While nursing homes remain under pressure due to departures at the highest levels of management, the huge pay increases of the pandemic years have continued to tapered off, according to the most comprehensive annual U.S. nursing home survey.

The average salary of nursing home managers was $135,744 in 2024, following a moderate annual increase of 3.8%, while nurse managers reached $117,754, due to a 3.75% increase. Their respective assistants saw salaries increase somewhat more slowly.

Meanwhile, hourly wages for nursing jobs were increased by 40% or more in most cases, an even clearer sign of a slowdown in the nursing ranks. The average wage for registered nurses rose to $39.74, for LPNs to $31.21 and for CNAs to $19.81.

“Actual salary increases have continued to decline along with the turnover rate,” said Rosanne Zabka, director of reports at Hospital & Healthcare Compensation Services (HCS), which released its 47th annual report on nursing home salaries and benefits on Friday. “That seems like good news for nursing homes, although I hesitate to say it out loud so as not to curse anything. Signing bonuses are still being used and have increased slightly again this year. Since salaries are not currently increasing astronomically, we have actually seen an increase in shift allowances, which is unusual. Nothing crazy, but more than their usual annual increase.”

The above-mentioned nursing stocks rose between 4.59% and 5.12%, far from the range of 9.4% to 11.5% last year. Meanwhile, the average increase in DONs fell from 4.67% to 3.75%. (See chart)

“The main thing is that salary increases are slowing down. That’s the main takeaway,” confirmed Matt Leach, senior consultant at Total Compensation Solutions. “If you look at year-over-year data, most titles are around 3.5%. We’re seeing that from other sources as well. CNAs are a little higher and some others are 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 earning categories, according to the survey results.

For the 319-page report, HCS compiled data from nearly 101,000 nurses across 914 facilities, covering 47 managerial and 55 non-managerial positions, and was produced in collaboration with LeadingAge and with support from the American Health Care Association.

New status for nursing homes

Leach, a veteran compensation and benefits analyst, said he is intrigued by how competitive salaries in nursing homes have become compared to those in long-term care senior living facilities.

“For years, CCRCs paid significantly more than nursing homes, were more profitable and were considered a better place to work from an employee perspective,” Leach said. “There are some jobs where nursing homes pay higher wages than CCRCs. That takes into account the current environment where providers have to compete with each other because they go where they can get paid.”

While nursing assistants in nursing homes and CCRCs received the same hourly wage of $19.81, nurses, nursing assistants and nursing home aides were all paid more. The salaries of nursing administrators, their assistants and aides were all within $2,000, often less. (HCS publishes a separate salary report for CCRCs each June, from which it used statistics for the comparisons. Data cutoffs for both were in the first quarter of this year.)

“It’s unbelievable that an assistant director of nursing in a nursing home makes more money while the director of nursing homes makes practically only $1,000. I don’t think we would have seen anything like this five to 10 years ago.”

Leach noted that the moderation of pay increases is a continuation of a movement that began last year. In some areas of the U.S., pay increases are even higher than the baseline of 3.5 percent, he added.

“Healthcare is paying higher premiums than historically usual,” he noted. “I don’t think that will change any time soon.”

In general, he explained, the Midwest pays a higher premium for workers, unlike places like Florida, where wage restraint is progressing more quickly.

More independence and bonuses

He said 2024 may go down in history as the year nurses stop using contract nursing.

“It’s more than just long-term care – it even applies to hospitals, but some organizations have decided to take the pill and increase their employees’ salaries as part of a market adjustment because traveling nurses were costing them so much,” Leach said.

“I think a lot of companies thought travel nurses were just a short-term thing and didn’t want to make adjustments to their employees. But then some nurses said that’s ridiculous. I’m going to be a travel nurse. I think they (the employers) just wanted to put an end to it.”

Due to the high number of retirements and turnover among top executives, “everyone is looking for talented leaders. One way is to increase the base salary.”

In this sense, Leach said the nursing home sector is “going all out” when it comes to bonuses and incentives.

“Many organizations do a good job of tying (bonuses) to the organization’s results,” he said.

In this year’s survey, nursing home managers received an average bonus of 16% of their base salary. Nursing home managers’ bonuses averaged 14.3% of their salary, while their assistants received just over 9%. About one in seven respondents provided both salary and bonus data, HCS said.

Welcome bonuses were also hot, with DONS leading the way with an average of $8,488 (up 14% year over year), while RNs received an average of $5,547, LPNs $4,421, and CNAs $2,491.

For ordering information on the complete HCS Nursing Home Payroll Book or other books, visit hhcsinc.com.