Who Leads the Leader?
Examining the Critical Role of Executive Director Retention and Support in Senior Living Operations
We talk constantly about turnover in senior living. We measure caregiver turnover, nursing turnover, agency usage, open positions, overtime, call-offs, and retention. We build recruitment strategies, employee-engagement initiatives, and action plans around those numbers, and we should. But there is another turnover problem sitting at the top of the building that we do not talk about nearly enough: the Executive Director.
The Executive Director is often the person expected to answer for nearly everything happening inside a senior living community. Occupancy, labor, financial performance, staffing, resident satisfaction, regulatory compliance, family concerns, dining, maintenance, clinical outcomes, sales, employee retention, culture, survey readiness, and emergency response can all eventually make their way back to one office. Depending on the organization, that responsibility does not necessarily end when the Executive Director leaves the building for the day.
I know the weight of that chair because I sit in it. I also know there are many talented people sitting in that same chair across this industry. What I have begun to question is whether senior living has become so focused on what Executive Directors are expected to produce that we have not spent enough time examining what we provide them in order to produce it.
There is evidence that this is more than an uncomfortable leadership conversation. Senior living operators have publicly described Executive Directors as particularly difficult to recruit and retain because of the complexity of the position, long hours, burnout, and the relatively limited pool of qualified candidates. At the same time, several operators have demonstrated that ED turnover can improve when organizations become intentional about selection, mentoring, compensation, career development, and support. Merrill Gardens, for example, reported reducing its Executive Director turnover from 23% to 13%, while 12 Oaks reported a substantially lower turnover rate after intentionally increasing its support of the role. These are individual company experiences, not national benchmarks, but they are worth paying attention to.
The research is even more concerning when we look at skilled nursing, where administrator turnover is better documented. A national study of nursing homes found administrator turnover rates above 50% in both 2020 and 2021. More important than the number itself was what happened around it. One administrator departure was associated with approximately 14% lower odds of achieving a higher quality star rating, while multiple departures were associated with roughly 25% lower odds. Administrator turnover was also associated with higher RN turnover.
Assisted living Executive Directors and licensed nursing home administrators are not interchangeable positions, and I do not believe in mixing statistics simply because they support a good headline. The regulatory environments are different. Still, the findings should make the broader senior living industry think seriously about leadership continuity. When the person responsible for developing department heads, maintaining family relationships, understanding the history of the building, responding to regulators, interpreting organizational expectations, and keeping operations moving walks out the door, something leaves with them that cannot simply be transferred through passwords and a handoff document. Institutional knowledge, relationships, context, and sometimes trust leave too.
The next leader does not walk into an empty building with a clean slate. They inherit whatever was there before them. That may include staffing vacancies, poor morale, compliance concerns, deferred maintenance, weak census, broken processes, dissatisfied families, financial pressures, unresolved employee issues, or leadership instability that existed long before their first day. Yet within a relatively short period, the new Executive Director may be measured on turnover, occupancy, labor, expenses, resident satisfaction, regulatory performance, and profitability as though all of those measures began when they accepted the position.
That is where I think we need to become more realistic about what stabilization actually looks like. Accountability is necessary, and I believe strongly in it. But accountability has to recognize starting conditions. If we expect a leader to repair a struggling operation while simultaneously hitting the same performance measures as a stable community, then we should at least be honest about what we are asking them to accomplish and the resources we are giving them to do it.
Training is another part of this conversation that deserves scrutiny. The expectations placed on an Executive Director are incredibly broad. We want someone who understands business operations and people, who can review a financial statement and recognize a resident-care concern, who can discuss occupancy in one meeting and regulatory risk in the next. We expect knowledge of human resources, sales, customer service, staffing, quality, crisis management, compliance, leadership, and often enough clinical understanding to know when something requires immediate attention.
Where exactly are we teaching all of that?
Assisted living administrator qualifications are not standardized nationally. Research examining administrator requirements across states found substantial variation in education, experience, training, competency testing, and continuing-education expectations, with some states having very limited qualification requirements. Industry research has raised a similar concern from the organizational side. An Argentum workforce survey found that 45.7% of respondents considered leadership development an important organizational practice, while another 30% said their organizations were investing in leadership development, but not at the level they should.
Those findings should give us pause because orientation and leadership development are not the same thing. We would never expect someone administering medication to simply figure it out because they are intelligent. We would not place an employee in front of complicated equipment without teaching them how to use it. Yet leadership onboarding can sometimes look dangerously close to receiving system access, reviewing policies, meeting department heads, attending corporate orientation, and then being expected to run the building.
That is not leadership development. That is access.
Some companies are beginning to approach this differently. Sonida Senior Living, for example, has developed a more structured first-90-day onboarding process for Executive Directors that includes sequenced learning, mentor support, in-person training, and an Executive Director training conference. Other operators are building leadership pipelines, peer mentoring, and development programs intended to prepare employees for larger roles before a vacancy forces the organization to begin searching. Perhaps the question is no longer whether intentional leadership development is valuable. The question is why it is not standard.
Then there is the education conversation. What degree makes the best Executive Director? I am not convinced there is one.
I value education. I have invested significantly in my own and continue to do so. Education can expand the way we think, strengthen our understanding of business and healthcare, improve critical thinking, and expose us to concepts we might not encounter through experience alone. I will always encourage people who want to further their education to do it.
But education is only part of what makes an effective leader.
A degree cannot manufacture common sense. It cannot automatically create empathy. It cannot guarantee good judgment or teach someone how to read a room. It cannot make a person recognize that an employee who appears frustrated may actually be overwhelmed or teach someone how to calm a frightened family member when there is no textbook answer available. A degree does not automatically teach humility, self-awareness, courage, or how to make a decision when every available option comes with consequences.
Those abilities come from some combination of education, experience, emotional intelligence, human compatibility, mentorship, exposure, mistakes, and lessons learned the hard way. Senior living needs leaders who understand the business, but it also needs leaders who understand people. The most credentialed person in the applicant pool is not automatically the person best equipped to lead a particular community.
That should change how we select Executive Directors. Instead of asking only whether a candidate possesses a certain degree or has held a certain title, perhaps we should be asking whether that individual possesses the combination of knowledge, experience, judgment, resilience, people skills, and operational understanding required for the community they are being asked to lead.
We should also be paying closer attention to who gets developed for these opportunities. The broader medical and health services management workforce is predominantly female; Bureau of Labor Statistics data for 2024 show women representing about 74% of that occupation.
Yet when we try to drill specifically into assisted living Executive Directors, and particularly Black women and other women of color, the national data become much harder to find and compare.
I think the absence of clear data is worth talking about. If the industry wants leadership pipelines that reflect the workforce and the residents being served, then we should know who is actually progressing through those pipelines. Who moves from caregiver to medication technician to supervisor? Who moves from nursing or wellness leadership into operations? Who moves from business office, sales, dining, or life enrichment into executive leadership? Who is identified early as having potential? Who receives mentoring and sponsorship? And who becomes extremely good at doing the work without ever being developed to lead it?
Those are workforce-development questions, not simply diversity questions.
There is another issue that may be even more uncomfortable: authority. If an Executive Director is accountable for employee turnover, how much influence does that person have over compensation and staffing models? If the ED is responsible for the physical condition of the building, how much authority exists over capital spending? If occupancy is a major performance measure, what sales and marketing resources are available? If resident outcomes fall under the ED's accountability, is there adequate clinical support? If an inherited community requires significant operational repair, what timeline has ownership established for stabilization?
Executive Directors should be accountable for their decisions. That comes with leadership. But there is a meaningful difference between accountability and responsibility for outcomes that someone does not have sufficient authority or resources to influence.
When accountability consistently exceeds authority, it eventually begins to look a lot like blame.
That may also help explain why some strong Executive Directors leave. Certainly, some leaders leave because they are not performing or because they discover that the role is not the right fit. Senior living is not for everyone, and the position should not be romanticized. But we should be careful about assuming every departing ED failed.
Sometimes capable leaders leave because capable leaders have options. Sometimes they leave because the expectations and available resources never matched. Sometimes they become exhausted from being available to everyone else. Sometimes every problem eventually arrives at their desk while many of the solutions still require approval from somewhere above it. And sometimes another organization simply offers an environment where they believe they can lead more effectively.
That is why the experience of operators improving ED retention is important. Senior Housing News has reported companies emphasizing mentoring, compensation, career development, stronger communication, thoughtful hiring, and greater support around the Executive Director role. Those organizations are not removing accountability. They are recognizing that support and accountability can exist together.
This conversation should not become an argument that Executive Directors have difficult jobs and therefore should be excused from results. That would be far too simple. The better question is whether senior living's investment in selecting, onboarding, developing, resourcing, and retaining Executive Directors actually matches the level of responsibility placed on the position.
The industry is facing growing resident complexity, workforce pressures, changing expectations, and continued competition for capable healthcare leaders. At the same time, organizations are beginning to place greater emphasis on leadership pipelines, mentoring, and succession planning rather than waiting until an Executive Director leaves to begin thinking about who could possibly replace them. That is movement in the right direction, but there is still more work to do.
We have spent years asking whether we can find enough people willing to work in senior living. Now we also need to ask whether we are developing enough people prepared to lead it. And once we find good leaders, we should be equally interested in understanding what makes them stay.
Compensation belongs in that conversation, but it cannot be the entire conversation.
So do onboarding, continuing education, mentorship, corporate and regional support, realistic workloads, decision-making authority, succession planning, leadership development, well-being, and reasonable expectations about what can actually be repaired in 30, 60, or 90 days.
Executive Director turnover is not simply an HR inconvenience. Leadership instability can affect employees, culture, operations, and continuity of care. Evidence from skilled nursing suggests it can be associated with both staff turnover and quality performance. Senior living should take that seriously.
Perhaps we have spent too much time asking, “Who can we hire to fill the Executive Director position?” when the more important questions are: Who are we preparing to sit in that chair? What are we giving them once they get there? What authority are we giving them to accomplish what we are holding them accountable for? And what are we doing that makes a good Executive Director want to stay?
Because if one person is expected to carry the accountability for an entire community, somebody should be equally accountable for making sure that leader is equipped to carry it.
