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Occupational injuries, especially back problems related to resident handling, are common in nursing home employees and their prevention may require substantial up-front investment. This study evaluated the economics of a safe resident handling program (SRHP), in a large chain of skilled nursing facilities, from the corporation's perspective.The company provided data on program costs, compensation claims, and turnover rates (2003–2009). Workers' compensation and turnover costs before and after the intervention were compared against investment costs using the “net-cost model.”Among 110 centers, the overall benefit-to-cost ratio was 1.7–3.09 and the payback period was 1.98–1.06 year (using alternative turnover cost estimates). The average annualized net savings per bed for the 110 centers (using company based turnover cost estimates) was $143, with a 95% confidence interval of $22–$264. This was very similar to the average annualized net savings per full time equivalent (FTE) staff member, which was $165 (95% confidence interval $22–$308). However, at 49 centers costs exceeded benefits.Decreased costs of worker injury compensation claims and turnover appear at least partially attributable to the SRHP. Future research should examine center-specific factors that enhance program success, and improve measures of turnover costs and healthcare productivity.