9 Things Skilled Nursing and Senior Living Leaders Should Know About On-Demand Pay

CNAs, nursing, and support staff at skilled nursing and senior living facilities can use earned wage access (EWA) to transfer a portion of the wages they’ve already worked for before payday, with no cost to the facility. Earned wage access changes when employees get paid, not how much.

Our recent webinar dove deep on this, The 9 Things Every Skilled Nursing and Senior Living Leader Should Know About On-Demand Pay, featuring Tapcheck’s SVP of Partnerships Michael Ross, moderator Kevin Goedeke of NHA Standup, and Taylor Florence of CEUs are Easy. Here are the 9 takeaways we have for you, or watch the full webinar on demand.

1. Caregivers run short between paydays

Most nursing assistants earn about $20 an hour, and bills don't wait for a two-week pay cycle. One flat tire or surprise bill can throw everything off.

Kevin Goedeke of NHA Standup, also a Tapcheck customer, described it as this: when the choice is groceries or gas to get to work, people make the short-term call.

Then it escalates:

• A missed shift becomes an attendance issue.
• Attendance policy has to apply to everyone.
• A caregiver you wanted to keep ends up let go.

And they're far from alone: two-thirds of U.S. households live paycheck to paycheck.

2. What do most facilities do when an employee asks for pay early?

For the employee, the bill is still due: rent, a car repair, a prescription. For the facility, there's no policy to help, so the answer is "wait" or an HR judgment call on the spot.

Neither ends well. An employee told to wait may call out or start job hunting. A yes for one employee and a no for another is a fairness complaint in the making.

That's where most facilities are today. Nearly 59% of the leaders we polled say wait, and 13.5% decide case by case. That's more than 7 in 10 without a consistent answer.

Every workaround also adds payroll work and invites errors. Earned wage access replaces them with one option for every employee, no judgment call required.

3. Outside options don’t solve the issue

When the employer has no option, employees turn to outside ones that come with costs of their own:

• Overdraft fees. Individual fees stack quickly when a paycheck lands a few days after a bill clears.
• Retirement withdrawals. In 2025, 6% of retirement plan participants eligible for hardship withdrawals took at least one, up from 5% in 2024, and nearly half of those took more than one, according to Vanguard. Among lower-income participants, avoiding eviction and covering medical bills were leading reasons.
• Waiting it out. Missed bills lead to late fees and a missed ride to work leads to a call-out.

4. What is Earned Wage Access?

Earned wage access is a third-party benefit, integrated with your payroll and time and attendance systems, that lets employees transfer wages they have already earned before payday. As employees work, they build an available balance based on parameters the employer sets. They transfer only when they need to, and the amount is reconciled through payroll on payday.

When we asked attendees how they would have described on-demand pay before the session, 55% correctly said access to wages already earned. Another 15% were not familiar with it at all, and the rest associated it with other pay products.

What isn’t earned wage access:

• Not pay for future shifts. It is based only on hours already worked.
• Not a pay card. A pay card is only a destination for funds. Some EWA programs offer one as an option.
• Not money from your operating account. The facility does not front wages or cut extra checks.

Because balances are capped at wages already earned and reconciled through payroll, the program runs inside your existing pay process rather than alongside it.

5. What CNA turnover actually costs your facility

CNA turnover costs more than most facilities have measured. When we asked whether attendees knew their all-in cost to replace one CNA or caregiver, only 12% said they track it. Another 43% had a rough estimate, 34% had never calculated it, a 11% said it sits above their level.

Michael offered a simple way to size the opportunity:

Picture this, a facility with 100 employees and 50% annual turnover loses about 50 people a year. Every departure you prevent saves your full replacement cost, including recruiting, onboarding, training, overtime, and agency fill. Even a small improvement in retention can add up quickly.

Staffing gaps limit the residents you can serve. In a business that runs on thin margins, every lost admission counts.

6. How turnover shows up

Turnover, staffing, and readmission numbers directly affect where senior living communities send their residents who need rehab. A resident who sees a new CNA every week is not getting care from someone who knows their routine. It isn’t just about the cost for roles. The higher the turnover, the more inconsistency in care.

Care Compare is an online tool by the Centers for Medicare & Medicaid Services (CMS) that helps find healthcare providers and compare them. You can view the turnover here and see from nursing staff, RNs, and administrators with more calculation from payroll-based journal data.

7. On-Demand Pay helps you compete with staffing agencies

Agencies win staff on 3 things: shift flexibility, higher hourly rates, and same-day pay. Match the third one, add the benefits and stability that agencies don't offer, and that's a hard combination to walk away from.

Most facilities can’t match agency rates or scheduling, but pay timing is one piece a W-2 employer can match, removing one reason to leave. With on-demand pay, your W-2 staff can access the wages they've earned soon after a shift, the way agency staff already do.

8. Why haven't more operators rolled out On-Demand Pay?

The benefit has moved from skepticism to acceptance to something close to table stakes for hourly workforces, yet adoption still lags.

Here are the three most common blockers why senior living communities don’t implement on-demand pay:

• "How would we measure it?" This is solvable with a baseline before launch (see takeaway 9).
• No deadline. With no cost to the employer, there is no discount expiring. Acquisitions, open enrollment, and other priorities push it down the list.
• Myths about employees. Some leaders assume staff will spend irresponsibly or have nothing left on payday. In practice, operators like Navion Senior Solutions report that caregivers use earned wages for gas, groceries, and other essentials between paychecks.

Another question usually comes from HR and payroll: Will this create more work for payroll, and doesn't our payroll provider already offer something like it? With a deduction-based, payroll-integrated model, the facility does not front any wages and does not reconcile transfers by hand.

Taylor Florence, a former administrator, recalled staff coming to her office embarrassed to ask for pay early after a car broke down, when she knew the policy meant the answer was no. An integrated program removes that conversation entirely.

9. How to evaluate an earned wage access provider

Programs vary widely, so ask the same questions to the provider.

1. What does it cost? Ask about upfront fees, ongoing fees, per-facility fees, and what it costs to leave or switch. Exit penalties are often buried in contracts.
2. Is the balance based on net pay or a gross estimate? Some providers take gross pay and apply a 50% or larger to protect against overdrafts. Others calculate net pay daily, after taxes, deductions, and garnishments, which lets employees access more of what they have earned. For example, a CNA earning $20 an hour who works a 10-hour shift has earned $200 in gross wages, but taxes and deductions mean the transferable amount is less.
3. Is there a no-cost transfer option for employees? Much of the state-level EWA legislation expects one.
4. Who funds transfers, and who is exposed if there is an error? Know before you sign. These can be the provider, the payroll company, the employer, or the employee.
5. How does it connect to our payroll and timekeeping? Ask whether the integration already exists or has to be built, and whether any third-party integration fees apply.
6. How is the available balance calculated, and how fast does it grow? Early in a pay period, known deductions can hold a balance down. It should grow quickly as the period progresses.

Realistically when adding an earned wage access provider, you’ll need to plan for the right people and a timeline. Below, you can see which roles would best need to be in the conversation about on-demand pay consideration and rollout.

Where to go from here

Turnover in nursing rarely comes down to one cause, but pay timing is one of the few you can change quickly. When employees to access their wages earlier, they’re less likely to call out and increase their attendance. Check your staffing, readmission, and turnover, then see the benefits from providers of on-demand pay.

Want the full conversation? Watch the complete 56-minute webinar, including the live Q&A with skilled nursing and senior living leaders.