRCs registered the identical $19.81 hourly wage, RNs, LPNs and assistant DONs all were paid higher at nursing homes. Healthcare administrators, their assistants and DONs all were within $2,000, often much less, between the two settings. (HCS publishes a separate CCRC salary report each June, from which it used statistics for the comparisons. Data cut-off for both was in the first quarter of this year.)
“It’s incredible that an assistant director of nurses is higher in nursing homes, and the nursing home administrator is basically within $1,000. I don’t think we would have seen anything like this five to 10 years ago.”
Leach observed that the moderation in salary rises in a continuation of a movement started last year. Some pockets of the US are experiencing higher than the baseline 3.5% rise, he added.
“The healthcare world is paying larger increases than historic norms,” he noted. “I don’t think that’s going away anytime soon.”
In general, he explained, the Upper Midwest is paying a higher premium for employees, as opposed to places like Florida, where the salary-moderation is more accelerated
More independence and bonuses
He said that 2024 may become known as the year providers staunched the use of agency nursing.
“It’s more than long-term care — it even goes for hospitals, but some organizations have decided to swallow the pill and increase the rates they pay their employees by giving them a market adjustment because traveling nurses were costing them so much,” Leach said.
“I think what happened was a lot of companies were thinking the traveling nurses were just a short-term thing and they didn’t want to make adjustments to their employee nurses. But then some nurses said this is ridiculous. I’ll be a traveling nurse. I think they (employers) just wanted to put an end to it.”
A lot of retirements and turnover at the top levels has “everybody scrambling for executive talent. One of the ways is to pay more in base salary.”
Along those lines, Leach said the nursing home sector has gone “full bore” with bonuses and incentive pay.
“A lot of organizations are doing a good job tying [bonuses] to the results of the organization,” he said.
Nursing home administrators in this year’s survey results averaged a bonus that was 16% of their base salary. DONs’ bonuses averaged 14.3% of their salary, while their assistants received just more than 9%. About 1 in 7 respondents reported both salary and bonus data, HCS said.
When it came to sign-on bonuses, that was another hot scene. DONS led with an average $8,488 (up 14% from a year earlier), while RNs got an average of $5,547, LPNs $4,421 and CNAs $2,491.
Ordering information for the full HCS nursing home salary book, or any of its others, can be found at hhcsinc.com.
