Every home health agency knows turnover hurts. Very few know what it costs them. When I went looking for a solid number to give agency owners, I found out why: nobody has published a per-departure cost for a US home health nurse or therapist. The best-known figures are hospital figures, and a hospital vacancy doesn't play out the way a home health vacancy does.
So this guide does two things. It gives you the turnover data that does exist for home health, with sources. And it gives you a method to estimate your own cost per departure as a range, using inputs you already know, instead of a single scary number borrowed from a hospital survey.
How Often Home Health Clinicians Leave
The national rate for home health RNs has come down every year since 2022: 31.19%, then 27.99%, 26.95%, and 25.46% in 2025. Before 2020, the same survey called 20 to 25% the typical rate.
National averages hide a wide spread. A 2024 Texas study of larger home health and hospice agencies found a median RN turnover of 20.0%, a mean of 30.2%, and a quarter of agencies at 49.6% or higher. Put plainly, roughly one agency in four loses about half of its RNs in a year.
Two more findings are worth knowing:
- New hires leave early. At one of the five largest US home health companies, 34% of full-time and 45% of part-time licensed nurses left in their first year, most of them within the first 180 days (Spetz et al., 2020).
- Long weeks push nurses out. In national nursing survey data, home health RNs were more likely than hospital RNs to change jobs once they worked past 40 hours a week (Samson et al., 2025).
I couldn't find a public turnover rate for home health PTs, OTs or SLPs. The paid Hospital & Healthcare Compensation Service report tabulates it, so if you want a therapist benchmark, that's where to get it. I'm not going to guess one here.
What One Departure Costs: The Evidence
Here is what's actually been measured:
| Source | Setting | Cost per departure |
|---|---|---|
| NSI National Health Care Retention Report, 2026 | Hospital bedside RN | $60,090 (average of ranges hospitals selected) |
| RETAIN study, Razmpour et al., 2026 | One academic medical center, med-surg RNs | $37,706 core cost; $85,498 when the gap was filled with contract nurses |
| Zagrodney et al., 2026 | Ontario home care personal support workers | CAD $22,000, driven mostly by referrals the employer had to turn away |
| US home health nurses or therapists | Not published |
The Zagrodney team, who built the first cost model specifically for home care, say it directly: cost estimates specific to home care "are not yet available."
The hospital numbers are real, but they don't transfer cleanly. They count closed beds, and they count contract nurses paid close to twice the staff wage. A home health vacancy usually gets covered by overtime, by per-diem staff, or by turning referrals away. And if you pay per visit, some of the ramp-up cost lands on the new clinician rather than on you. That's why a home health estimate should sit lower than the hospital figures, and why it swings so much between agencies.
How to Estimate Your Own Cost per Departure
This method follows the phases in the Zagrodney home care model and the RETAIN hospital model. Work out each component with a low and a high, using your own numbers wherever you have them. The answer is a range, and that's the honest way to state it.
The six components
A. The vacancy. While the job is open, its visits go one of three ways: absorbed by your team at straight time (close to free), covered at a premium (overtime or per-diem), or not done at all (lost margin). Split the visits across those three, and never count the same visit twice.
- Visits affected = days open ÷ 7 × 5 × visits per day
- Cost = (covered visits × hours per visit × premium per hour) + (visits not done × revenue per visit × your margin)
- How long jobs stay open: in the Texas study, 28.6% of agencies filled an experienced RN job within 30 days and 34.3% took more than 90.
- Revenue per visit: the CMS 2026 national per-visit rates are a fair stand-in, $176.96 for skilled nursing and $193.42 for PT. For the margin on a visit you didn't make, use your own number. MedPAC's 21.2% average Medicare margin for freestanding agencies is a conservative floor. The share you really lose on a missed visit is usually higher, because you also didn't pay the wage or the mileage.
B. Recruiting and hiring. Job boards, recruiter fees, sign-on bonus, background checks and credentialing, plus the hours you and your managers spend screening and interviewing.
- SHRM's healthcare cost-per-hire: $667 median, $4,770 average.
- Home health RN sign-on bonuses averaged $7,499 in 2025, and about half of agencies offer one.
- Staffing firms typically quote 15 to 25% of first-year salary. One recruiter fee can outweigh everything else on this list.
C. Orientation. The hours a new hire is paid but not yet seeing a full caseload, plus the preceptor's time.
- In a national home health survey (BerryDunn, 2022), 56% of agencies expected new nurses to take six weeks or more to reach full productivity, and 25% expected one week.
- New graduates take about six months to become independent (Association for Home & Hospice Care of North Carolina).
D. Ramp-up. After orientation, the weeks the new clinician runs below a full caseload. Cost = weeks × 40 hours × the share of the caseload they aren't carrying yet × loaded hourly cost. If you pay per visit, count it as lost visits instead.
E. Management, admin and exit. Exit paperwork, deprovisioning, the phone or equipment that doesn't come back, and the scheduler rebuilding routes. The RETAIN study measured $612 per nurse for the exit side alone.
F. Quality and continuity. A new face in the home, a missed visit, a patient who didn't get the same clinician twice. It's real, and in the BerryDunn survey higher turnover went with lower patient satisfaction. Nobody has put a reliable dollar figure on it, so don't add one. Just remember it sits on top of the total.
A worked example: one home health RN
These inputs use the BLS May 2025 average wage for RNs in home health care services ($44.99 an hour, $93,580 a year), loaded 1.30 to 1.42 times for benefits, 5 visits a day, and 1.5 hours per visit including drive time and charting.
| Component | Low | Central | High | What drives it |
|---|---|---|---|---|
| A. Vacancy | $1,100 | $6,300 | $20,000 | Low: open 30 days, most visits absorbed, a few on overtime. High: open 90 days, half covered per-diem, half not done. |
| B. Recruiting and hiring | $1,000 | $9,100 | $14,200 | Low: a job post and a few interviews. High: average cost-per-hire plus a full sign-on bonus. |
| C. Orientation | $5,800 | $7,800 | $12,500 | Two to six weeks of partly unproductive paid time, plus preceptor hours |
| D. Ramp-up | $1,900 | $4,900 | $9,200 | Four to twelve weeks below a full caseload |
| E. Management and exit | $600 | $1,200 | $2,500 | Exit, deprovisioning, rescheduling |
| Total | about $10,000 | about $29,000 | about $58,000 |
Run the same method for a PT at the BLS home health average ($56.85 an hour) and you get about $13,000 to $65,000, with a central estimate near $33,000.
If you use a recruiting firm, add the fee. At 20% of salary it adds roughly $14,000 more to the RN high end. If you hire a new graduate, the longer ramp-up adds more again.
The two numbers that matter most
About two-thirds of the gap between the low and high totals comes from two inputs:
- How long the job stays open, and what happens to its visits. A 30-day gap your team absorbs costs very little. A 90-day gap where half the visits never happen can cost $20,000 on its own.
- Whether you pay a sign-on bonus or a recruiter fee.
If you only fix one thing, fix the time to fill.
What it means for a whole agency
Multiply headcount by turnover rate by cost per departure. An agency with 30 RNs at the 2025 national rate of 25.46% loses about 7.6 nurses a year. At the central estimate that's roughly $220,000 a year, and the likely range runs from about $80,000 to about $445,000.
I'm not doing that calculation for therapists, because there's no public therapist turnover rate to multiply by.
Why Clinicians Leave
In the BerryDunn survey, agencies named burnout as the top reason clinicians left. On their engagement surveys, the top concerns were pay, lack of flexibility, and not enough room to grow. From my own time in the field, I'd add what feeds the burnout.
Documentation that follows you home
CMS's own paperwork estimate puts a start-of-care OASIS at roughly 56 minutes of clinician time, for the data entry alone. That's before the visit note, the care coordination call, and the orders that need chasing. A lot of that work gets done at the kitchen table after the last visit, and that's where people start doing the math on their real hourly rate.
Caseloads that keep growing
"Just take one more" adds up. In the BerryDunn survey, most top-performing agencies held case managers to 20 to 25 patients. Agencies at 25 or fewer averaged a four-star quality rating. Agencies at 26 to 30 averaged three and a half stars, and those above 30 averaged two. That's a correlation, not proof, but it points the same way as everything clinicians tell you.
Scheduling that ignores the map
A clinician who crisscrosses the county all day is paying for your scheduling in unpaid drive time and wear on their car. It shows up in how they feel on Friday.
Working alone
Home health is solitary. Car, home, car, home. Without regular contact with colleagues and a supervisor who picks up the phone, clinicians start to feel like contractors, and eventually they act like it.
Pay that doesn't match the work
Often it isn't the base rate. It's unpaid documentation time, mileage that doesn't cover the miles, and on-call expectations nobody mentioned at the interview.
What Keeps Clinicians
The best evidence I found on why home care nurses stay comes from a study of Ontario home care nurses (Tourangeau et al., 2017). Nurses were more likely to plan to stay for the next five years when they had:
- continuity with the same patients
- a good relationship with their supervisor
- a workable balance between work and life
- steady, predictable income, and pay and benefits they were satisfied with
- work that felt meaningful, with a variety of patients
- confidence in the quality of care their agency delivers
Almost every item on that list is operational, not a benefits-package problem. Here is how that translates day to day.
Keep patients with the same clinician
Continuity is good for the patient and it's one of the strongest reasons nurses stay. Build schedules around it, not around whoever has an open slot.
Give clinicians a territory
A clinician who knows their area, its streets and its patients is faster and happier. Constantly sending someone across town wears down both.
Hold the caseload line
Set a caseload ceiling and keep to it. The BerryDunn range of 20 to 25 patients per case manager is a reasonable place to start. For productivity, most top agencies in that survey expected five to five and a half nursing visits in an eight-hour day.
Protect the first 180 days
That's when most new-hire attrition happens. Assign a preceptor, check in weekly, keep the new clinician's caseload geographically tight, and don't hand them the hardest patients in week two.
Make pay predictable
Income stability matters as much as the rate. If you pay per visit, think about a guaranteed minimum, paid orientation, and paid documentation time. Reimburse mileage at or near the IRS rate, which is 76 cents a mile from July 1, 2026.
Show a path forward
"More visits" isn't a career. Senior clinician and preceptor roles, specialty tracks like wound care, cardiac or ortho, and supervisory roles for those who want them all give people a reason to stay.
Stay connected
A 15-minute weekly huddle, peer mentoring for new hires, case conferences on hard patients, and a supervisor who calls back the same day. None of it costs much.
What to Measure
Track these monthly or quarterly:
- Turnover rate: separations ÷ average headcount, by discipline. Compare against the national RN figure and your own trend.
- First-180-day turnover: the share of new hires who leave within six months. This is where most attrition happens.
- Days to fill: from resignation to the new hire's first independent visit. This is the biggest single driver of your cost.
- Visits covered, absorbed and lost while positions are open.
- Weekly hours per clinician, including documentation time. Watch anyone who is regularly over 40.
- Caseload per case manager.
- Clinician satisfaction: a short quarterly pulse survey, and act on what it tells you.
Then run the cost method above once a year with your own numbers. The first time you put a dollar figure next to "we lost six nurses this year," retention stops being an HR topic and becomes a budget line.
Key Takeaways
- National home health RN turnover was 25.46% in 2025, down from 31.19% in 2022, and one agency in four loses about half its RNs in a year.
- No study has published a per-departure cost for US home health. Built from home health inputs, a departing RN costs about $10,000 to $58,000, with about $29,000 as a central estimate. A PT costs about $13,000 to $65,000.
- Time to fill and what happens to the open visits drive most of that cost. Recruiter fees and sign-on bonuses come second.
- Most new-hire attrition happens in the first 180 days. That's where onboarding effort pays back.
- The things that keep clinicians are mostly operational: patient continuity, a supportive supervisor, workable caseloads, predictable pay, and a life outside work.
Frequently asked questions
How much does it cost to replace a home health nurse?
No study has published a per-departure cost for US home health nurses. Building one from home health wages, fill times, orientation and sign-on bonus data gives a likely range of about $10,000 to $58,000 per departing RN, with a central estimate near $29,000. Where an agency lands depends mostly on how long the job stays open and whether the lost visits are covered at a premium or not done.
What is the turnover rate for home health nurses?
Hospital and Healthcare Compensation Service reports national home health RN turnover of 31.19% in 2022, 27.99% in 2023, 26.95% in 2024 and 25.46% in 2025. Agencies vary widely: in a 2024 Texas study the median agency had 20.0% RN turnover and a quarter of agencies were at 49.6% or higher.
Why is the home health figure lower than the hospital figures I have seen?
Hospital estimates such as NSI's $60,090 per bedside RN include closed beds and contract nurses paid at close to twice the staff rate. A home health vacancy is usually covered by overtime, per-diem staff or declined referrals, and per-visit pay shifts some ramp-up cost onto the clinician, so the typical cost sits lower.
When do new home health nurses leave?
Early. At one of the five largest US home health companies, 34% of full-time and 45% of part-time licensed nurses left within their first year, and most of that attrition happened in the first 180 days.
Info
See also: Most of the same retention forces hit the home-care (non-medical / personal care) workforce harder than they hit clinicians. If you run or care about that side of the industry, our companion piece Direct care workforce 2025: what the data says lays out the wage, turnover, and labor-market data agency operators should know cold.
Sources
- Hospital & Healthcare Compensation Service, 2025-2026 Home Care Salary & Benefits Report press release (November 2025, 1,111 agencies) and 2024-2025 release (November 2024).
- Texas Department of State Health Services, 2024 Home Health and Hospice Care Nurse Staffing Study: Vacancy and Turnover and Staffing (February 2025).
- Spetz J, Bergman A, Song H, Rose A, David G. Understanding Nursing Turnover: The Case of Home Health Care. Innovation in Aging, 2020.
- Samson Z, Wagner LM, Hunt LJ, Muench U. Predictors of job turnover among home health versus hospital nurses. International Journal of Nursing Studies, 2025.
- Zagrodney KAP et al. The Cost of Turnover in Home Healthcare: A Conceptual Model, and The Cost of Homecare Personal Support Worker Turnover. Healthcare Management Forum, 2026.
- NSI Nursing Solutions, 2026 National Health Care Retention & RN Staffing Report.
- Razmpour O et al. Operationalizing the RETAIN Framework: Calculating the cost of nurse turnover in practice. Nursing Outlook, 2026.
- BerryDunn, National Healthcare at Home Best Practices and Future Insights Study, May 2022.
- Association for Home & Hospice Care of North Carolina, Onboarding Model for Home Health, October 2020.
- Tourangeau AE et al. Work-related factors influencing home care nurse intent to remain employed. Health Care Management Review, 2017;42(1):87-97.
- SHRM, Talent Access Report: Healthcare/Social Services, 2022.
- BLS, Occupational Employment and Wage Statistics, May 2025, Home Health Care Services, and Employer Costs for Employee Compensation.
- CMS, CY 2026 Home Health PPS Rate Update, Transmittal 13488 (per-visit rates), and the OASIS-E2 Paperwork Reduction Act supporting statement, CMS-10545 (2025).
- MedPAC, March 2026 Report to the Congress, Chapter 8.
- IRS, Standard mileage rates.
The cost ranges above are estimates built from the component method in this article, not figures from a published study. Swap in your own wages, fill times and margins and the range will tighten to your agency.