Retention and Leadership Development in Senior Living Care

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Retention in Senior Living Care

Turnover in the senior living care industry is very high, at a rate of approximately 35% annually. To counteract that rate, three primary factors that drive employee retention in this industry are providing good compensation plus benefits, providing professional development opportunities, and ensuring that workloads are managed properly. Four metrics that can indicate upcoming turnover in the industry are employees frequently coming late to work or calling off of work, if an employee hasn't received a pay raise within the previous year, job dissatisfaction, and poor management culture.


A. Primary Factors that Drive Employee Retention

1. Good Compensation & Benefits

  • A primary factor that drives employee retention in the senior living care industry is providing good compensation plus benefits to employees.
  • Hourly wages among the majority of staff members who work in the long-term care industry are "consistently in the bottom quarter of U.S. hourly wages and less than half the national average." The low compensation offered by the senior living care industry has led "many qualified employees to other healthcare outlets."
  • A reason behind the low compensation is that the industry has thin margins. Even if companies can't provide competitive compensation, it's advised that they offer good benefits and incentives as a way to boost retention, such as bonuses tied to how long they have worked there.
  • By offering higher wages, health benefits, paid time off, and performance bonuses, retention in the senior care living industry can be significantly improved, which "can also improve the quality of candidates needed to fill job vacancies, ultimately reducing turnover."
  • Cash bonuses are also a great way to drive employee retention in this industry because approximately just "25% of assisted living residences provide" such to employees. What's more, three years it the average time that an employee has to stay with an employer in this industry in order to receive a retention bonus. The average amount of that bonus was slightly more than $600.
  • One senior living company, Stellar Senior Living, took a unique approach to providing compelling compensation to its employees by using a pay service called DailyPay. DailyPay works by recording employees' hourly compensation amounts and allows them to transfer those earnings as pay to themselves whenever they so choose.
  • DailyPay provides three retention-related statistics on its homepage that show the effectiveness of its compensation solution: (1) Companies that use DailyPay have experienced an employee turnover reduction decrease of 41%; (2) 73% of workers who use DailyPay reported being "more motivated to come to work;" and (3) "People are 1.9x more likely to apply for a job that pays daily."

2. Proper Workload Management

  • A primary factor that drives employee retention in the senior living care industry is properly managing employee workloads.
  • The work at senior living care communities is difficult both emotionally and physically. Thus, job burnout is major problem for the industry and actually "is responsible for the bulk of turnovers in the industry." What's more, when staffing shortages occur, employees might be asked to make up for the difference, leading to even further burnout.
  • A specific way to properly manage employee workloads is by increasing the number of staff members assigned to each resident. Though a simple step, "[s]tudies have shown that increasing key staff numbers per resident substantially reduces turnover."

3. Professional Development Opportunities

  • A primary factor that drives employee retention in the senior living care industry is ensuring that professional development opportunities are offered to employees.
  • A lack of career growth opportunities contributes to the turnover rate in this industry. Examples of the lack of such opportunities include employees who might have topped out in their allowable earnings due to a salary cap or are restricted from "expand[ing] their skill sets" for one reason or another.
  • Professional development programs are a great way to foster employee retention, as they have been described as a way to tremendously increase employee satisfaction in the industry.
  • Examples of professional development opportunities that senior living care companies can implement include discussing career paths with employees, which sends a strong message to employees of their "long-term value," as well as by holding coaching workshops, offering professional growth opportunities both externally and internally, offering supervisory training, and offering feedback to employees through evaluations of their job performance/skills.
  • Investments that companies in this industry make in employee training and professional development programs also provide the added benefit of "improv[ing] patient outcomes, as employees understand that" senior leadership values their work.

B. Metrics Indicating Potential, Upcoming Turnover

1. Employees Frequently Coming Late to Work or Calling-Off of Work

  • When employees start to consistently call-off of work or arrive to work late, those are signs that they are probably disengaged from their jobs.
  • Thus, such patterns are an indicator of their likely exit from the company in the near future.

2. Lack of a Pay Raise Within the Previous Year

  • An indicator of upcoming turnover in the senior living care industry is if an employee hasn't received a pay raise within the previous year. If more than that amount of time has elapsed for such, the employee is very likely to start looking for a new job.

3. Low Job Satisfaction

  • Though more difficult to gauge than the previous two indicators, low job satisfaction is another indicator of potential, upcoming turnover.
  • Job satisfaction within the senior living care industry is largely tied to three elements: (1) If employees have "creat[ed] bonds with residents and [feel they are] helping them achieve the best quality of life possible;" (2) Whether the employee finds the difficult "nature of the job" to be discouraging; and (3) Whether employees are treated well by their employers. If the answer to (1) is "No," to (2) is "Yes," and/or to (3) is "No," an employee is likely to look for a new job.
  • Ways that employers can foster employee retention with regard to job satisfaction include offering good balance between work and life to employees, offering flexible scheduling, and promoting the well-being of their employees. Employers who do so can gain an advantage over other employers in terms of retaining employees by showing those employees that they care about them.

4. Poor Management Culture

  • Poor management culture is an indicator of impending turnover in the senior living care industry.
  • People who work in the senior living and long-term care industries "are more likely to stay with an employer if they have a strong relationship with their manager and feel that he or she understands their daily challenges and triumphs."
  • When leadership is not in-tune with their work culture, that can result in large levels of employee turnover. Two simple ways that management can stay in-tune with their employees is by regularly distributing pulse surveys and holding stay interviews. The feedback generated from those measures makes leadership aware of problematic internal issues and also offers them the chance to fix those issues prior to turnover resulting from such.

Your Research Team Applied the Following Strategy:

We categorized the three primary factors that drive employee retention within the senior living industry as "primary factors" because (1) they were each described as such by at least two reputable, U.S.-based sources knowledgeable about the industry and (2) they were the ones we found cited most-often throughout our research. We included information about both the employee retention strategies, as well as the underlying causes behind them, in order to provide a problem-solution framework. We ensured a U.S. focus to our research by only using U.S.-based sources. The metrics indicating impending turnover came from the employment industry source OnShift, Inc. `
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Leadership Development in Senior Living Care

The two best practices for leadership development in senior living care are: 1) providing training and promotion opportunities and 2) rewarding employees. These are considered best practices as these methods are recognized as successful methods by industry experts such as Andy Richardson, President of Vi; and Lori Alford, Co-Founder of Avanti Senior Living. These two methods are additionally implemented by companies awarded as "Best Place to Work".


  • Include both entry-level training and specialty training

Why this is a best practice

  • Senior living care facilities/companies recognized the practice as main reason for retaining employees.
  • Companies that practice this method are among the Top 10 Best Workplaces for Aging Services 2018 awarded by Fortune magazine research partner Great Place to Work.


  • Merill Gardens' CEO David Eskenazy said that they provide career paths that offer opportunities to grow within the company.
  • At Sunrise Senior Living, they offer extensive onboarding practices and executive director training programs.
  • The Seabrook Retirement Community, an Erickson Living Continuing Care Retirement Community (CCRC), also attribute their high retention rates to their passion for developing people and offering promotions, according to executive director Paula Digerness. They offer formal mentoring and training programs.
  • According to Richardson, Vi's President, their high retention rate is due to training employees to be better managers and leaders. Vi is a family of CCRCs.
  • At Vi, front-line employees participate in Vi’s one-year Management Development Program (MDP) and attend virtual training sessions led by company executives on a variety of topics.
  • At Avanti Senior Living, women in executive positions mentor other staff, especially younger employees looking to advance in their career.


  • In Seabrook Village, average turnover is 31% and the retention rate is 79% mainly due to people development and promotions.


Why this is a best practice

  • Senior Living care facilities/companies recognized the practice as main reason for retaining employees.
  • Companies that practice this method are among the Top 10 Best Workplaces for Aging Services 2018 awarded by Fortune magazine research partner Great Place to Work.


  • At Thrive, the company gives incentives to employees with the most knowledge of Thrive residents, in which they could earn up to $300 more a month.
  • Sunrise Senior Living recognizes its top performers with service awards.
  • At Seabrook, they offer employees with an array of benefits which include health plans, dental, life and disability insurance, paid time off and tuition reimbursement.


  • According to a LeadingAge publication, research shows that companies with a “recognition rich culture” experience 31% lower turnover rates than their peers.
  • Eighty percent of employees overall report that recognition is an important driver of their job performance.


We considered the both training and promotion opportunities and rewarding employees as best practices as research showed that these practices are recognized by the industry executives, per the 2017 Senior Living Innovation Forum. Additionally, these are practices implemented by companies that are in the Top 10 of the Best Workplaces for Aging Services 2018 awarded by Fortune magazine research partner Great Place to Work. Metrics and statistics around employee retention rates and turnover published by Seabrook Village were used as an industry proxy.

From Part 02
  • "Reward employees who go the extra mile, ban gossip, and let poor performers go after three months (rather than three years) were just a few of the straight-talk tips on leadership in senior living from an engaged leadership panel at the 2017 Senior Living Innovation Forum."
  • "Now, Vi invests more in the hiring and onboarding process, which includes an intense 90-100 days to make sure new employees are acclimating to their work environment, understanding their job responsibilities and becoming a part of the company’s culture."
  • "At the same time, Avanti’s culture is down on gossip."
  • "Furthermore, research shows the likelihood of a learner’s success is stronger when a learner feels explicit support from his or her manager. A Learning leader’s ability to articulate the value of senior leader engagement in learning programs, and the ability to activate executives, is key to driving a sustainable high-performing learning culture."
  • "To help instill that culture, Sunrise employs extensive onboarding practices and executive director training programs. The company also recognizes its top performers with a service award. Those programs don’t just help build a culture — they also help tamp down turnover among the provider’s 25,000 U.S. workers."
  • "“Our leadership development focus is very much tied to lower turnover,” Winkle said. “We find that when people connect to the mission, they stay.”"
  • "“We attribute our retention successes to our passion for developing people, and the numerous promotions and transfers of our staff members within Seabrook, and to other locations in the Erickson Living enterprise.”"
  • "“We have formal mentoring and training programs at Seabrook and in Erickson Living, but we think we have something special that many other companies don’t have, and that is the residents who live at Seabrook who informally mentor and teach us to be better ourselves by sharing their own life and work experiences,” Digerness said. “This is truly part of our mission to ‘share our gifts to create communities that celebrate life.'”"