What Staff Turnover Really Costs Canadian Long-Term Care Homes

Ask any long-term care administrator in Canada what keeps them up at night and staffing will be near the top of the list. Turnover in LTC isn't just a scheduling headache — it drives up agency spend, stretches supervisors thin, and makes it harder to hit provincial staffing and training requirements. The picture also isn't uniform: staffing rules, funding models and reporting requirements vary by province, so the scale of the problem — and what "acceptable" looks like — differs from Ontario to British Columbia to Nova Scotia. What's consistent everywhere is the direction of travel.

What the data shows about LTC staffing stability

The Canadian Institute for Health Information (CIHI) has tracked a clear erosion in LTC's core nursing workforce. Between 2021 and 2023, the number of Licensed Practical Nurses primarily employed in long-term care fell 6.1%, and Registered Nurses in LTC fell 2.1% — even as demand for LTC beds kept rising. The decline is sharper further back: registered psychiatric nurses working in LTC dropped from 548 in 2014 to 315 in 2023, a fall of 42.5%.

Perhaps the clearest single signal of turnover-driven instability is CIHI's finding that purchased (agency) staffing hours per organization rose 238% between 2020–21 and 2023–24. That's not a modest adjustment — it's homes structurally shifting toward expensive, temporary staffing to plug gaps that stable, permanent staff used to fill.

Provincial data tells the same story at ground level. The Ontario Long Term Care Association reports that in 2025, 90% of member homes surveyed had difficulty filling RPN shifts, and a third had difficulty filling RN shifts; more than 60% struggled to fill dietary roles and over 30% struggled with PSW shifts. Ontario's health care and social assistance vacancy rate climbed from 3.2% in July 2019 to 3.6% by May 2026 — and OLTCA projects the province will need at least 25,400 additional nurses and personal support workers by 2029, more than double the current LTC nursing and PSW workforce.

What turnover costs a home in practice

A precise national dollar figure for "cost per leaver" in Canadian LTC isn't published the way, say, hospital nurse turnover cost is in the US — and given how much staffing models and wage scales vary province to province, a single number would be misleading anyway. But the cost categories are the same everywhere:

• Agency premiums — CIHI's 238% rise in purchased hours is, in effect, a direct measure of how much more homes are now paying to cover shifts that used to be filled by permanent staff.
• Recruitment and screening costs — including vulnerable-sector checks and credential verification for every new hire.
• Supervisory and administrative time — directors of care and administrators managing constant rota gaps instead of quality improvement or audit preparation.
• Training repetition — mandatory orientation, safety and competency training has to be delivered again for every replacement, at real cost in both time and instructor resource.

Turnover and accreditation/compliance risk

Staffing instability also shows up directly in survey and accreditation findings. Homes preparing for an Accreditation Canada survey need to demonstrate consistent staff competency and training records — something that gets materially harder when a large share of the direct-care workforce is new, agency-sourced, or mid-onboarding. Ontario's long-term care compliance training requirements similarly assume a stable, trained workforce; chronic turnover means training compliance becomes a moving target rather than a completed checklist.

Where CPD and structured onboarding help

Homes making headway on retention tend to focus on:

• Faster, more structured orientation so new PSWs and nurses feel competent within their first weeks, not months.
• Clear, trackable CPD pathways — nursing staff in particular value visible development toward specialty or leadership roles.
• Centralized training records that make accreditation and provincial compliance prep continuous rather than a last-minute scramble.
• Flexible online delivery that works around shift patterns instead of pulling staff off the floor.

Provincial variation means no single fix applies everywhere, but the underlying lever is consistent: a workforce that's well-trained and sees a development path stays longer, and a home that keeps its training records current is far better placed for both accreditation and day-to-day quality.

FAQs

Is LTC staff turnover the same across all Canadian provinces?

No. Staffing models, funding and regulatory requirements are set provincially, so turnover pressure varies. Ontario's data (OLTCA, 2025) shows widespread shift-filling difficulty, but the scale differs elsewhere — the underlying national trend from CIHI (rising agency reliance, falling core nursing workforce in LTC) holds broadly across the country.

What's the clearest indicator that turnover is rising in Canadian LTC?

CIHI's data on purchased (agency) staffing hours, which rose 238% per organization between 2020–21 and 2023–24 — a direct proxy for homes losing permanent staff and paying a premium to cover the gap.

How many more staff will Ontario LTC need by 2029?

At least 25,400 additional nurses and personal support workers, according to the Ontario Long Term Care Association — more than double the current nursing and PSW workforce in the sector.

Does turnover affect accreditation outcomes?

Indirectly but significantly — accreditation surveys assess staff competency and training evidence, and high turnover makes it harder to maintain complete, current records across the workforce.

The bottom line

Canadian LTC turnover looks different province to province, but the trend is the same everywhere: a shrinking core nursing workforce, a sharp rise in expensive agency cover, and growing pressure on training and accreditation compliance. Homes that invest in structured onboarding and visible CPD pathways are better placed to hold onto staff — and to walk into a survey with training records that hold up.

Related reading: the financial cost of aged care staff turnover in Australia and the real cost of nursing home staff turnover in the US.