By Steve Moran

We know finding and keeping senior living team members is a huge problem for almost every senior living company. The question is this: where is the low hanging fruit? I did some digging on the website Glassdoor to figure it out. I came up with a list of 9 complaints that surfaced over and over again. While pay was mentioned some of the time, it was far from the top issue.

Here is what I did:

  • I looked at employee reviews from around a dozen senior living companies
  • I ignored the 5-star ratings, figuring they would mostly have accolades
  • I ignored the 1-star ratings, figuring that in many cases those people had a bad attitude, and were a bad fit, a bad employee, and likely would post nothing actionable
  • I looked for common themes

The List

Sample comments in italics have been lightly edited for readability. 

  1. Listen to the team — This was by far and away the most common comment. The sense was that front line workers had strong feelings about what would make their work life easier, would improve the lives of residents, and would actually make the organization more money.

    “Leadership should get more input from the employees regarding operational changes to create more buy in. There also needs to be better communication across departments. The company culture lacks ‘fun’. Having a popcorn social does not motivate employees.”

    “Listen to employees about changing and improving things.” 

    “Take more time to stop and smell the roses at each and every one of your residences. Treat your managers with more respect and listen to what they have to tell you instead of trying to ram corporate garbage down their throats.” 

    “It would be helpful if ‘they’ would actually listen to the staff when they have concerns instead of letting problem managers continue to get away with bad attitudes and general lack of respect for their employees and the work they do.” 

    “Really listen to the feedback from the employees because you don’t work the floors as we do. Also, staff hates when you try to cover up or run around situations. Your staff is not stupid!”  

    “Middle management buffers corporate folks from knowing what really goes on in their communities.”

  2. Lack of positive feedback — It is clear that team members feel like they work hard to do a great job and that what they do is not noticed and appreciated. There is good data that shows this is one of the biggest disconnects between management and team members. The bottom line is that you cannot say thanks too much. 

“Appreciate the good employees you have. Don’t take them for granted, especially the ones with longevity.”

“Highly stressful, low engagement of employees, low recognition and praise, expectations that are almost impossible for anyone to achieve.”

“Appreciate the people you have working for you. You’re letting great talent get away and not looking to see if senior management is the problem.”

  1. Leadership Turnover — There were many complaints about how difficult is to work in an environment where leadership changes every few months. In theory, a company’s policy and procedure manual becomes the standard playbook that leaders use, meaning changing leadership should not be very impactful. 

    The problem is that how those “rules” are interpreted and implemented varies widely from leader to leader and every time they are reinterpreted by a new leader it causes fear and unhappiness.

    “Healthcare supervisors changed several times while employed with the company.”

    “Management changed hands several times in just 2 years.”

    “Regional management changed every few months. — Value employees, there is too much turnover in sales and sales management.”

“There is too much top down, old-fashioned hierarchy in leadership. In one company I worked for, the CEO made 30 times what front line staff made. I don’t know what the best ratio should be, but why do we say that our front line staff matter the most then pay them so poorly? I think it goes along with the upper echelon of leaders in senior living thinking they have all the best ideas and thus deserve to make a ton of money, when many of them come from finance or real estate and don’t really know a hill of beans about seniors. I worked for a company where the COO would visit and say to me, ‘Keep me away from the residents’.”

Kent Mulkey, Senior Living Sales Evangelist | Writer for Senior Living Foresight

  1. Favoritism — I want to start by saying that I don’t believe all favoritism is bad. When a team member does exemplary work there should be favoritism. However, too often favoritism is not about who is doing the best job for residents and the organization but rather about who is friends with the supervisor. This is perhaps one of the toughest problems leaders face . . . being blinded by the weaknesses of their friends.

    “Management is like a high school clique.”

    “Quit overlooking good employees and treat employees fairly.”

    “Terrible management, they are all friends, so despite doing things that should get them fired they never will. There is never enough help and they give too much leeway to long-tenured employees.”

  2. Understaffing — I am more and more convinced this is a huge problem that we are not talking very much about. In the moment, most of the time, understaffing has way more upside than downside. It controls costs and avoids costly agency staffing. Except, over time it takes a toll in the form of lower employee, resident, and family member satisfaction. It also creates serious risk for something horrible to happen to a resident.


    “More help is always needed.”

    “District management and corporate leaders only care about their bonuses. They operate short-staffed to improve the profit margin, which is reflected in their bonuses.”

    “We are understaffed almost every shift, and have high turnover.”

    “Too much work . . . we are understaffed almost all the time.”

    “Short staff! Short staff! Short Staff!”

    “Low pay, disorganized and unreliable management, frequent under-staffing, overcharges residents to make a quick buck, nurse frequently ignores aids’ concerns for residents.”

    “Never fully staffed in all departments”

“Hate, animosity, resentment. You can blame it all on your culture. The truth is your team members are very attuned to the health of your organization. Their common complaints are the outcomes of your under prioritized culture, which is probably more misaligned than you realize. We hear it all the time during our culture analysis work with organizations from all over the country, team members want more and it’s usually not pay they’re after! It’s very doable, very reasonable, very fixable if you’re willing to tackle it. We’ve seen it time and time again, if you listen to them and do the work, you can get your team members to LOVE working for you! The first step is uncovering what the real problem is.

This is not a chicken or egg dilemma. It’s a fact. You have a staffing crisis because you have a culture crisis.”
                          Sheila O’Grady, Drive

  1. Inconsistent following of the rules — I am a big believer that rules are made to be broken and that often asking forgiveness rather than permission is the right thing to do. There are lots of times when the rules need to be broken because they do not adequately serve a particular situation, but way too often rules are selectively enforced in ways that are ultimately detrimental to residents, team members, the mission, and profitability of the organization. In addition, it was common to see complaints about how gossip and favoritism are big problems. That when people kissed up to their supervisors, the quality of their work or how they treat fellow team members mattered little.

    “No one in senior positions follows their own policies, including corporate.”

    “Make the rules the same for everyone.”

    “Don’t share information and talk about employees behind their back  — Be fair.”

    “Managers’ interpretation of the handbook varies across the company. They interpret different parts differently.” 

    “The culture is very appealing, but make no mistake, the politics run deep and the turnover over 50% for new executive directors is real.”

  2. Little room for advancement — One of the best things about senior living is that it does provide real opportunity for individuals at the bottom of the employment stack to be just about anything they want to be, but so often the path seems unclear or impossible.

“A formal performance review and career path development on an annual basis would be really helpful. Having conversations with the home office about what your career path might look like or what you would like it to look like then putting together a plan to make that happen would be great.”

“Promotions are a joke.”

“Lack of internal promotion. No bonuses except for management.”

“Not much room for advancement. You can meet your goals and never see even a cost-of-living raise of even 1 percent in a year.”

“Not a lot of room for growth.”

  1. Leadership needs to get their hands dirty — This came across in so many comments. The idea that leaders have no idea what it is like to work on the front line. That it is easy to tell people what to do when you don’t understand how too often what is being asked is impossible or unreasonable.

    “Tell regional and area management to lighten up! Spend time working with us instead of walking around with your white gloves on and doling out criticism.”

    “Be out in the community more and greet every care manager by name.”

    “Don’t take advantage of employees. Do some work for once, leave the desk and help your team get the work done.”

    “Get out into your communities and take a closer look at the working conditions your employees face every day. You have it nice at the home office with free water, drinks, snacks, beautiful work stations. At your communities, employees are suffering with poor office equipment and dreary workspace. Your employees live in fear of losing their job so they don’t complain.”

  1. More leadership training — This is an area I am passionate about and so maybe not rational. My sense is that most senior living companies wish they could do more leadership training but mostly think what they are doing is adequate. In my view, this is a mostly delusional belief. Spending more resources on leadership training would have way more monetary value to the company than any extra marketing effort.

    “Very intense sales culture, but with very little training, made worse by unavailable regional directors of operations, a lack of transparency, and an outdated management structure.”

    “Leadership training for everyone, not just the “best” managers. Training just the top-performing leaders seems opposite to what should be happening. The under-performing leaders should have more access to training in order to do their jobs better.”

    “Unfortunately when there is an immature, inexperienced Executive Director in place, decisions are made that are not in the best interest of the staff, or the community.”

    “Make sure to train new employees to know the importance of every department.” 

    “The company can provide better initial training for the new employees instead of letting the employees find out what is what and how is how by self-discovery and the rules of thumb by the coworkers.”

“Listen to the team, lack of feedback, leadership turnover, favoritism, understaffing, inconsistent following of rules . . .” These are the signs and symptoms that our managers are struggling. These are the people who need our immediate attention and support. Many companies focus on grooming the Executive Directors (EDs) or Administrators, and assume that these leaders will then groom their department heads. However, not everyone is a skilled teacher and sadly many EDs/Administrators are so overwhelmed with their work that they don’t feel they have the time to grow their department heads. One of the best things companies can do is to hire an organizational development expert with strong leadership skills. This person can assess the situation, then work with leaders to develop strategies for improving workplace dynamics; and ultimately help leaders, at all levels, to be more successful.  

Veronica Barber, Healthcare Executive | Chief People Officer | Chief Leadership Officer | Chief Operating Officer