Building Bench Strength: Brookdale, Brightview, Cedarhurst Confront Executive Director Turnover, Burnout

The senior living industry is grappling with a historic staffing crisis in 2022 — and turnover among executive directors is exacerbating the issue.

As leaders of their communities, executive directors are responsible for smooth operations in everything from infection control and sales and marketing to resident satisfaction and employee recruitment and retention. An executive director position left vacant for too long can throw a community off of its rhythm, and even have a ripple effect on other vacant roles.

Given the important role executive directors play, senior living operators are investing considerable time and energy in keeping them in the fold. But doing so is a challenge in 2022 — one that is made harder by the fact that executive directors are feeling all the pressures of the pandemic firsthand.

The problem is such that many executive directors are burned out from the long hours and constant stressors, and some are now leaving the senior living industry altogether.

Despite those pressures, operators have found ways to thread the needle in the meantime. They include Brightview Senior Living, which uses a “floating executive director” model to backfill leadership where needed; Brookdale Senior Living (NYSE: BKD), which has worked to tamp down on turnover among executive directors specifically; and Cedarhurst, which is hiring a significant number of people from outside the industry and training them on how to lead senior living communities.

‘Some people fear speaking up’

It’s no secret that burnout is common among frontline caregivers, and that many senior living companies face high levels of staffing shortfalls in 2022.

In a recent National Investment Center for Seniors Housing & Care (NIC) survey of 69 senior housing and care companies, a little more than one-quarter of respondents said their staffing shortages are “severe” (27%), while another two-thirds (67%) said it was “moderate.”

Executive directors are often the ones making up for these shortfalls, either by finding replacements via agency staffing, setting overtime — or sometimes, stepping in to do the work themselves.

This has caused some in the industry to head for the exits. One outgoing executive director at a large national operator told Senior Housing News the constant grind of little corporate guidance, short-staffing and long hours played into her decision to leave the industry altogether. While in her role, she said she experienced a range of compounding issues, from dwindling staff to the burden of taking on more wide-ranging responsibilities. She also stressed her community took on higher acuity patients even while short-staffed in an effort to build back pre-pandemic occupancy.

“The expectations over the phone from corporate was ‘Well, you just have to figure it out.’ — okay, but I have worked all night because we didn’t have any staff overnight,” the executive director told Senior Housing News. said. “Some people fear speaking up to say they can’t work five over-nights in a row and be on all the Zoom calls during the day because they need the job.”

Executive director turnover is not a new industry issue. For instance, Chicago-based Ventas (NYSE: VTR) in 2015 estimated turnover at the position was approximately 50%.

While executive director turnover isn’t as dire as direct-care staffing, hiring certified nursing assistants (CNA), operators are feeling the strain of a shallower talent pool, Ziegler Senior Living Research Director Lisa McCracken told Senior Housing News.

“While I am sure that the ED role has increased in turnover the past two years, I do not see that it is anything close to the level of the direct-care staff,” McCracken said. “The ability to find qualified EDs and administrators was a challenge pre-Covid as well.”

Executive director roles are also more challenging to hire for, given the time it takes to train and certify workers for the job, according to Eric Lesnock, managing director at Specialty Consultants Inc., an executive talent recruiting firm that works with senior living operators. Fatigue among existing leaders is common, he added.

“One of the biggest issues at the site level for executive directors has been burnout from the last two years dealing with the pandemic,” Lesnock told SHN.

Operators echoed similar concerns regarding challenges in hiring executive directors, citing the grind of the last two years during the pandemic and the wealth of responsibilities placed on frontline leaders.

The senior living industry’s frontline leaders are feeling burnout in similar ways as other health care providers, according to Brookdale Executive Vice President of Human Resources Jaclyn Pritchett.

“Pretty much every company is going through that right now,” Pritchett said.

The pandemic has brought on a lot of new challenges and stressors for executive directors, according to Andrea Griesmar, a senior vice president at Brightview Senior Living.

“It’s a difficult job as it is, and it’s a lot of responsibility,” Griesmer told SHN. “We’ve chosen, even post-pandemic, to maintain and continue our emphasis on growing talent from within.”

Recruiting and retaining EDs

Faced with those challenges, some providers have found success in attracting talent from other industries. For example, Houston-Texas based Lifewell Senior Living pulled frontline leaders from the hospitality industry, according to President and COO Kimberly Erickson.

“Through the course of the pandemic, we had three sales directors and three executive directors join us from hospitality,” Erickson said. “Two communities have a new sales director and ED that had actually worked together at one point in hospitality.”

Lifewell has eight communities in New Mexico and Texas.

Other companies are taking steps to improve recruitment and retention efforts of leadership. They include new strategies for ensuring work-life balance among frontline leadership at communities and finding ways to grow internal talent pipelines to avoid external staffing headwinds.

Brookdale, the nation’s largest senior living operator with over 650 communities, has been focused on reducing turnover and boosting retention ever since its 2014 merger and integration with Emeritus, But the pandemic has completely disrupted the staffing and labor landscape across nearly all industries.

As of the third quarter of 2021, Brookdale’s retention rate for community executive directors sat around 70%, with two-thirds having worked in their roles for more than two years.

“If a company’s not learning to adapt with the changing needs of their employee base, that’s a recipe for stalled growth,” Pritchett said.

Maintaining flexibility within employee scheduling, managing part-time workers and using technology to leverage operational efficiencies could maintain retention among senior living communities, Pritchett said. The company implemented a more robust employee orientation program to help newcomers feel welcome. 

Baltimore, Maryland-based Brightview tasks an experienced executive director with serving as a “floating executive director” who travels to s the company’s 48 communities when staffing needs arise, according to Griesmar.

Griesmar said the role shifted from providing “email-free vacations” before the pandemic, to filling in for vacant leadership roles at communities in the Northeast as the pandemic progressed. Doing so has helped executive directors rest and recharge without stressing out about what will happen when they are gone.

“We’ve got this seasoned, experienced person that everybody knows and trusts,” Griesmar said. “They’re willing to step away and know that their community is going to be just fine when they get back,”

Senior living operators must consider being more aggressive in providing short-and-long-term retention bonuses to incentivize people to stay on board, said Lesnock. He referenced a relationship with a senior living developer that had recently implemented a 10-year incentive bonus of $125,000 for staff that stayed on with the company long-term.

“That’s huge,” Lesnock said. “ It’s about finding unique ways to reward people financially.”

But getting to a decade of service is a seemingly insurmountable task when you have staff who are not sticking around past their first year, Cedarhurst CEO Joshua Jennings told Senior Housing News.

“If we can get people to one-year, statistically, they will stay with us a long, long time,” Jennings said. “When we look at the people who have been with us a year, those are the folks that we want. Those are the folks we want to set the culture.”

Building bench strength

With the labor pool shrinking and workers leaving the industry, some operators are looking internally for leaders.

But building talent pipelines remains a challenge for operators compared to other similar industries — such as multi-family development, which relies on hiring talent from other industries including hospitality and retail, Lesnock said.

“The industry, quite frankly, has been horrible at building bench strength,” Lesnock added.

Brightview offers training to prospective community leaders through an associate executive director program. Faced with pandemic staffing challenges, Brightvie has beefed it up over the last two years, Griesmar said.

The operator also has a director of talent development who specifically seeks out potential company leaders.

At Cedarhurst, Jennings said the company also relies on an executive director training program, estimating that around a third of the company’s executive directors were initially hired in other capacities before being put through the company’s “farm system.”

“They were hired to be in other cabinet-level positions in a community with the idea of us saying, ‘Hey we see something in you, that’s great. We hope you see something in us.’” he said. “How do we get people successful, and how do we grow? We are really interested in growth.”