Senior living operators confronted projections this week showing a combined shortfall of 193,100 registered nurse positions, 245,950 licensed practical nurse positions, and 73,000 certified nursing assistant openings by 2028 through 2038, according to federal Bureau of Labor Statistics data and Health Resources and Services Administration (HRSA) estimates cited by Senior Housing News.
TL;DR: Federal agencies project a combined 512,000-position shortfall in licensed nursing and CNA roles by 2038, with rural markets facing an 11% RN shortage compared to 2% in metro areas.
Rural Markets Face Five-Times-Worse RN Shortages
Non-metropolitan senior living communities will face an 11% registered nurse shortage by 2038, compared to 2% in metropolitan markets, HRSA reported. Rural hospitals and health systems already operate near double-digit nursing shortages, according to the agency’s May 2026 workforce analysis.
The geographic disparity compounds recruitment challenges for assisted living and memory care operators in smaller markets, where competition with local hospitals for clinical talent already tilts toward health systems offering higher base compensation. RN positions nationally are expected to grow 6% over the next decade, adding 177,440 nurses, but projected openings total 193,100 through 2032 due to retirements and workforce exits, Bureau of Labor Statistics data shows.
Burnout Persists Despite Post-2020 Wage Increases
Sixty-five percent of nurses reported high stress and burnout levels in a 2025 Cross Country Healthcare and Florida Atlantic University study, with top stressors including staffing shortages, inadequate pay, lack of leadership support, and patient abuse. The burnout trend continues despite a 30.9% increase in senior living hourly wages between 2019 and 2023, averaging 6.2% annual growth, according to Argentum’s five-year wage study.
“The reality is the shortage is massive,” Todd Kiziminski, senior vice president and chief people officer at Louisville, Kentucky-based Trilogy Health Services, told Senior Housing News.
Trilogy enrolled 190 employees in an internal CNA training program in 2026, achieving 80% retention among program participants compared to CNAs not in the program. The provider recently launched its own LPN school to support continuing education and improve retention.
Operators Deploy Internal Training, Loan Forgiveness
Alexandria, Virginia-based Goodwin Living increased CNA wages $10 per hour since 2019, from $13.25 to over $23, while establishing a student loan payment program through its charitable foundation. Eligible staff can receive $5,250 in annual student loan relief without a cap, according to CEO Rob Liebreich.
“Those kinds of programs and thoughtfulness have been really intentional for us,” Liebreich said in the report.
Goodwin Living reduced nursing turnover below 25% and CNA turnover below 15%, even as Washington, D.C.-area developers increased senior living supply 5.3% in 2025, intensifying competition for clinical staff. The provider structured compensation and benefits to compete directly with hospital systems.
“We need to be on par or better than the options that people have in the community,” Liebreich said. “We should be able to compete with hospital systems.”
West Linn, Oregon-based Anthem Memory Care, with 500 clinicians among its 1,500 employees, eliminated agency staffing in favor of permanent hires. The provider uses mentorship programs and “realistic job previews” to align candidate expectations with clinical complexity in assisted living settings, according to COO Lewis McCoy.
“The clinical complexity in assisted living requires nurses to have stronger assessment skills, manage multiplicity of medication issues, chronic disease management and oversight, more so than we’ve seen in previous decades,” McCoy said.
Other operators addressing licensed care staffing include Masonicare, which fields recruitment and training programs similar to Trilogy’s approach.
Providers Implications
The compounding shortfall creates immediate pressure on caregiver recruitment operations, particularly for agencies and communities relying on rural labor markets where the 11% RN deficit quintuples metro-area gaps. Operators unable to match hospital-system wages will need to differentiate through training pathways, loan forgiveness, and career-ladder programs that convert recruitment into retention.
Agencies marketing in undersupplied geographies should highlight clinical training programs and continuing-education benefits in job postings and recruitment channels to capture candidates weighing senior living against hospital roles. Internal LPN and CNA schools, as Trilogy deployed, convert operational budget from agency-staffing fees into workforce development that compounds retention over time.
The Bureau data signals a long runway for this staffing dynamic. Providers building career advancement systems now position themselves to capture the 177,440 new RN entrants over the next decade, before competitors in tighter labor markets establish similar programs.
