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Leadership engagement to promote employee retention and career paths within the senior assisted living industry

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Leadership engagement to promote employee retention and career paths within the senior assisted living industry

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Content Running head: LEADERSHIP ENGAGEMENT FOR SENIOR ASSISTED LIVING 1

Leadership Engagement to Promote Employee Retention and Career Paths within the Senior
Assisted Living Industry
by
Mia Adler Ozair

A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

December 2019

Copyright 2019 Mia Adler Ozair

LEADERSHIP AND SENIOR ASSISTED LIVING 2

Dedication
To the millions of loving, dedicated assisted living professionals who work tirelessly to
provide seniors with exceptional quality of care to age gracefully, comfortably, and with the
dignity that God intended.
To the senior leadership within assisted living across the United States, may you be
blessed with the strength, courage, and wisdom to succeed in this monumental responsibility.
You are the guiding light for how to care for our nation’s senior citizens, and for setting the
course for the future of senior assisted living within our nation.
LEADERSHIP AND SENIOR ASSISTED LIVING 3

Acknowledgements
Achieving doctoral status, especially from a prestigious university such as USC, has been
a dream and aspiration since the age of 16. There is no way I would have been successful at this
massive undertaking without the love, support, and collaboration of so many people.
To my guardian angel, my Opa, I know you are with me every step of the way
whispering words of encouragement in my ear and pushing me forward in those moments I want
to quit. I miss and love you so much and I know you are smiling from above, proud of me and
waiting to see what we will work on next.
To my parents, thank you for instilling in me the deep understanding and value that
education is the key to freedom, to achievement, to fulfillment, and to “taking the road less
traveled” as Robert Frost would say. I am deeply thankful and love you both so much.
To the esteemed faculty and staff at University of Southern California’s Rossier School
of Education, I am a profoundly changed person and professional as a result of all each of you
has done to challenge, enlighten, and sharpen my way of thinking as well as my ability to deeply
reflect and analyze the world around me. To my dissertation committee, Dr. Wayne Combs, Dr.
Courtney Lynn Malloy, and especially my dissertation chair Dr. Kim Hirabayashi, thank you for
whole-heartedly supporting the subject of research I desired to focus on and for guiding me
through this arduous process. I would also like to thank my long-time friend and colleague Dr.
Laila Hasan who has been a source of inspiration and support for well over a decade.
To Brent Weil, Vice President Workforce Development at Argentum, the premier
association for senior living leadership, this dissertation literally could not have been done
without you. Your generosity with your time, resources, and overall encouragement is what
enabled me to take a subject that was essentially foreign to me and to hopefully give meaning
LEADERSHIP AND SENIOR ASSISTED LIVING 4

and insight into a very complex and industry-challenging issue. If this work helps senior living
leadership even slightly, then it will be in full credit to you and your willingness to support the
research.
To the senior living executives who took precious time out of their busy schedules to
participate in this study, your passion for senior care is palpable. It was an inspiration to hear
your stories, listen to your experiences and successes, and learn through your honest and
forthright challenges. Your contributions to this study are deeply appreciated.
To Cohort 7, and especially to the members of “Mia’s Madhouse,” I could not have made
it through without your constant sense of comradery and support. What an incredibly talented,
bright, and accomplished group of amazing humans! I feel so lucky to know you and hope we
stay connected for years to come.
Most important, I would like to thank my family. Claudia, thank you for working for our
family with dedication and love. Your willingness to take on extra hours and change your
schedule every semester is what allowed me to do what I needed to in order to achieve this
dream. To my five beautiful children, I know you made sacrifices for me to be able to graduate
from this program. I know you missed me at bedtime, you had to be quiet in the house while I
was in class, I was not always available for you when you needed to talk, and you had to give up
time with me on weekends so that I could study and do homework. Iyla, thank you for helping
with the kids whenever I needed you to, I know it was not always easy to do that and balance
your own school work. You are all truly my Fabulous Five and I’m so lucky to be your mom.
To my husband, Shaul, the words you’ve been waiting to hear . . . “Honey, I finally
graduated.” You can call me Dr. Wife now. Love you, on to the next “project” LOL.

LEADERSHIP AND SENIOR ASSISTED LIVING 5

Abstract
This study utilized a modified gap analysis to evaluate the current state of leadership
within senior assisted living as it relates to employee retention and career paths. Specifically, the
purpose of this study was to gather information on current and best practices of senior leadership
to better understand and address the employee retention issue that plagues the senior assisted
living industry. The study used qualitative data collected from interviews of top industry
leadership to identify aspects of knowledge, motivation, and organizational influences on the
problem of practice. Data indicated that concerns about employee retention exist across the
United States and among a variety of organization sizes. Data showed that senior leadership
within the assisted living industry are well aware of the problem and are deeply desirous of a
collaborative approach to address employee retention for their own organizations and the entire
industry. Leaders often feel overwhelmed and helpless when it comes to employee retention and
openly seek new and innovative ideas to approach retention and establish long-term career paths
for employees. Recommendations regarding the primary influences of knowledge, motivation,
and organizational culture are included to assist in addressing the national employee retention
challenges within senior assisted living.
Keywords: senior assisted living, employee retention, attrition, leadership, baby boomers,
quality of care, employee development, retention strategy, senior care

LEADERSHIP AND SENIOR ASSISTED LIVING 6

Table of Contents

Dedication 2

Acknowledgements 3

Abstract 5

List of Tables 8

List of Figures 9

Introduction to Problem of Practice 10

Field Based Context 10

Importance of Addressing the Problem 11

Global Performance Goal 12

Stakeholder Group of Focus and Stakeholder Goal 13

Purpose of the Project and Questions 14

Methodological Approach and Rationale 14

Review of the Literature 15
Status of the Workforce in Assisted Living for Seniors 15
Employee Retention and Turnover in the Assisted Living for Seniors Workforce 16
Leadership Influence and Organizational Impact on Retention and Turnover 18
Employee and Supervisor Training as a Means to Improve Retention and Industry Career
Paths 19

Knowledge, Motivation, and Organizational Influences 20
Knowledge and Skills 20
Motivation Influences 23
Organizational Influences 27

Interactive Conceptual Framework 30

Data Collection 32
Interviews 32

Data Analysis 34

Findings 34
LEADERSHIP AND SENIOR ASSISTED LIVING 7

Interviewed Stakeholders 34

Solutions and Recommendations 55
Knowledge 55
Motivation 59
Organizational Influences 63

Limitations and Delimitations 64

Recommendations for Further Research 64

Conclusion 65

References 66

Appendices 73
Appendix A Participating Stakeholders with Sampling Criteria for Interview 73
Appendix B Qualitative Protocols and Interview Questions 74
Appendix C Credibility and Trustworthiness 78
Appendix D Ethics 79
Appendix E Integrated Implementation and Evaluation Plan 81
Appendix F Training Survey Immediately Following Learning Event 93
Appendix G Delayed Training Survey Form 95

LEADERSHIP AND SENIOR ASSISTED LIVING 8

List of Tables
Table 1. Knowledge Influences 22
Table 2. Motivational Influences 27
Table 3. Assumed Organizational Influences and Organizational Influence Assessments 28
Table 4. Senior Living Industry Leadership for Qualitative Interviews 35
Table 5. Supportive Statements for Metacognitive Reflection on Employee Retention 36
Table 6. Most Commonly Known Strategies for Employee Retention 39
Table 7. Lesser Known Innovative Employee Retention Strategies 41
Table 8. Participant Comments Demonstrating Mastery Goal Orientation 50
Table 9. Participant Comments Demonstrating Performance Goal Orientation 51
Table 10. Organizational Cultural Model as Relates to Employee Retention 52
Table 11. Organizational Cultural Settings as Relates to Employee Retention 54
Table 12. Summary of Knowledge Influences and Recommendations 55
Table 13. Summary of Motivation Influences and Recommendations 60
Table E1. Outcomes, Metrics, and Methods for External and Internal Outcomes 82
Table E2. Critical Behaviors, Metrics, Methods, and Timing for Evaluation 84
Table E3. Required Drivers to Support Critical Behaviors 85
Table E4. Evaluation of the Components of Learning for the Program 88
Table E5. Components to Measure Reactions to the Program 89
Table E6. Sample Data Analysis and Reporting, Quantitative 90

LEADERSHIP AND SENIOR ASSISTED LIVING 9

List of Figures
Figure 1. Graphic representation of conceptual framework 31

LEADERSHIP AND SENIOR ASSISTED LIVING 10

Introduction to the Problem of Practice
The immediate post-World War II era in the United States of America saw a remarkable
and unprecedented increase in population. Prior to 1946, the birth rate in the United States
averaged between 2.3 to 2.8 million births per year (U.S. Census Bureau, 2017). As soldiers
returned home and began building families in the years between 1946 to 1964, known as the
Baby Boomer generation, the United States saw a leap in births-per-year to an average of 3.47
million (Rosenberg, 2018). With an estimated 75.37 million births in those 18 years, the Baby
Boomer generation influenced and drove almost every aspect of the U.S. economy, from
products and homes to automobiles and services. In 2011, Baby Boomers began turning 65
years of age, and by 2029, the entire generation will cross that age threshold to create one of the
largest demands for services geared towards senior citizens (Colby & Ortman, 2014). As the
Baby Boomer generation continues to age, the demands for senior assisted living services will
grow exponentially, putting an additional strain on an industry already facing significant
employee retention and long-term career issues. Across all aspects of senior living, including
food service, janitorial, direct care, and nursing, the projected shortfall of quantity and quality of
workers will mean a reduction in the level of service being provided to seniors-in-need on a daily
basis (Argentum, 2018c). Without investment in and value of proper employee retention
programs, the senior assisted living community stands to suffer a great loss. This would
eventually translate into one of our largest generations in history being left without proper
support in their elder years (“Graduate training and employee retention”, 2017).
Field Based Context
The senior assisted living industry is generally comprised of organizations in private and
non-profit sectors that offer a large range of support for residents. Care may range from
LEADERSHIP AND SENIOR ASSISTED LIVING 11

assistance with basic daily living needs, called “non-medical care”, to extensive nursing and
medical support. For the purposes of this study, the focus was on private sector organizations
offering assisted living care, medical and non-medical, in the format of a residential facility.
Senior assisted living companies within private industry face a daunting task in
identifying, hiring, and retaining qualified leadership (Argentum, 2018a). As the demands of the
Baby Boomer generation increases, one of the greatest threats this industry faces is a substantial
lack of qualified employees who make the senior assisted living industry their career path of
choice. Employee retention rates are low, and there are many unknowns regarding industry
retention programs to encourage a leadership track (M. McNevin, personal communication,
November 16, 2018). Not only do these organizations need to create and implement a vision and
mission for high quality services, but they must do so while remaining competitive and
profitable. Without talented, committed leadership who can oversee all aspects of running a
service-oriented company, the senior assisted living industry will experience high employee
turnover, low employee productivity, a lack of experienced, dedicated leadership, and eventually
suffer on the bottom line of profitability and service excellence (N. Wilson, personal
communication, November 16, 2018).
Importance of Addressing the Problem
The United States is experiencing a substantial increase in demand for senior assisted
living services. Argentum, one of the nation’s leading professional associations for assisted
living executives, found that the assisted living industry is riddled with rapid employee turnover
rates and faces a 1.2 million employee shortfall through the year 2025 (B. Weil, personal
communication, November 28, 2018). Seniors require appropriate living space to address the
physical needs of aging, as well as human resources who can assist them with basic daily activity
LEADERSHIP AND SENIOR ASSISTED LIVING 12

such as food preparation, medicine dispensary, mobility in and out of the home, bathing, and
other important aspects of human engagement and socialization. This problem cannot be
understated. Assisted living leadership must find a way to retain employees to ensure proper
care for seniors in assisted living.
In addition to the direct and profound impact lack of quality care will have on seniors,
research shows that lack of services for older people translates to their children missing work and
threatens the welfare of the family as a whole (Gautun & Bratt, 2016). The stress on the children
of seniors impacts not only the health of the elder, but also the health and well-being of the next
generation of adults who are trying to live their own lives while tending to the increasing
demands of aging and potentially ailing parents (Gautun & Bratt, 2016). Additionally, when
seniors cannot gain access to the proper care, the financial burden of seeking adequate care
predominantly falls to the children of the seniors, adding an enormous burden to families who
are working hard to raise their own children at the same time (Gleckman, 2017).
Global Performance Goal
A primary global goal, as it relates to this study, is to increase the number and quality of
employees and leaders who choose a long-term career path in the senior assisted living industry.
This goal emerged from detailed interviews and conversations with senior assisted living
industry professionals. While researching the industry for an economics course, it became clear
that there is larger problem of practice warranting a deeper look through dissertation research.
The subject of employee retention and career paths to build an assisted living workforce is a
global goal of interest to the industry. Conversations with the professional association Argentum
led to their agreement in assisting this research and outreach to industry stakeholders.

LEADERSHIP AND SENIOR ASSISTED LIVING 13

Stakeholder Group of Focus and Stakeholder Goal
The stakeholder group of focus for this study was current leadership within the senior
assisted living private industry community. Leadership for this study is defined as a person
holding a position within the top tiers of an organization’s leadership hierarchy at the corporate
level (e.g., CEO, Executive Leadership, Regional VP, etc.) or community service provider levels
(e.g., Executive Director, Administrator Skilled Nursing, Department Manager, Supervisor, etc.).
The stakeholder goal is that senior citizen assisted living leadership will implement retention
strategies to support long-term career growth within the senior assisted living industry by 2020.
This goal aims to address both the employee retention problem currently faced by the industry,
as well as the clear lack of leadership career paths within the industry.
This key group of stakeholders, specifically those holding leadership positions within the
industry at various levels, have frontline access to the problem of practice and how this problem
impacts the daily operations of senior assisted living companies and daily lives of seniors. These
leaders were able to share their personal experiences and professional expertise to gain a better
understanding of why the industry faces an employee retention problem, how retention programs
may support a shift towards greater retention, and how to direct employees to leadership career
paths within the senior assisted living industry.
The stakeholder group of industry leaders was selected as the focus of this study because
research supports the direct and important impact leaders have on retention and organizations.
Leaders influence organizational culture and help mold the employee experience (Northouse,
2016). Effective leaders are seen as assets to the organization and impact everything from
customer satisfaction to the financial bottom line (Northouse, 2016). In addition, leaders are
LEADERSHIP AND SENIOR ASSISTED LIVING 14

influential in any organizational change efforts which, in the case of the senior living industry
and employee retention, is critical to the mission of improving retention (Lewis, 2011).
Purpose of the Project and Questions
The purpose of this project was to understand the connection between employee retention
programs and long-term career paths as they relate to building a workforce within the assisted
living industry. Using the Clark and Estes’ (2008) gap analysis model, the study explored: (a)
what effective leadership engagement meant to the retention of employees; (b) how it was or was
not utilized within the organizational structure and culture; and (c) what current leadership feel
were the essential ingredients to retaining and building a dedicated workforce. The project
examined three primary areas of influence including knowledge, motivation, and organizational
context of leadership.
The following questions guided this study:
1. What is the stakeholder knowledge and motivation within assisted living leadership as it
relates to retention programs that support long-term career development within the
assisted living industry?
2. What is the interaction between organizational culture and context and stakeholder
knowledge and motivation?
3. What are the recommendations for organizational practice in the areas of knowledge,
motivation, and organizational resources?
Methodological Approach and Rationale
The methodological approach used in this study was a qualitative design that sought to
understand, through interviewing, the current engagement levels of leadership regarding
employee retention, as well as identify perceived needs for improving these practices to promote
LEADERSHIP AND SENIOR ASSISTED LIVING 15

employee retention and career path selection within the senior assisted living industry. The
research framework set forth by Clark and Estes (2008) provides a detailed, strategic lens
through which to both identify and potentially resolve important gaps related to stakeholder
interest and organizational performance. This framework examines the specifics of knowledge,
motivation, and organizational influences to determine if organizational goals and performance
measures are on target and accurately serving stakeholder needs. The knowledge aspect of this
framework addresses the information and skills necessary for leadership engagement and
performance with employee retention efforts (Clark & Estes, 2008). The motivation element of
this framework addresses employee self-efficacy and the three primary facets that motivate
performance (active choice, persistence, and mental effort) (Clark & Estes, 2008). The
organizational elements of this framework address organizational culture, values, and the
alignment of the organization’s environment with employee behaviors (Clark & Estes, 2008).
Ideally, to address any performance gaps and provide suggestions to stakeholders, the
knowledge, motivation, and organizational elements are examined in detail to create an overall
analysis of current circumstance as compared to desired outcomes. What follows is the detailed
breakdown of each of these three influences as they relate to specific stakeholder needs and
employee/organizational performance.
Review of the Literature
Status of the Workforce in Assisted Living for Seniors
Those working with direct access to seniors are often referred to as frontline workers or
direct care workers (Smith & Baughman, 2007). Within an assisted living facility setting, there
is a large range of position types including healthcare, personal care, management, support staff,
food service, and cleaning and maintenance (Argentum, 2018b). Eighty percent of frontline
LEADERSHIP AND SENIOR ASSISTED LIVING 16

workers are women, nearly one-fifth are healthcare workers, 20% of personal care workers were
born outside of the United States, and 71% of professionals are working full-time (Argentum,
2018b). It is estimated that approximately 300,000 in-facility workers must be recruited into the
industry immediately (Argentum, 2018b).
Frontline workers are considered the “eyes and ears” of the industry and face complex
work demands that are both physically and emotionally challenging (Stone, 2004). Although
several states are working to improve relevant policies and increase government support for
assisted living expenses, industry workers continue to face low wages, lack of access to health
care, and challenging work environments (Hernandez, 2007). These factors cause direct care
workers to frequently move from job to job within the industry, or choose to leave the industry
entirely (Smith & Baughman, 2007). Overall, a large majority of the workforce has some level
of formal education with at least a high school diploma, while 14% of workers are currently
furthering their education (Argentum, 2018c). A key factor in building an assisted living
workforce to meet the needs of millions of seniors will be to better organize community services
to make care more accessible and to make the work itself viewed as more culturally valuable
(Knickman & Snell, 2002).
Employee Retention and Turnover in the Assisted Living for Seniors Workforce
Inconsistency in quality of care, replacement costs, training time, and reduction in
productivity are the hallmarks of low retention and high turnover, with over 90% of senior
facilities reporting shortages (Argentum, 2018a). Research shows that turnover decreases by
approximately 20%, and family satisfaction improves by 30% when employees have completed
effective training for their positions within assisted living (Larsen, 2000). Those workers who
choose to stay within the industry typically do because of their patient-centered approach;
LEADERSHIP AND SENIOR ASSISTED LIVING 17

however, a national study revealed an average yearly rate of turnover in nursing homes of
upwards of 75% (Chou, 2012). Job dissatisfaction is reported as the key aspect of employee
turnover, with personal stressors and job-related stressors as the top reasons for dissatisfaction
(Ejaz, Noelker, Menne, & Bagaka’s, 2008). Personal stressors encompass both the physical and
emotional health changes that direct care workers experience as a result of the work, while job-
related stressors relate to supervisor and co-worker relationships, pay, work schedule, and work
environment (Chou, 2012; Ejaz et al., 2008).
Direct care worker turnover and retention are multifaceted, complex issues that must be
examined critically to address why people leave the industry or why people choose to stay
(Mittal, Rosen, & Leana, 2009). The National Bureau of Economic Research reports that
working conditions, pay, health care access, and job amenities all play crucial roles in
determining a worker’s commitment to his or her position (Maestas, Mullen, Powell, von
Wachter, & Wenger, 2018). In addition, workers consider advancement opportunities, workload,
and team spirit within the workplace to be determining factors when deciding to stay or leave the
assisted living workforce (Brannon, Barry, Kemper, Schreiner, & Vasey, 2007). Research has
demonstrated that frequent turnover of frontline workers can affect a senior’s mental and
physical functioning, as well as the status and well-being of the senior’s family as they attempt to
pick up the burden left by the departed worker (Stone, 2004). Satisfied employees are
significantly more likely to stay working within assisted living, and focusing on retention of
quality employees is both cost effective and advantageous to the quality of care received by
seniors (Chou, 2012).

LEADERSHIP AND SENIOR ASSISTED LIVING 18

Leadership Influence and Organizational Impact on Retention and Turnover
Research repeatedly highlights the influence and impact of leadership and organizational
culture on employees at all levels of an organization (Ashton, 2004). Leadership, and the power
it wields, can either grow and develop a workplace and its employees, or wreak havoc on every
facet of an organization and its culture (Northouse, 2016). At the core, leadership is an essential
element to learning within an organization, to creating a culture that allows achievement towards
some purpose, and an expectation of specific behaviors to manifest organizational goals (Schein
& Schein, 2017). The leadership and supervision within an organization directly influence an
employee’s intent to stay or leave; therefore, strong supervisor training programs to build skills
assist in retaining employees (Brannon et al., 2007). An organization’s structure directs workers’
attention to what is culturally important and fundamentally influences employee learning and
engagement (Ashton, 2004).
Within assisted living, the research is clear. The frontline worker/supervisor relationship,
as well as quality of training and support provided to employees, is directly tied to retention and
turnover rates (Brannon et al., 2007). Leadership must create an environment where employees
feel positive about their work and their workplace to build a pipeline of leadership from within,
leading to long-term commitment (Whitcomb, 2015). Research also highlights the obligation of
organizations to build cultures within which supervisors set clear expectations, require
accountability, and give on-going support and guidance to employees (Stone & Dawson, 2008).
The highest predictor of organizational commitment within assisted living is tied to the
organization’s culture of high morale, teamwork, and on-going education and support for
employees (Sikorska-Simmons, 2005). Opportunities for on-the-job learning and career
LEADERSHIP AND SENIOR ASSISTED LIVING 19

advancement, along with organizational justice regarding fair work schedules and pay, directly
contribute to lower employee turnover and greater retention within assisted living (Chou, 2012).
Employee and Supervisor Training to Improve Retention and Industry Career Paths
Effective training and development of employees foster a sense of connectedness,
motivation, engagement, and positive work environments that directly impact an employee’s
desire to remain with the organization (Fletcher, Alfes, & Robinson, 2018). Assisted living is a
complex, often difficult work environment that, without proper training and performance
feedback, can leave employees feeling under-appreciated, unskilled, and burned out (Falk-Huzar,
2017). Research states that the longer an employee stays with one company offering the proper
training and support, the greater that employee’s productivity is, the greater employee loyalty is,
and the more likely the employee is to develop a long-term career path in that company and/or
industry (Anis, Ijaz-Ur-Rehman, Nasir, & Safwan, 2011). Within assisted living, administrators
reported a sense of “building employees up” through effective training programs, leading to
reduced turnover and better care for seniors (White & Cadiz, 2013). When staff have a clear
understanding of the complexities of assisted living work and are trained and supported in their
positions, the results show greater job satisfaction and better outcomes for the seniors (Falk-
Huzar, 2017).
Extensive research has identified a conceptual model of employee retention tied to non-
financial (e.g., intrinsic and extrinsic work-related factors) and financial (e.g., pay and
promotion) factors that can be measured against conditions of any particular industry (Shakeel &
Butt, 2015). These factors are crucial in identifying why an employee would choose to stay or
leave, and whether the employee is influenced positively or negatively by company practices
(Shakeel & Butt, 2015). For direct care workers, there are reportedly few opportunities for in-
LEADERSHIP AND SENIOR ASSISTED LIVING 20

depth training and skill development, leaving employees feeling unsupported and under-valued
(Lopez, White, & Carder, 2014). In order to meet positive benchmarks to promote retention,
assisted living administrators need to provide enriching environments for employees that include
long-term training, mentoring, and compensation structures that demonstrate value for the direct
care worker (Lopez et al.,2014). Various innovations in the assisted living workplace are being
tested, including leadership career paths within entry-level training programs that include real-
life scenarios, and a better understanding each employee’s career goals to encourage
commitment to the assisted living industry (Stone, 2004).
Knowledge, Motivation, and Organizational Influences
Knowledge and Skills
Proper knowledge and the necessary accompanying skills to implement that knowledge
are crucial to the realization of stakeholder goal attainment (Clark & Estes, 2008). Knowledge
types are generally fall into four primary categories: (a) factual, (b) conceptual, (c) procedural,
and (d) metacognitive (Krathwohl, 2002). Factual knowledge is the basic element of a
knowledge base affiliated with a particular task or field. Conceptual knowledge draws
connections between knowledge elements enabling a larger, more rich understanding and
application of information. Procedural knowledge delves into the details of the “how” in
executing a skill or activity. Metacognitive knowledge deals with one’s awareness of one’s own
knowledge and ability (Krathwohl, 2002). Knowledge is the culmination of facts, concepts, and
processes that have been collected over time by an individual (Clark & Estes, 2008). When
working towards organizational or stakeholder goals, a clear understanding of and ability to
apply the various knowledge types can be of great benefit to both the individual and the
organization.
LEADERSHIP AND SENIOR ASSISTED LIVING 21

Human capital in the workplace captures the collective skills, knowledge, and
motivations of the group (Aguinis & Kraiger, 2009). The skill building required to develop that
human capital requires response strengthening, information acquisition, and knowledge
construction (Mayer, 2011). Knowledge and skill gaps, that information or talent which an
employee does not know or have, cause challenges in the workplace and require assessment,
evaluation, and eventually solution (Rueda, 2011). Knowledge cannot be acquired without the
necessary motivation to do so (Eccles, 2006); therefore, both knowledge and motivation are
crucial to the achievement of stakeholder goals. This section focuses on assumed knowledge
influences related to the organizational mission and stakeholder goal for leadership to
demonstrate the effective knowledge of strategies to promote employee retention.
Knowledge of active reflection. The first knowledge influence is that leadership need to
be able to reflect on employee retention strategies within their organization. This is considered a
metacognitive type influence. Metacognition is generally defined as thinking about thinking and
is a cornerstone concept of integrating new knowledge (Baker, 2006). Metacognition is such a
fundamental part of acquiring and applying new knowledge that it was added as a fourth and new
category to Bloom’s Taxonomy (Krathwohl, 2002). This concept of metacognitive knowledge
captures the framework of awareness of one’s own cognition and how understanding one’s own
knowledge base and thought processes influence a person’s ability to grow, change, and learn
from one’s own learning and experience (Krathwohl, 2002). The concept of metacognition
addresses when an individual knows when and why to apply appropriate learning processes
(Mayer, 2011).
Knowledge of effective retention strategy. The second knowledge influence is
leadership need to know specific strategies for employee retention within their organizations.
LEADERSHIP AND SENIOR ASSISTED LIVING 22

This is considered a conceptual knowledge influence which addresses theories, ideas, principles,
and models (Rueda, 2011). In this case, it is knowledge about how to retain employees.
Conceptual knowledge of employee retention strategy is essential to leadership and
organizational ability to test, pilot, and launch successful retention programs.
Knowledge of how to retain employees. The third knowledge influence is leadership
need to know how to effectively retain employees within their assisted living organization. This
is considered a procedural knowledge influence and calls upon leadership to have a certain level
of education in professional training techniques and strategies in the workplace. This also
requires a certain level of personal engagement in the work within the workplace. Success in
this knowledge type indicates behavioral, cognitive, and affective engagement, which promotes
learning and enjoyment in the workplace (Rueda, 2011). This type of procedural influence is
also directly connected to motivation.
To properly apply knowledge influence strategies, a person must be motivated enough to
exert the mental effort to do so (Mayer, 2011). Table 1 provides an overview of all knowledge
influences and how they were assessed.
Table 1
Knowledge Influences
Global Goal
Increase the retention rate of employees who choose a long-term career path in the senior
assisted living industry.
Knowledge Influence Knowledge Type Knowledge Influence
Assessment
Leadership need to be able to reflect
on employee retention strategies
within their organization.
Metacognitive Interview of leadership
Leadership need to know specific
strategies for retention of
Conceptual Interview of leadership
LEADERSHIP AND SENIOR ASSISTED LIVING 23

Motivation Influences

According to Mayer (2011), motivation has four components, each determining the
motivation of a particular person and how that motivation will propel a person toward goals.
The four components are: (a) personal, (b) activating, (c) energizing, and (d) directed (Mayer,
2011). Personal motivation indicates that motivation is an internal drive. Activating motivation
indicates that motivation acts as a catalyst towards action. Energizing motivation indicates it
provides persistence. Finally, directed motivation indicates it is with purpose towards a clear
goal or directive (Mayer, 2011). Each of these motivation types can inform each other, working
to create increased motivation overall (Mayer, 2011). Increased levels of intrinsic motivation
indicate higher levels of creativity, curiosity, and flexibility within the workplace, leading to
increased self-determination and sense of being respected by supervisors (Paramitha & Indarti,
2014). This helps to create a workplace environment that supports employee satisfaction and
growth.
In the context of stakeholder goal achievement and knowledge attainment towards those
goals, motivation must be reviewed as a driving force behind success (Eccles, 2006). The
workings of motivation are based upon five conceptions: (a) interest, (b) beliefs, (c) attributions,
(d) goals, and (e) social partnership (Mayer, 2011). These conceptions are not mutually
exclusive; however, when evaluating the role of motivation towards the achievement of
stakeholder goals, it is clear that certain conceptions play a more prominent role in outcomes
(Mayer, 2011). Motivation ties heavily to learning and the general desire to want to apply
employees within their
organization.
Leadership need to know how to
effectively retain employees within
their assisted living organization.
Procedural Interview of leadership
LEADERSHIP AND SENIOR ASSISTED LIVING 24

metacognitive skills to promote learning and growth (Mayer, 2011). Key elements of success in
application of motivation are related to questions that help identify what, if anything, will
motivate an individual (Pintrich, 2003). These questions include understanding what a person
wants, understanding how motivation and cognition lead to one another in a symbiotic
relationship, and exploring how motivation may change and develop over time (Pintrich, 2003).
When applied to employee training and job satisfaction, motivation remains a key underlying
factor in an individual’s desire to further explore his or her own ways of thinking and processing
to lead towards growth outcomes (Phi Delta Kappa Intl., 2012).
Individual motivation levels can also be significantly influenced by environmental
settings, including the physical setting, interactions among employees, and relationships with
superiors (Rueda, 2011). If the environment supports innovation, creativity, and learning, there
is fertile ground for building intrinsic motivation in employees (Paramitha & Indarti, 2014). To
establish a culture that values employee growth and engagement, personal motivation is crucial;
without it, meaningful change is not likely to occur (Dweck, 2012). Motivation is also connected
to the desire and ability to accurately identify existing knowledge and skill gaps to stakeholder
goals (Rueda, 2011). Without the motivation to see the reality of a current situation, it will be
very challenging to understand what exists versus what is desired (Rueda, 2011). This section
outlines key motivational influences on leadership’s ability to implement employee retention
concepts to work responsibilities and performance.
Self-efficacy theory. The first motivational influence is that leadership feel confident in
their ability to retain employees. Self-efficacy theory posits that the thoughts and beliefs one has
about one’s self underlie foundational elements of motivation and personal well-being, which
directly influence ability to achieve (Pajares, 2006). Self-efficacy beliefs influence choices,
LEADERSHIP AND SENIOR ASSISTED LIVING 25

determine courses of action, influence how much a person may dedicate to any particular
activity, impact successes, outline how one might react to failures, and directly influences
emotional states of being (Pajares, 2006). Individuals with high self-efficacy are more resilient,
determined, and motivated to achieve, while individuals with lower self-efficacy may struggle
with academic performance, social interactions, and emotional regulation (Pajares, 2006). Self-
efficacy beliefs are particularly important when encountering challenges and difficulties. Having
high self-efficacy will enable better navigation of hard times and result in shorter periods of time
prior to re-engagement after a challenge (Rueda, 2011). Ideally, leadership will feel a sense of
self-efficacy in being able to implement employee retention strategies and lead within the senior
assisted living industry.
Self-efficacy is extremely important in the job performance of leadership. Individuals
must feel skilled and capable in their respective areas of industry and feel competent to be able to
navigate any challenges that arise throughout the company (Rueda, 2011). In addition,
administrative staff must feel they have the proper knowledge and talent to manage the business
needs of the company with accuracy and effectiveness. Finally, it is essential clients and
customers within senior living see confidence from leadership and experience employee self-
efficacy to have confidence the organization will produce what is promised (Stone, 2004). In
particular, self-efficacy plays a key role in the development of a culture of employee engagement
and growth (Phi Delta Kappa Int., 2012). In order to reach stakeholder goals, high leadership
self-efficacy will be essential to success.
Expectancy value theory. The second motivational influence is that leadership need to
see the value of retaining their employees through different retention strategies. An important
motivational and social factor of influence is the concept that a person must believe in the value
LEADERSHIP AND SENIOR ASSISTED LIVING 26

of what is being asked of them to learn and/or do for the person to gain the motivation to make it
happen (Eccles, 2006). Leadership, and the employees they are leading, may ask themselves,
“Can I do this task being asked of me?” and “Do I want to do this task being asked of me?”
(Eccles, 2006). In answering these questions, individuals may weigh several factors, including
their own personal opinion on the value of the activity, how they personally feel connected to the
activity, and what the perceived costs are of engaging in said activity (Eccles, 2006). For
training programs to be effective in promoting employee retention and long-term career paths
within the senior assisted living industry, leaders will need to feel fully connected to the value of
such programs and be motivated to engage in the programs with full energy and commitment to
their success.
Goal orientation theory. The third motivational influence is that leadership need to
have a mastery goal orientation towards retaining employees. Goal orientation theory examines
why people engage in their work in an attempt to achieve mastery goals and to maintain a
mastery orientation towards self-improvement and improved knowledge (Yough & Anderman,
2006). Goal orientation theory also encompasses performance goals driven to demonstrate
competence and achievement in comparison to others (Yough & Anderman, 2006). Both
mastery and performance goal orientations can be valuable in the workplace and in working
towards stakeholder goal attainment. Mastery goals, as discussed in the context of this study, are
engaged by the goal setter with the intention to learn new skills, gain new knowledge, and be
challenged by new levels of activity (Rueda, 2011). In addition, goal content is an important
consideration. Based heavily on Bandura’s social cognitive theory, the characteristics of the
goals, such as challenge level and content of the goals, can impact a person’s level of motivation
to want to achieve those goals (Rueda, 2011). Key to motivation is the active choice to pursue a
LEADERSHIP AND SENIOR ASSISTED LIVING 27

goal, the persistence to continue working towards that goal, and the mental effort it takes to
achieve that goal (Clark & Estes, 2008). When goals are aligned with stakeholder and
organizational values, they are more likely to appeal to those needing to meet those goals and
increase motivation levels towards accomplishment (Rueda, 2011). Research has demonstrated a
clear and direct correlation between effective employee training and reduction of employee
turnover (Anis et al., 2011). Retention rates of employees increase when leadership
demonstrates investment of time into job skills related training which helps to increase employee
performance (White & Cadiz, 2013). Leadership who establish clear goals for effective training
of and investment in employees may experience a more committed workforce (Lopez et al.,
2014). Table 2 overviews all motivational influences and how they were assessed.
Table 2
Motivational Influences

Organizational Influences

A basic understanding of organizational culture helps to frame the concepts of
organizational influence. Culture can be defined through a variety of measures including
common behaviors, norms, habits, values, rituals, and identity factors as shared by the members
Organizational Global Goal
Increase the retention rate of employees who choose a long-term career path in the assisted living
industry.
Assumed Motivation Influences Motivational Influence Assessment
Self-efficacy: Leadership feel confident in their
ability to retain employees.
Interview of leadership
Value: Leadership need to see the value of
retaining their employees through different
retention strategies.
Interview of leadership
Goal Orientation: Leadership need to have a
mastery goal orientation towards retaining
employees.
Interview of leadership
LEADERSHIP AND SENIOR ASSISTED LIVING 28

of a group or community (Schein & Schein, 2017). Applied towards a specific organization,
culture influences almost all aspects of a work environment including expected employee
behavior, communication methods, shared organizational values and goals, general feel of
organizational environment, and employee satisfaction and engagement levels (Clark & Estes,
2008). Organizational cultures are fluid in nature, and can shift and change frequently depending
upon leadership, geographic location, employee character, team dynamics, market activity,
organizational financial stability, and client relationships (Schein & Schein, 2017).
Within organizational cultural influences, one will find cultural models and cultural
settings. Cultural models address the under-the-surface fears, trust issues, and resistance that
organizations experience (Rueda, 2011). Cultural model influences touch on the deeper
underlying elements of an organization’s dynamics (Clark & Estes, 2008). Cultural settings tend
to address the less emotional, more factual elements of resources, goal setting, financial
resources, and training opportunities (Rueda, 2011). Table 3 presents the assumed
organizational influences, both cultural model and cultural setting influences, as they relate to
reaching the organizational and stakeholder performance goals. Following the table, a discussion
addresses the cultural influences.
Table 3
Assumed Organizational Influences and Organizational Influence Assessments
Organizational Global Goal
Increase the retention rate of employees who choose a long-term career path in the assisted living
industry.
Assumed Organizational Influences Organizational Influence Assessment
Cultural Model Influence:
Organization needs culture that values retention
of employees.
Interview of leadership
Cultural Setting Influence: Interview of leadership
LEADERSHIP AND SENIOR ASSISTED LIVING 29

Cultural model influence. The cultural model influence for this study is that the
organization needs a culture that values employee retention. Research shows a direct correlation
between quality of training and supervision received by assisted living employees and their
willingness to commit to the assisted living industry long-term (Ejaz et al., 2008). For
stakeholders to navigate the organizational culture and work towards goal achievement, it will be
imperative for leadership to invest time into training and supervising employees to build a
dedicated workforce (Brannon et al., 2007). Stakeholder leadership may experience increased
turnover rates of employees without the necessary relationships to promote career development
of key employees (Ejaz et al., 2008). Employees who feel supported by organizational
leadership develop a sense of loyalty to the organization and their work, fostering a sense of
dedication (Chen, 2014). Trust acts as a foundational cultural model influence as it works to
determine the very nature and success of organizational relationships (Korsgaard, Brodt, &
Whitener, 2002). The creation of a learning culture which propagates a pipeline of leadership
from within helps retain quality employees over time (Whitcomb, 2015).
Cultural setting influence. The cultural setting influence for this study is that the
organization needs to provide resources to leadership to retain employees. Improper or lack of
leadership resources within the senior assisted living industry will work as a significant
disadvantage to stakeholder leadership and the organization as a whole. The establishment of a
supportive culture is vital to the longevity and success of an organization (Senge, 1990).
Ultimately, without such structure, organizational growth will stagnate and prevent the
development of achieving stakeholder goals. Given that organizations are the people within
Organization needs to provide resources to
leadership in order to retain employees.
LEADERSHIP AND SENIOR ASSISTED LIVING 30

them, the organization can only grow to the extent that the people within it do (Schneider, Brief,
& Guzzo, 1996). Valuable resources, including time, money, and experiential knowledge, must
be allocated towards getting stakeholders the proper mastery of training strategy and
implementation.
Interactive Conceptual Framework

While the knowledge and motivational influences are important to understand in their
own right, it is essential to examine them within a context that explores their relationship within
the organization and the organizational stakeholder goals (Merriam & Tisdell, 2016).
Conceptual frameworks provide a scaffold and system through which to more deeply explore the
guiding research questions and better understand the problem of practice (Merriam & Tisdell,
2016). A conceptual framework is constructed based upon researcher experience, literature
support, and aims of the research study (Maxwell, 2013). It is a dynamic framework that will
grow, change, and evolve along with the research (Maxwell, 2013). The conceptual framework
helps to narrow the knowledge, motivation, and organizational influences, while allowing room
for adjustments along the way (Maxwell, 2013). The following is the conceptual framework
demonstrating the relationship between knowledge of strategies for employee retention and
motivation to use them, and how those two are interrelated to help the stakeholder achieve the
organizational goal.
LEADERSHIP AND SENIOR ASSISTED LIVING 31

Figure 1. Graphic representation of conceptual framework.
Assisted Living for Seniors, Private Industry
Organizational Influences
Cultural Model Influence:
Organization needs culture that values retention of employees
Cultural Setting Influence:
Organization needs to provide resources to leadership in order to retain
employees

Increase the retention rate of
employees who choose
a long-term career path in the
assisted living industry
Industry Leadership
Knowledge Influences
Leadership need to be able to reflect on employee
retention strategies within their organization
(Metacognitive)
Leadership need to know specific strategies for retention
of employees within their organization (Conceptual)
Leadership need to know how to effectively retain
employees within their assisted living organization
(Procedural)

Motivational Influences
Leadership feel confident in their ability to retain
employees (self-efficacy)
Leadership need to see the value of retaining their
employees through different retention strategies (value)
Leadership need to have a mastery goal orientation
towards retaining employees (goal orientation)
LEADERSHIP AND SENIOR ASSISTED LIVING 32

The conceptual framework, as represented in Figure 1, explores the relationship of how
knowledge of leadership retention strategies and the motivation to apply retention programming
influence desired outcomes of employee retention and career path development. As seen in the
outer circle, the organization must have active leaders who care to keep their employees engaged
and developing within the industry.
This figure demonstrates the interrelatedness of the gap analysis framework as described
by Clark and Estes (2008). Motivation provides stakeholders the energy and incentive to engage
in the application of the skills and talents gained through knowledge attainment (Clark & Estes,
2008). As Figure 1 depicts, achieving stakeholder goals would be almost impossible without the
teamwork of motivation and knowledge. The organizational culture, the circle that contains both
the knowledge and motivation factors for stakeholders, is a determining influence on how
successful stakeholders can close performance gaps and achieve organizational goals (Clark &
Estes, 2008). The arrow pointing to the final box demonstrates how this conceptual framework
can lead to stakeholder goal achievement of creating a culture of employee value from the top
down through leadership modeling and application of retention strategies.
Data Collection

Data collection for this research was conducted using the qualitative method approach of
interviewing. Interviews delved into the problem of leadership’s ability to retain employees as a
means to build a dedicated workforce within assisted living organizations.
Interviews
A semi-structured interview process was used to develop rapport with interviewees and
provide flexibility in the questioning process to adapt and pivot as necessary depending upon
how the interview was flowing (Bogdan & Biklen, 2007). A series of open-ended questions
LEADERSHIP AND SENIOR ASSISTED LIVING 33

attempted to get the interviewee to uncover thoughts, views, behaviors, and intentions on how
retention strategies and programs may or may not impact employee retention. Based upon
Patton’s question types, six types of questions were asked, defined by experience and behavior,
opinion and values, feelings, knowledge, sensory, and background/demographics (Merriam &
Tisdell, 2016). In addition, depending upon participant answer, probing questions were asked to
get to deeper answers and understandings (Bogdan & Biklen, 2007). Interviews were conducted
during March 2019.
Interview procedures. Interviews were conducted at a time suitable to the interviewee.
Each interviewee was interviewed one time for approximately 30 to 60 minutes, followed by any
necessary additional clarifications requested via email. Interviews were formal as this researcher
was an outsider requesting access and received appropriate approval from senior leadership to
engage in the line of questioning. However, the interview style was kept casual and relaxed so
that the interviewee felt comfortable to open up and act naturally in the interview. All interviews
were conducted via recorded conference call. Data was captured through hand-written notes and
audio recording. Prior to the interview, interviewees received an email restating the reason for
the interview, purpose of the study, privacy details, and a link to schedule the interview time.
Participants were given the option to decline the interview. A calendar invite was sent once a
meeting time had been selected, and a reminder was sent via email 24 hours prior to the
interview time. Recorded interviews were then sent for transcription. Ten leaders were
interviewed. Appendix B details the qualitative protocols for data collection.

LEADERSHIP AND SENIOR ASSISTED LIVING 34

Data Analysis

Data analysis of the interviews began during data collection. Handwritten notes were
taken throughout the interview process to correspond with each interview question, as well as
capture the interviewee’s tone and feeling. Once interviews were complete, interviews were
transcribed and coded. In the first phase of analysis, open coding was used, empirical codes
were identified, and a priori codes from the conceptual framework were applied. A second phase
of analysis was conducted where empirical and a priori codes were aggregated into analytic/axial
codes. In the third phase of data analysis, pattern codes and emergent themes were identified in
relation to the conceptual framework and study questions.
Findings
The following are the findings as structured based upon the knowledge, motivation, and
organization (KMO) framework (Clark & Estes, 2008) and the first two research questions.
Discussion concerning the third research question will be addressed in the Solutions and
Recommendations section.
1. What is the stakeholder knowledge and motivation within assisted living leadership as it
relates to retention programs that support long-term career development within the
assisted living industry?
2. What is the interaction between organizational culture and context and stakeholder
knowledge and motivation?
Interviewed Stakeholders
A total of 10 industry leaders were interviewed via conference call to obtain the data for
this study. Interviewees are referred to by assigned pseudonyms to protect their identities. All
interviewees hold high-level leadership positions and work full-time within the senior assisted
LEADERSHIP AND SENIOR ASSISTED LIVING 35

living industry. The average length of an interview was 41 minutes, with the shortest interview
clocking in at 33 minutes and the longest interview running 55 minutes. Table 4 details
participant years in the industry, job title, total organization employees, and number of direct
reports.
Table 4
Senior Living Industry Leadership for Qualitative Interviews
Participant
(Pseudonym)
Years in
Industry
Job Title Total
Organizational
Employees
Number of
Direct & Indirect
Reports

Aaron 5 yrs Executive Director <500 50-75
Abby 32 yrs Senior VP Human Resources 1000-1500 <10
Jake 8 yrs Chief Human Resources
Officer
1000-1500 <10
Julie 29 yrs VP Talent Resources 1000-1500 <10
Mark 6.5 yrs VP People Operations 1500-2499 11-25
Martha 15 yrs Chief People Officer 1500-2499 11-25
Michelle 23 yrs Senior VP Chief
Administrative Officer
1500-2499 <10
Nick 4 yrs Licensed Nursing Home
Administrator
15,000+ 100-125
Sean 7 yrs VP Human Resources 2500-5000 11-25
Susan 9.5 yrs Senior VP Human Capital <500 11-25

Knowledge findings. The knowledge findings discussed are related to metacognitive,
conceptual, and procedural knowledge.
Metacognitive knowledge findings. Through metacognition, leadership need to be able
to reflect on employee retention strategies within their organizations. Participants were asked if
LEADERSHIP AND SENIOR ASSISTED LIVING 36

and how they deeply reflect upon issues related to employee retention within their respective
organizations and if they have specific systems or strategies for this reflection process. When
asked about their reflection processes and strategies, the majority of participants launched into a
dialogue about the various programs and incentives offered to employees to retain them. Their
interpretation of my question on reflection was taken as how they solve problems and not
necessarily reflection as a thought process and strategy. Six of 10 participants reported elements
of metacognition and active reflection upon employee retention that included specific strategies
to provide opportunity and time to reflect both individually and with colleagues. Schön
discusses the importance of reflection when he highlights leadership as intuitive artistry that
must be done through one’s ability to connect and reflect on the day-to-day goings on that a
manager or leader experiences (Sergiovanni & Corbally, 1984). It seems imperative for leaders
in today’s world to be actively engaged in regular and intentional reflection as a means to hone
leadership skills and craft an organization that supports employee retention. Table 5 provides
participant comments reflecting metacognitive reflections on employee retention within their
respective organizations.
Table 5
Supportive Statements for Metacognitive Reflection on Employee Retention

Participant
(Pseudonym)
Supportive Statement
Abby “I’m not proud to say we have high turnover . . . but it is a topic we talk about
with a leadership team on a monthly basis. For senior leadership it’s weekly.
We’re continuously talking from a very high senior leadership role about how
do we attract? How do we engage? How do we retain?”
Jake “There’s so many different ways to go about it (reflection), in some ways I
think you can over-analyze it . . . Ultimately what I try to come at it with is
knowing what is the actual data, and providing that data to as many
LEADERSHIP AND SENIOR ASSISTED LIVING 37

stakeholders invested in the problem . . . strategy-wise, number one, you’ve
got to have the right data.”
Julie “It (retention) is a part of our strategic plan . . . started on a formal basis about
three years ago. Once retention was part of our strategic goals it became
internalized and was led by top leadership committee meeting monthly to talk
about recruitment and retention strategies. There’s measurable goals . . . and
we continue to meet monthly knowing it’s a continual top-of-mind issue.”
Mark “One of the first few things . . . is sitting down with the executive team and
identifying what metrics are important to them (regarding retention) . . . I can
say (when I worked with a different company) we did not focus on retention
in a strategic way . . . (here) we ask what is our strategy moving forward?
And I felt that was really empowering.”
Nick

“Oh, it (reflection) seems constant . . . it’s a daily piece we talk about staffing
. . . and come up with what we can do to retain staff. We also have a facility
action committee where we have regional people come in. Every single one
(of those meetings) I’ve been in a retention plan was created, it is something
under constant work.”
Sean “Yes, we certainly have (a system for reflection), I’ll call it a metric . . .
centered around our core values. There’s 12 of us that are part of a leadership
development program and one of the projects is around ensuring our
workforce.”

Four participants either did not have a specific method or strategy for reflecting on
retention issues or supplied answers that veered off into other areas such as listing current
retention programs available through the organization. Aaron answered by commenting on how
hard his staff works and how lucky he is to have a team that has been with him for a while.
Martha responded by explaining their programs in place for different tracks of career growth.
Michelle explained that in her organization the focus is primarily on turnover numbers and they
have only recently begun conversations about employee retention programs. Susan discussed, in
detail, the internship and mentorship programs offered and the talent pipeline that exists in her
organization. Whereas the first six participants discussed an active reflection processes while
LEADERSHIP AND SENIOR ASSISTED LIVING 38

engaging with employee retention issues, the remaining four participants referenced what is
currently in place within their respective organizations.
Conceptual knowledge findings. Leadership need to know specific strategies for
retention of employees within their organizations. Participants were asked with what types of
employee retention strategies they are familiar. Although several participants reported
exceedingly high turnover rates, some as high as 89%, all 10 participants were able to express
knowledge regarding conceptual ideas for potential strategies to retain employees. Several
retention strategies seemed most commonly understood by participants, as outlined in Table 6.
These strategies are consistent with relevant literature as common practice within the industry
and seem to be essential components of any formal employee retention program.
As Table 6 details, the most commonly known strategies typically related to two primary
categories: (a) employee experience and (b) employee development. Employee experience
relates to things such as pay, benefits, awards, recognition, organizational communication, and
workplace environment and culture. Employee development relates to all areas where the
organization and leadership chose to invest resources to help build up an employee’s self-
efficacy and skill level. Participants shared insights on both employee experience and
development when addressing specific retention strategies with which they were familiar. For
example, Abby discussed their tradition of awarding gold coins to employees who reach
important employment anniversaries. Jake discussed how he feels there is a tendency in the
industry to minimize the importance of compensation and benefits, but that everyone knows
these are crucial to successful retention. Julie discussed recent wage increases for their nursing
staff, while Mark discussed their focus on employee on-boarding and training as a means to
increase retention. As illustrated in Table 6, the vast majority of leaders were familiar with these
LEADERSHIP AND SENIOR ASSISTED LIVING 39

commonly known retention strategies and each seems to be implementing the strategies in ways
that work best for their organizations.
Table 6
Most Commonly Known Strategies for Employee Retention
Primary category Employee
retention
strategy
Examples of strategy Number of
participants
who
referenced
this strategy
Names of
participants
who referenced
this strategy
Employee
experience
Financial
incentives
Competitive pay; pay
raises; holiday or other pay
bonuses; health/other
benefits

9
Aaron, Abby,
Jake, Julie,
Martha,
Michelle, Nick,
Sean, Susan

Awards based
upon tenure
Awards ceremonies;
celebratory meals; honorary
and symbolic status benefits
such as special parking or
other priority benefit
9

Aaron, Abby,
Jake, Julie,
Martha,
Michelle, Nick,
Sean, Susan
Effective and
engaged
leadership
Strong, involved corporate
leadership; caring managers
and supervisors; person-
centered approach

10
Aaron, Abby,
Jake, Julie,
Mark, Martha,
Michelle, Nick,
Sean, Susan
Effective
communication
Clear, meaningful
communication on all levels
of the organization both up
and down the hierarchy as
well as among staff;
opportunity for employees
to communicate their
concerns and opinions and
feel valued and heard
8 Aaron, Abby,
Jake, Julie,
Martha,
Michelle, Nick,
Susan
Appealing culture
and workplace
Inviting and supportive
culture; focus on employee
experience; physical space
that is both functional to the
demands of the job while
being clean and
aesthetically pleasing to
spend time in
10

Aaron, Abby,
Jake, Julie,
Mark, Martha,
Michelle, Nick,
Sean, Susan
Recognition for
quality work
Employee of the
month/year; “above-and-
8

Aaron, Abby,
Jake, Julie,
LEADERSHIP AND SENIOR ASSISTED LIVING 40

beyond” awards;
certificates of
acknowledgement;
prominent photo placement
with words of praise
Michelle, Nick,
Sean, Susan
Employee
development
Succession
planning
Career-path planning for
employees; mentoring
programs; promoting from
within where possible;
professional development
relevant to employee’s
position and success in
workplace
9

Aaron, Abby,
Jake, Mark,
Martha,
Michelle, Nick,
Sean, Susan
Continuing
education
Offer of financial assistance
and/or tuition
reimbursement for external
continuing education and/or
certification programs;
internal offerings for
additional training and
development
7

Abby, Jake,
Mark, Martha,
Michelle, Nick,
Susan
Formal employee
training
Internship and mentorship
programs; employee
onboarding programs;
apprenticeship
8

Abby, Jake,
Mark, Martha,
Michelle, Nick,
Sean, Susan

Innovative implementation of retention strategies. As participants discussed their
conceptual knowledge of various employee retention strategies, several strategies emerged as
being unique, innovative, and implemented by very few organizations. These strategies fell into
categories such as employee benefits/rewards, community partnerships and involvement,
continuing education/employee development, employee experience, and technology. Leaders are
focused on the global goal of keeping and developing employees; therefore, they are stepping
outside of the typical retention strategies box to innovate. Michelle commented, “We keep
employees by providing them with a great place to work, but also with innovative opportunities
for growth—even if they wish to keep the same position, we still want people staying and
growing.” Nate touched on the importance of consistently supporting and recognizing
LEADERSHIP AND SENIOR ASSISTED LIVING 41

employees as a means to keep them, stating, “Personal recognition goes a very long way and [I]
work to bring in new ways of doing that as often as possible.” Sean reiterated how crucial
innovative retention practices are, “There’s 12 of us that are a part of a leadership development
program and one of the projects is around ensuring our workforce—we are all sharing our
dreams and visions for what it might take to have people beating down our door to work for us.”
Table 7 details the participants and the innovative employee retention strategy currently
being tested or implemented within their respective organizations. These strategies are
considered innovative as they are not referenced in the current literature as commonly known
practices, and it seems, based upon participant reporting, that these ideas and strategies were
developed either by the leader directly or by the team of employees addressing employee
retention within their respective organization.
Table 7
Lesser Known Innovative Implementation Retention Strategies
Primary category Participant
(Pseudonym)
Strategy with brief description
Employee
benefits/rewards
Jake Flexible scheduling: To the extent possible employees have
direct input on scheduling shifts and are given some leeway
to get creative where necessary to accommodate life outside
of work including family, continuing education, etc.
Julie Critical Needs Fund: Employees who have a certain tenure
may request a financial gift in times of need to assist in
overcoming difficult times.
Community
partnerships &
involvement
Julie A committee comprised of mostly residents and some team
members charged with understanding recruitment and
retention issues and coming up with ways to support and
keep team members. Committee members innovate ways to
support and celebrate the entire community’s employees
creating a thriving community of team members and
residents.

LEADERSHIP AND SENIOR ASSISTED LIVING 42

Martha A community board where employees earn stickers from
families and residents that translate to a financial reward and
employee of the month recognition.

Susan Establishment of collaborative partnerships with local
university to build awareness of senior assisted living
industry and generate a pipeline of talent from the student
body.
Continuing
education/employee
development
Martha Targeted leadership training: Targets an employee who has
been with the company for 90+ days, shows consistent
punctuality, receives a recommendation from a resident or
family member, and passes an interview. These employees
are then invited to participate in special quarterly trainings
lead by senior leadership involving continuing education
and leadership development. Those employees then go back
into their communities and help to train others in their
departments.
Martha Employees who have been with the company for over one
year may receive financial tuition assistance for short-term
degree programs, CNA certifications, and eventually long-
term degree programs.
Nick Highly personalized career development plans for those
recognized as top achievers and who exhibit a desire to
promote within the organization.
Employee
experience
Aaron Constant attention to the environment for both residents and
employees, both through aesthetically pleasing accents and
an uplifting environment that encourages light-heartedness,
warmth, and sense of belonging. The metric for this method
is the number of smiles you see on the faces of residents and
employees when you walk around the building.
Jake One-on-one meetings conducted on a quarterly basis by
leadership with team members in an effort to preemptively
address retention issues and improve employee experience.

Michelle Random acts of praise: Phone calls and note cards from
leadership to employees to express gratitude for jobs well
done sent on no particular schedule as a means to surprise
and uplift the employee.
Nick Two days per week all department managers are required to
send out personally written thank you and acknowledgment
note cards to employees of their choosing to build
relationships and encourage bonding which then promotes
retention.

Sean Focus groups with frontline workers run directly by senior
leadership to target employee satisfaction with work
environment and experience.
LEADERSHIP AND SENIOR ASSISTED LIVING 43

Technology Abby Online learning: Proprietary online LMS system offering a
huge library of continuing education opportunities for all
associates
Julie Branded and specialized use of online platforms and
applications to increase and improve community-wide
communication among staff and leadership regardless of
employee position type.
Mark Integration of AI/software/technology to make the employee
onboarding experience more streamlined and allow the in-
person training time to be spent on the more important
aspects of people’s relationships and key training concepts.

Mark Use of iWorkzone which involves behavioral based
interviews and assessments to help place good candidates in
the right positions. The idea is that the proper fit of
candidate to position increases the likelihood of greater
retention.
Michelle Video series highlighting existing long-term employees
shown to newer employees as a means to illuminate
potential career paths and encourage retention.

Procedural knowledge findings. Leadership need to know how to effectively retain
employees within their assisted living organizations. The procedural knowledge question built
upon the conceptual knowledge question by asking participants to further identify which
retention strategies are currently being implemented and, more specifically, if or how those
strategies are being measured for effectiveness. This question sought to examine to what degree
leadership is able to effectively implement employee retention strategies and if they are actively
engaged in tracking those strategies. The results on procedural knowledge and the ability to
measure effectiveness of employee retention strategies varied greatly and generally fell into one
of two categories identified as minimal retention tracking and active retention tracking. The
data on procedural knowledge findings did not reveal any one consistent way that leaders
measure employee retention efforts and it appears the lack of industry norms on how to measure
employee retention is a point of frustration for many participants.
LEADERSHIP AND SENIOR ASSISTED LIVING 44

Minimal retention tracking. Three participants described minimal retention strategies.
Aaron, an executive director with a team of 50 employees, reported having no data points or
measurement tools for retention, but relied solely on “feeling it in the air if something is off.”
Aaron is also blessed with very high employee retention within his organization and seemed
quite comfortable with his methods. Sean, who has a considerably larger organization than
Aaron, commented, “It’s admittedly something we don’t do as good of a job as we actually
should. Some strategies we implemented about a year and half ago we are only now going back
to study.” Sean continued:
In the end, I don’t know that we’ve done a great job of measuring those things (retention
rates). For me, I was hearing anecdotally the dissatisfaction so I started to look back and
try and find out, ‘Okay who is saying this? What’s the circumstance?’ so I’m collecting
data but not scientific survey data and it’s more specific around, ‘You like it? You don’t
like it? And why don’t you like it?’ . . . if that makes sense.
Michelle, Senior VP Chief Administrator Officer of a large organization, discussed the
frustrations of measuring employee retention and said she has only recently been able to further
measure employee retention effectively by utilizing the measurement systems developed by a
national professional organization for senior living executives. Michelle expressed her
frustrations, “In our industry nobody counts turnover the same way, and not body counts
retention the same way . . . what [our professional association] did was come up with a way to
help measure retention and we are on a beta test of that.”
Active retention tracking. Five participants discussed active retention tracking strategies.
Participants Julie and Martha indicated their primary method for tracking employee retention is
by looking closely at their turnover percentages on an annual or semi-annual basis. Martha
LEADERSHIP AND SENIOR ASSISTED LIVING 45

described the process as using the employee orientation as a starting point for baseline
performance and then looking at the turnover rates for those employees every three and six
months. Both Julie and Martha reviewed employee turnover rates on an annual basis with
leadership teams as a means of evaluation.
Other participants had differing ways of actively tracking employee retention. Susan,
Senior VP of Human Capital, describes working with third-party partners who use data to
evaluate potential candidates and track retention of those potential employees based upon
organizational fit. In Susan’s case, they are using a pre-emptive approach to predictively
measure employee retention by engaging in detailed pre-employment screening and position
matching. Within her organization, the various assisted living facilities track employee retention
within their own buildings and each uses their own metrics.
Other participants describe very specific retention tools used within their organizations.
For example, Nick, a Licensed Nursing Home Administrator, discussed two specific metrics his
organization uses. The first, referencing nursing continuity, is examined annually and looks at
the percentage of nurses who have been employed with them for over one year. The second tool
examines the degree to which employees are engaged with their jobs. It is examined semi-
annually, with a focus on the level of an employee’s current engagement with his or her work,
giving insight into their intentions to stay or leave the organization. Jake, Chief Human
Resources Officer, discussed how within his organization, they conduct interest interviews
designed to catch employee dissatisfaction before it becomes a turnover statistic. He describes it
as follows:
We do stay interviews, it’s operationalized, we require our leaders to meet with their
team members one-on-one once a quarter and there are different iterations of it. They
LEADERSHIP AND SENIOR ASSISTED LIVING 46

have to ask questions like, ‘What would make you leave? What’s most important to you?
What kind of recognition is important to you?’ . . . I want the leader to feel like these
(meetings) are important because you can glean a lot of really important information . . .
and hey, good news, it’s not on your financials (there are not affiliated costs).
Motivation findings. The motivation findings discussed here are related to self-efficacy,
value, and goal orientation theories.
Self-efficacy. Participants were questioned about their current level of self-confidence in
their ability to retain employees and/or address retention issues as an organizational leader and
what factors, if any, contribute to their sense of ability or lack thereof. Six participants (Aaron,
Abby, Jake, Julie, Martha, and Sean) reported high levels of self-confidence. Two participants,
Mark and Nick, reported a fair level of self-confidence, while Michelle reported a currently low
level of self-confidence. Susan did not give a direct answer regarding her current level of self-
confidence. Some participants expressed this confidence to be conditionally tied to their ability
to access tools and resources, such as competitive pay, employee benefits, and other important
aspects of employment that directly impact retention. The participants who reported having high
organizational support also reported having high self-efficacy to address retention challenges,
although that did not also equate to those who reported fair or low levels of self-efficacy.
Michelle lacked confidence, stating, “I’d hate to even try and throw out a percentage (of
confidence level). I would not be confident right now . . . due to our lack of training that’s out
there right now that we’re developing.” Nick commented, “I feel fairly confident if and when I
am able to adjust my retention strategies to the marketplace when it comes down to pay. If that’s
stripped from you, you really are at a huge disadvantage . . .”. Mark rated himself a “six” on a
scale of ten,
LEADERSHIP AND SENIOR ASSISTED LIVING 47

I would describe myself on a scale of one being extremely uncomfortable, to ten being
absolutely confident, I’d say I’m probably a six right now . . . how do we get our people
managers to really follow those process . . . and recognizing that, while this is my
world—I live, breathe, talk, sleep, and dream employee retention and satisfaction and
employee experience, four our executive directors, wellness directors, this may be only
10% of their jobs . . . and that’s (conveying importance of use of retention strategies) is
not always the easiest thing to do.
Aaron expressed significantly more confidence, positing, “Yeah, I would say I’m very
confident in knowing that the people that I’ve got are pretty much here to stay . . . (during hard
times) I didn’t have anyone abandon ship either . . . there’s a lot of faith here.” Jake also
expressed a strong sense of confidence as it relates to his ability to build relationships and as a
result retain employees. He said, “When it comes to retention the number one component . . . is
the relationship with the supervisor . . . and I feel like I do that very well. I feel very strongly
about modern servant leadership principles.” Sean declared, “My level of confidence is high . . .
but it’s going to take a heck of a lot of work. The reason my confidence is high is that the
company has put a very high priority on it (retention).”
Two participants expressed a disparity in confidence levels depending upon which aspect
of employee retention was being considered. Abby commented with mixed reviews:
I think my personal experience with my direct links, my direct reports, with my peer
group within the company, is very, very high. I think my confidence in what I will call
my frontline staff, that staff that makes or breaks our company, is where I have a low
confidence level . . . It doesn’t matter that I have this beautiful, brand-new community in
an unbelievable location with all of the bells and whistles that a project can offer. That
LEADERSHIP AND SENIOR ASSISTED LIVING 48

really doesn’t matter when it comes down to the feel of a community when you walk in
the door, and the culture that exists . . . so it’s not the bricks and mortar, it’s truly the
frontline staff (that matters).
Julie echoed this sentiment, acknowledging that confidence doesn’t come easily, “I’m confident
that we have buy-in from top leadership on this (retention) initiative . . . but honestly it’s a
struggle, it’s always an issue of time and resources. I am confident that we have the will and grit
to just keep pushing at this.” Martha shared a certain optimism about her confidence levels,
“Every year I think it gets better . . . every year I try to get more and more knowledgeable and
still be out there to listen and hear and shake hands and give hugs . . . I feel confident in our
strategies.”
Value. Leadership need to see the value of retaining their employees through different
retention strategies. Participants were asked what, if anything, motivates them to experiment
with and implement different retention strategies. All participants reported high levels of
motivation to address employee retention issues and seemed interested in experimenting with
various retention strategies. While all participants are highly motivated, the specifics of their
motivational drives were rooted in different areas. Both Julie and Jake shared that they are
driven by their natural curiosity and a deep desire to disrupt industry practices as a means to
cracking the employee retention code. Julie commented, “I’m always pushing the norm. I love
to disrupt HR practices.” Jake shared a similar sentiment, “One of my least favorite terms is
‘industry norm,’ I like thinking of ways to disrupt the industry.” Abby’s motivation stems
heavily from feedback and her ability to use feedback constructively to address challenges in
retention and constantly work to make things better. “I used to work in the hospitality industry,
LEADERSHIP AND SENIOR ASSISTED LIVING 49

and the company I worked for, the slogan was, ‘Feedback is a gift, accept and appreciate it’ . . .
we encourage continuous feedback.”
Mark spoke with pride as he discussed motivations for valuing different retention
strategies. “We have this really great sense of curiosity at the executive level, and so as long as
it’s not cost prohibitive, we’re willing to try products and systems to see how that works out.”
While Martha spoke about being motivated by studying other senior living operators and other
industries to see what types of retention innovations they are coming up with, perhaps it is Nick
who really summed up the baseline motivating factor for valuing different retention strategies:
When you are sitting with 10 nurse openings, anything that you can think of that would
work, that you may think would work, is something that you’re very interested in.
Because when you have those openings, it really takes away from everything else . . . It’s
just a mess when you don’t have the staff to take care of the people that need you.
Based upon responses from participants, it is apparent that senior assisted living leadership are
open to and excited about any and all employee retention strategies that seem effective and
financially sound. The value they assessed to addressing employee retention issues stemmed
from their desire to provide continuity of care for seniors, as well as to prevent financial losses
traditionally associated with employee turnover and employee replacement.
Goal orientation. Leadership need to have a mastery goal orientation towards retaining
employees. With the organizational focus and goal being employee retention, participants were
asked how they would, as a leader, approach this goal in the bigger picture of the organization.
The question was framed as, “If employee retention is this giant mountain you need to climb, this
hurdle you need to overcome, and you are standing at the foot of the mountain looking up at your
challenge, how would you approach it? How do you tackle this mountain called ‘employee
LEADERSHIP AND SENIOR ASSISTED LIVING 50

retention’?” The purpose of this line of questioning was to illuminate the participant’s
orientation towards goal setting to determine it if is truly a mastery orientation, one oriented
towards learning and gaining new competence, or a performance orientation, one oriented
towards employee and organizational performance and outcomes.
Of the 10 participants, only three demonstrated a definitive mastery goal orientation
towards employee retention. Aaron, Julie, and Martha answered the interview question with a
distinct internal drive to learn more about the employee retention problem and gain new
competencies to address the problems. This in contrast to the other seven participants, who
answered with a performance goal orientation. They discussed employee and organizational
performance and identified various employee retention strategies and outcomes. Table 8 outlines
participant comments reflecting a mastery goal orientation.
Table 8
Participant Comments Demonstrating Mastery Goal Orientation
Participant
(Pseudonym)
Mastery goal orientation comments
Aaron “. . . and so if retention was an issue I’d say hey, we’re really struggling with
retaining our employees, what am I/we doing wrong? Who do we need to
hear from and learn from? In general I feel like you can learn from
everyone.”
Julie “I think what I would do is understand the issue first . . . talk to a lot of
people, reach out to others in the industry. Once I understood the problem. . .
I’d try to inspire, either through messaging or small successes, the leadership
team and members to know that we understand your pain when you have five
vacant positions and no applicants.”
Martha “I think the big thing is you have to hear what people are not satisfied with . .
. really hearing and going out and seeking that information and being open-
minded to what they have to say. I think that will help you to understand
where your deficiencies are and then build a game plan on not attacking
everything . . . really learning, (asking) what do we need to solve?”

LEADERSHIP AND SENIOR ASSISTED LIVING 51

In contrast to mastery goal orientation, several other participants demonstrated a
performance goal orientation, with comments reflecting individual and/or organizational
performance toward employee retention. Abby commented that, in her organization, most
everything related to goal setting and goal achievement is spoken about in terms of return on
investment and financial impact. Jake discussed his goal orientation in terms of percentages of
employee retention and turnover reduction, and how assisted living communities are trending.
Mark detailed how his organization breaks down goal attainment by specific types of turnover
related to department and position type. Susan’s response was tied to how the organization looks
at employee turnover through costs associated with employee replacement. Table 9
demonstrates participant comments reflecting a performance goal orientation.
Table 9
Participant Comments Demonstrating Performance Goal Orientation
Participant
(Pseudonym)
Performance goal orientation comments
Abby “Senior leaders are always going to look at what the cost is and what is the
return on investment.”
Jake “If you go make a 5% reduction every 90 days, in two years you’re going to
look back and go oh my gosh look at what we’ve accomplished.”
Mark “It’s looking at the types of turnover (executive director, housekeeping, etc.)
and the costs associated with that.”
Susan “Turnover creates real cost . . . cost of rehiring, cost of lost opportunity, cost
of lost institutional knowledge, and cost of downtime.”

LEADERSHIP AND SENIOR ASSISTED LIVING 52

Organizational findings. The organizational findings discussed are related to cultural
model influences and cultural setting influences. The cultural model influences focus on the
overall culture of the organization as it relates to employee retention. The cultural setting
influences relate to the goals and resources provided by the organization for employee retention.
Culture of employee retention. Senior assisted living organizations need cultures that
value employee retention. Participants were asked how they would describe their organizational
culture, specifically as it relates to employee retention. As a probing question, participants were
then asked if there are others in the organization who engage in addressing and reflecting upon
employee retention. All participants reported having organizational cultures that support and
value employee retention. Table 10 details the employee retention culture at each participant
organizations.
Table 10
Organizational Cultural Model Toward Employee Retention
Participant
(Pseudonym)
Culture as relates to
employee retention
(synopsis of participant comments)
Aaron Very positive, sense of family, extensive interpersonal communication
building a bonded staff
Abby Decision-making process always asks how any program or initiative impacts
culture, culture includes emphasis on happiness of staff and residents
Jake Leadership team entirely invested in employee engagement and increasing
retention
Julie Culture dictates that rules are not as important as people and relationships are
critical to success. Focus is on collaborative culture to support retention
LEADERSHIP AND SENIOR ASSISTED LIVING 53

Mark Strong culture with a focus on how to help people manage other people
successfully
Martha Culture supports a dedicated department that focuses just on people, retention
is one of the greatest focuses
Michelle Promoting from within is valued practice, leadership is ranked according to
performance and a forced distribution
Nick Huge priority, heavily invested, HR business partners to focus on retention,
very positive culture
Sean Senior leadership intensely focused on retention and most others are also
giving some degree of attention to retention
Susan Performance driven culture, work hard to connect people with mission, strong
culture towards retention

Goals and resources regarding employee retention. Senior assisted living organizations
need to provide resources to leadership to retain employees. Participants were asked what their
organization’s goals are toward employee retention, as well as the types of resources made
available to them to support those retention goals. Finally, participants were asked if there were
any specific resources they felt were lacking to accomplish organizational goals. All participants
indicated that their organizations had goals and resources in place to address employee retention
on some level.
A surprising aspect that emerged from the data was that only three of the participants
indicated specific resources that they felt were lacking. Sean expressed that he feels he could do
“amazing things” with more people on his HR staff, and Julie stated that she would love more
skilled recruiters on her team. Jake commented, “Our health insurance costs and design are
LEADERSHIP AND SENIOR ASSISTED LIVING 54

simply not good enough.” The assumption was that all ten participants would have significant
unmet needs and would provide a proverbial laundry list of what they wished they had to better
address employee retention issues. To the contrary, the majority of participants expressed
satisfaction with organizational resource support and felt it was more a matter of circumstance
versus needing something different or additional. Table 11 details the goals and resources
identified at each participant organization.
Table 11
Organizational Cultural Settings Toward Employee Retention
Participant
(Pseudonym)
Goals and resources as relates to employee retention
(synopsis of participant comments)
Aaron 60% of staff have been there over 10 years, owners give him
complete discretion on setting culture but he does work within a
specified budget for various retention strategies
Abby Current turnover rate 76% and aiming for 65%, however as opposed
to focusing on rates this year they will focus on feedback and new
initiatives to support retention improvement and employee
satisfaction
Jake Currently focusing on 90-day retention rates with goal to drive
turnover down to about 15%, lack of adequate health insurance
benefits to retain employees
Julie Current turnover rate at 38%, desired resources include more skilled
recruiters and any resources that can help employees navigate the
difficult housing market in their area
Mark Current turnover rate not shared but goal is to reduce that rate by
10%, signature training programs resulted in a 79% retention rate,
significant resources invested in education, training, and coaching
Martha Retention data not shared, primary goal is to improve every month
and to address retention needs by region
LEADERSHIP AND SENIOR ASSISTED LIVING 55

Michelle Current turnover rate at 50%, goal is to maintain rate after an increase
in the rate last year, no lack of resources identified
Nick Current turnover rate 50-55% with goal for 2019 to be 40%, given
monthly budget allowance for employee activities to support
retention
Sean Currently at a 39% turnover rate down from 44% in 2017 with a
continuous goal to drive down that number, aiming to retain 90% of
top performers, would love five more people on the HR team
Susan No turnover rates shared, felt resources were ample and nothing
lacking to work towards retention goals

Solutions and Recommendations
Knowledge
Knowledge, and understanding what employees do or do not know as it relates to their
respective work, is an essential aspect of job performance and success in the workplace (Clark &
Estes, 2008). In this study, three potential knowledge influences were examined to identify if
any gaps existed within assisted living leadership that may be impacting employee retention
within their organizations. Of the three influences, the conceptual/declarative knowledge
influence was not identified as a need, while the metacognitive and procedural knowledge
influences were identified as having needs. Table 12 summarizes the knowledge findings.
Table 12
Summary of Knowledge Influences and Recommendations
Assumed Knowledge
Influence
Principle and Citation Context-Specific
Recommendation
Leadership need to be able to
reflect on employee retention
strategies within their
organization
The use of metacognitive
strategies facilitate
learning
(Baker, 2006).
Provide leaders with job aids and
dedicated time for reflection on
employee retention efforts as a
means to consider personal
LEADERSHIP AND SENIOR ASSISTED LIVING 56

(Metacognitive Knowledge) engagement as a leader and
synthesize new knowledge about
one’s own position within the
organization’s retention efforts
and strategies.
Leadership need to know how
to effectively retain
employees within their
assisted living organization
(Procedural Knowledge)

To develop mastery,
individuals must acquire
component skills,
practice integrating them,
and know when to apply
what they have learned
(Schraw & McCrudden,
2006).
Provide leadership training on
how to design metrics with every
retention program in order to
track the effectiveness of that
program and adjust program
efforts according to outcomes.

Leadership need to know
specific strategies for
retention of employees within
their organization
(Conceptual/Declarative)
Not validated as a need Not validated as a need

Metacognitive knowledge solutions.
Leadership need dedicated time to meaningfully reflect on employee retention
issues. Although all study participants expressed a clear understanding of the importance of
employee retention within their organization and the industry, less than half of the participants
consciously set aside time to deeply and meaningfully reflect on current retention efforts and
their effectiveness. Metacognitive strategies, as rooted within Information Processing Systems
Theory, provide opportunity for the reflection and learning necessary to improve employee
retention programs and outcomes. Baker (2006) articulated the importance of the metacognitive
process for learning and implications for peer collaboration and increased
comprehension. Leadership engagement with metacognitive processes, including adequate time
for reflection on employee retention issues and the opportunity to share insights resulting from
such processes, may provide both individual and team gains through a deeper understanding of
the influencing issues and experienced outcomes of current retention programs. The
LEADERSHIP AND SENIOR ASSISTED LIVING 57

recommendation is to provide leadership with dedicated time for reflection on employee
retention efforts to consider personal engagement as a leader, and synthesize new knowledge
about one’s own position within the organization’s retention efforts and strategies. An example
of this strategy would be to designate 30 minutes per week to reflection time for all appropriate
leadership, specifically on employee retention programs and personal and/or reported
experiences with those programs, along with a job aid to be used as a tool to help guide
reflection. This would then be followed by a 60-minute monthly meeting with all appropriate
leaders to share insights from the personal reflection time and exchange ideas and build upon
existing knowledge about programs and outcomes.
Metacognition, considered a higher-order strategy for thinking and facilitating creative
and critical thinking (Baker, 2006), may be highly beneficial when applied to the assisted living
employee retention problem currently experienced by organizations nationwide. Scholars
propose that dedicated time for reflection allows managers the opportunity to actively evaluate
and reflect upon performance and, at the same time, integrate any new knowledge and
experience discovered through that reflection (Anseel, Lievens, & Schollaert, 2009). Ashford
and DeRue (2012) stated that people do not automatically learn from experience, and it is only
through a mindful approach involving designated time to grow awareness of new lessons that
leadership may make gains in performance and productivity. Sinha (2017) expanded this
concept by stating that self-awareness that arises from contemplative thought is what creates
authentic leadership where a strategic leader may apply learned wisdom to improve
organizational function and performance. A leader who is unable or unwilling to reflect on his
or her own performance, or that of his or her employees and organizational performance, is
overlooking one of the most powerful tools available to consistently move towards growth and
LEADERSHIP AND SENIOR ASSISTED LIVING 58

meaningful assessment (Gardner, Cogliser, Davis, & Dickens, 2011). Dedicated time for in-
depth reflection by leadership on employee retention programs and strategies, followed by an
opportunity to share metacognitive insights with colleagues, may result in greater depth of
understanding employee retention issues and lead to more effective solutions for their respective
organizations.
Procedural knowledge solutions.
Leadership need effective metrics to properly evaluate employee retention
programs. The vast majority of participants did not report having detailed metrics tied to each
specific employee retention program and/or efforts taking place within their organization. A
recommended solution stems from Information Processing System. Schraw and McCrudden
(2006) stated that individuals must develop and integrate new knowledge and skills, as well as
understand the appropriate way and time of how to apply them. The assisted living industry
would benefit greatly from having an in-depth understanding of how current employee retention
programs are impacting retention rates and how to design metrics with each retention program to
track the effectiveness of that program and adjust program efforts according to the outcomes.
The recommendation is to provide leadership with training on how to design metrics for every
employee retention program within their organizations. For instance, when employee retention
programs are being conceived, it becomes an organizational protocol that a unit tied to program
metrics is both developed and learned through any training protocol tied to the new retention
program. As additional support to the training, program developers will also develop job aids of
effective tools to track program metrics consistently and systematically across the organization to
be used during program implementation.
LEADERSHIP AND SENIOR ASSISTED LIVING 59

Evidence suggests that retention efforts are often misguided, with decisions being based
in managerial instincts rather than on complete and relevant data (Allen & Bryant, 2012). It is
the customer data, and in this case the employee is the customer of the retention program, that
determines program effectiveness, as well as financial return on program investment and costs to
implement (Murphy & Zandvakili, 2000). One of the most difficult challenges, yet essential
elements to success, is training the workforce to implement effective programs focused on
metric-based outcomes (Murphy & Zandvakili, 2000). The outcomes of metrics measuring
employee satisfaction will be determining factors to support management decision-making
(Murphy & Zandvakili, 2000). Allen and Bryant (2012) defined this approach as evidence-based
management, where it is the scientific evidence of metrics that translate knowledge and
principles into informed practice. Specifically, this concept has been applied to evidence-based
retention management where it is the metrics of retention program outcomes that work to
determine the viability of any particular employee retention effort (Allen & Bryant, 2012). It is
incumbent upon assisted living leadership to design employee retention programs with
measurable outcomes in mind and with periodic and consistent metrics that can gauge program
effectiveness throughout program engagement.
Motivation
Motivation, comprised of three facets including active choice, persistence, and mental
effort, is the cornerstone of activating knowledge and produces tangible benefits within
individuals and organizations (Clark & Estes, 2008). Three motivational influences were
examined in this study; two of which were validated as needs within the problem of practice.
Table 13 summarizes these findings.

LEADERSHIP AND SENIOR ASSISTED LIVING 60

Table 13
Summary of Motivation Influences and Recommendations
Assumed
Motivation
Influence

Principle and
Citation
Context-Specific Recommendation
Leadership feel
confident in their
ability to retain
their employees
(Self-Efficacy)
Use models that
build self-efficacy
and enhance
motivation
(Pajares,
2006).

Use models for success through professional
development and/or modeling as a means to
promote and build upon successful employee
retention strategies.
Leadership need
to have a mastery
goal orientation
towards retaining
employees
(Goal Orientation)

Encourage
learners to set
productive goals
for themselves
that are
challenging but
achievable, and
encourage self-
evaluation
(Denler, Wolters,
& Benzon, 2006).
The recommended solution is to help leadership
build a mastery goal orientation by establishing
small, achievable goals as stepping stones for
reflection towards larger goals, and encourage goal
setting and goal evaluation to be engaged through a
lens of learning and understanding.
Leadership need to
see the
value of retaining
their employees
through different
retention strategies
(Value)

Not identified as a
need
Not identified as a need

Self-Efficacy.
Increase self-efficacy among senior leadership. Among study participants,
approximately 50% indicated a strong sense of confidence in their abilities to retain employees
within their organizations. One theory utilized to address gaps in this influence is Social
Cognitive Theory. Pajares (2006) suggests using models that build self-efficacy and enhance
LEADERSHIP AND SENIOR ASSISTED LIVING 61

motivation. The nature of the employee retention problem in senior assisted living is pervasive
and, as a result, senior leadership often feel overwhelmed and/or helpless. The recommendation
is to use models for success through professional development and/or self-modeling as a means
to promote and build upon successful employee retention strategies. Applied to organizational
employee retention efforts, senior leadership modeling can build a stronger sense of confidence
as it relates to retention abilities.
Self-efficacy is rooted in the desire to be effective in our lives and work (Clark & Estes,
2008). The work environment must provide the opportunity, through performance goals and
feedback, to help build the self-confidence of leadership in relation to goal attainment (Clark &
Estes, 2008). Rueda (2011) adds that one’s beliefs about one’s own abilities to achieve a goal
may directly impact whether or not a goal is achieved. Both modeling by vicarious experience
and self-modeling through recorded feedback, enhance personal awareness and understanding to
build skills and self-confidence (Gist, 1987). Senior leadership within assisted living are
challenged with a multitude of external factors that influence their ability to retain employees. It
is beneficial to both organizations and leaders to increase self-efficacy wherever and whenever
possible.
Goal Orientation.
Increase mastery goal orientation among senior leadership. Among study participants,
approximately 30% demonstrated a mastery goal orientation in response to a question about goal
setting and goal achievement. The theory used to address solutions for this gap is Goal
Orientation Theory. A mastery goal orientation indicates in-depth learning and goal setting for
the purpose of integration, mastery, and application of knowledge (Yough & Anderman, 2006).
Pintrich (2003) discusses the importance of focusing communication efforts on mastery,
LEADERSHIP AND SENIOR ASSISTED LIVING 62

learning, and understanding. A mastery goal orientation for senior leadership within assisted
living would provide a paradigm for an alternative view of the employee retention problem, and
may facilitate a shift that would view the employee retention problem from one of a
performance-based evaluation of goals to one of an understanding-based examination of goals.
The recommended solution is to support leadership to build a mastery goal orientation by
establishing small, achievable goals as stepping stones for reflection towards larger goals, and
encourage that goal setting and goal evaluation be engaged through a lens of learning and
understanding. For instance, when an employee retention program seems to be ineffective or
non-productive, the problem can be examined from the standpoint of how the program could or
should perform better, as well as from the standpoint of understanding and learning about the
underlying program design, the program implementation, and the fundamental elements of why
that program was initially developed. Knowledge obtained by viewing the problem through a
mastery goal orientation may also be applied across many programs.
The role of goal setting is generally rooted in motivating behavior, while goal orientation
addresses the purposes or reasons for engaging in achievement (Rueda, 2011). A mastery goal
orientation is generally related to adaptive outcomes and often taps into metacognitive skills,
building increased interest in understanding the workings behind goal attainment (Yough &
Anderman, 2006). Individuals with a mastery goal orientation seek deep and comprehensive
understanding of challenges and will persist to find solutions in the face of failures (Cerasoli &
Ford, 2013). Given the current employee retention challenges faced by senior leadership in
assisted living, it would seem a natural fit for leadership to desire greater metacognitive
strategies through mastery goal orientation that would ultimately influence performance
behaviors and outcomes (Cerasoli & Ford, 2013). Without question, the purpose and reasons for
LEADERSHIP AND SENIOR ASSISTED LIVING 63

engaging in achievement-oriented tasks within senior assisted living is abundantly clear. The
employee retention challenges within the industry directly impact the level and consistency of
care elders experience while in the care of the assisted living community.
Organizational Influences
Organizational culture has a direct and sizeable influence on all aspects of an
organization's functioning, and improvement efforts will depend heavily on that culture (Clark &
Estes, 2008). Participants in this study were questioned about both cultural models and cultural
settings that may be influencing employee retention efforts. All participants reported having
highly supportive cultural models where employee retention was seen as a top priority. In
addition, all participants reported having ample resources allocated to address the employee
retention challenges. In this study, there were no identified needs in either cultural model or
cultural setting areas.
Cultural model and setting not identified as a need. Both the cultural model of having
a culture that values retention, and the cultural setting of having a culture that provides resources,
were not identified as needs within the context of this study. All participants reported having
organizational cultures that recognized the importance of and offered resources for employee
retention efforts. Although there were no needs in these areas, it is important to reiterate that
these two organizational cultural aspects are crucial to successful retention efforts. Research
indicates that new employees who are working within environments that promote a culture of
interpersonal relationships and support employee retention with necessary resources have new
employees stay a period of 14 months longer than those working within unsupportive or task
oriented environments (Sheridan, 1992). Organizations with these two aspects are far better
LEADERSHIP AND SENIOR ASSISTED LIVING 64

suited to succeed with retention efforts than their counterparts who may have organizational
cultures lacking in retention value and/or resources.
Limitations and Delimitations

This study was limited by surveying a small sample of 10 senior leaders within the
private senior assisted living industry. Senior leadership was defined as anyone working within
an assisted living private industry company within the top three tiers of the organization’s
company structure at either the corporate level or community level. Generally, position titles
may include CEO and Regional VP Level for corporate enterprises and Executive Director and
Department Manager for community organizations. Additional limitations included looking only
at knowledge, motivation, and organizational influences. This was a non-generalizable study.
The delimitations of this study include not being limited by any one organization’s size or
structure.
Recommendations for Further Research
Future research may include a larger sample of leadership, qualitative and/or quantitative
data gathered directly from frontline workers, and reaching out to international communities to
learn if they face similar challenges and how they are addressing those challenges. It is
recommended that further research be conducted as a means to better understand how various
retention strategies impact employee retention or attrition, to identify industry best practices for
better employee retention rates and long-term career paths within senior assisted living, and to
develop consistent and commonly used metrics for measuring employee retention numbers
industry-wide.

LEADERSHIP AND SENIOR ASSISTED LIVING 65

Conclusion
The impact of challenges associated with low employee retention in the senior assisted
living industry are serious and far-reaching. Facing a 1.2 million employee shortfall through
2025, it is imperative the assisted living industry develop effective strategies to curb employee
turnover, reduce costs associated with employee replacement, and develop a stable and dedicated
workforce to promote consistency of care for the seniors across our nation. The senior assisted
living industry within the United States shares a global goal of improving employee retention
and promoting long-term career growth for employees in all levels of service within the industry.
Using a KMO framework (Clark & Estes, 2008), this study identified recommendations tied to
knowledge, motivation, and organizational culture, which may lead to increased employee
retention and long-term career paths within the senior assisted living industry.

LEADERSHIP AND SENIOR ASSISTED LIVING 66

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Appendix A

Participating Stakeholders with Sampling Criteria for Interview

Participating Stakeholders
Interview Sampling Criteria and Rationale
Criterion 1. Participants must be a top three tier leader within the senior assisted living
industry within either the corporate level or the community level, as defined by direct interaction
with the senior citizen community.
Criterion 2. Participants must be actively working as a leader within a senior assisted
living organization based in the United States.
Criterion 3. Participants must voluntarily sign up for the interview via the link
connection found in the invitation email.
Interview (Recruitment) Strategy and Rationale
Potential participants were invited via email through Argentum and other sources. The
researcher hand-selected those professionals chosen to interview based upon participant position
and availability. In an effort to gain insight from a variety of participant types, the researcher
selected candidates who were diverse in both years of experience, geographical location, type of
position held, and other miscellaneous factors. Once interviewees were selected, an email was
issued to the volunteers restating the reason for the interview, purpose of the study, privacy
details, and a link to schedule the interview time. Participants were given the option to decline
the interview. A calendar invite was sent once the interview was scheduled and a reminder email
was sent to participants 24 hours prior to the interview time. Interviews were conducted via
recorded conference call and then sent for transcription. Ten industry leaders were interviewed
for this study.
LEADERSHIP AND SENIOR ASSISTED LIVING 74

Appendix B
Qualitative Protocols and Interview Questions
Industry leadership received an invitation email with volunteer sign-up link which read:
Dear XXXX,
My name is Mia Adler Ozair and I am a doctoral student at University of Southern
California conducting research related to the assisted living industry. Your contact information
has been provided to me by (insert source). (Source) has identified you as someone who
possesses important knowledge about the industry and who may be interested in participating in
my research study.
The purpose of this study is to better understand the connection between retention and
career-paths as relates to the building of a workforce ultimately committed to positions within
the assisted living industry. Using the Clark and Estes’ (2008) gap analysis model, it will
explore: what effective leadership influence means to retention of employees; how it is or is not
utilized within the organizational structure and culture; and what current leadership feel are the
essential ingredients to retaining employees and building a dedicated workforce.
Interviews will be approximately 30 to 60 minutes in length. You can schedule an
interview through this link: https://calendly.com/adleroza/research-interview-with-mia-adler-
ozair
The consent form is attached. I'm also happy to answer any questions you may have. Thank you
in advance for considering participation and I hope to speak with you soon.
Best,
Mia Adler Ozair

LEADERSHIP AND SENIOR ASSISTED LIVING 75

The following are the questions asked of participants:
Basic demographics
My position title is: _________________
I have held this position for: _____ months _______ years
How large is the assisted living community you work with? (number of total employees and
direct reports)
I have worked within the assisted living industry for: _______ months________ years
Introductory questions
IQ1: Please share how you came to work in the senior assisted living Industry.
IQ2: What brought you to the leadership position you currently hold?
Knowledge
K1 (metacognitive). How do you reflect on issues of employee retention within your
organization? Do you have a system or strategy for thinking deeply about
your organization’s retention rates? If so, what is it?
K1 (metacognitive). How may your reflection practices compare to other leaderships’
practices in
the assisted living industry as a whole?
K2 (conceptual). What types of employee retention strategies are you familiar with?
K3 (procedural). What retention strategies are you currently implementing to increase
employee retention? Follow up: How effective are they? How do you
measure their effectiveness? Are there specific areas of training and/or
LEADERSHIP AND SENIOR ASSISTED LIVING 76

employee relations that you feel you would like to know more about?
Motivation
M1 (self-efficacy). How would you describe your current confidence level as a leader in
being able to retain employees within your organization? Follow up: What contributes to
your level of confidence?
M2 (value). What, if anything, motivates you to experiment with different employee
retention strategies? How important is it to implement retention strategies in
your organization? In the field?
M3 (goal orientation). If an increase in employee retention is the organizational goal, how
would you as a leader approach the goal in the bigger picture of the organization?
Cultural models/cultural settings
CM1. How would you describe the culture of your organization as relates to
employee retention? Are there others who engage in
evaluating/addressing/reflecting upon organizational retention?
CS1. What are the organization’s goals as relate to employee retention? What
types of resources does your organization make available to support those goals? What
necessary resources are lacking to accomplish retention goals?
Concluding questions for broader perspective
C1. What are the major challenges you are facing in managing employee retention? What
obstacles and restraints have you faced and how have you/have you overcome/addressed
them?
C2. What are the key factors you feel facilitate successful employee retention within senior
assisted living?
LEADERSHIP AND SENIOR ASSISTED LIVING 77

C3. Is there anything else you would like to share with me about retention efforts in your
organization or about the industry in general that we have not already covered?

LEADERSHIP AND SENIOR ASSISTED LIVING 78

Appendix C

Credibility and Trustworthiness

The concept of credibility touches on the researcher’s ability to be believable, rigorous in
the inquiry process, and make a valuable contribution to the knowledge on the subject matter at
hand (O’Leary, 2004). To maintain credibility and trustworthiness throughout the research
process, this researcher engaged in internal consistency as a qualitative interviewer. In addition,
the research was matched to reality to ensure high internal validity (Merriam & Tisdell, 2016).
Consistent presentation and line of questioning throughout the interviews was crucial in ensuring
the data being collected is in response to predetermined questions (Salkind, 2017). In addition,
member checks were conducted with a selection of interviewees to ensure the accuracy of data
collection and analysis (Merriam & Tisdell, 2016). To build trustworthiness, this researcher
developed a rapport with interviewees by being transparent, authentic, and reflective (Merriam &
Tisdell, 2016). Finally, the process of preparation for data collection, data collection, and data
analysis took place over a four-month period, providing ample time to triple check accuracy,
integrity, and process of the research.

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Appendix D
Ethics
This dissertation study was not conducted within one organization; rather, it included
high-level leadership from a broad spectrum of organizations within the senior assisted living
industry. The study took place through recorded conference call interviews of a select sample of
leadership. The researcher did not have any direct-report relationships with the leadership
interviewed as either supervisor or subordinate. As a result, there were no potential problems
related to power influences on study participants. The researcher’s role was as a colleague
conducting research to assist in understanding the employee retention issues facing the assisted
living leadership community, as well as to gather data on what current leadership may believe
about improving retention and promoting career longevity within the industry. Identities of the
interview participants were protected at all times. Prior to data collection, all research protocols
were approved by the Internal Review Board (IRB) to ensure interview protocol met the highest
standards of the scientific community and protected the welfare and integrity of all participants.
Leadership were invited without coercion or obligation. Interview questions were open-
ended and neutral, allowing the participants to fully express their views without influence
(Patton, 2002). Informed consent was obtained from all participants. In keeping with ethical
considerations, written consent to record and transcribe interviews was requested (Weiss, 1994).
Data was stored on the researcher’s conference call account, and only two individuals had access
to the data (the researcher and the transcriptionist). Questions were designed to maintain respect
for people of diverse backgrounds and allowed interviewees to explore their theories and
practices about employee retention within the senior assisted living industry. As an interviewer
on the subject of employee retention, this researcher addressed bias that effective retention
LEADERSHIP AND SENIOR ASSISTED LIVING 80

efforts are substantially important to building a sustainable pipeline of qualified, dedicated future
industry leaders. The researcher was attuned to interviewees to ensure that any negative
messages or associations regarding retention efforts were not subconsciously discounted.

LEADERSHIP AND SENIOR ASSISTED LIVING 81

Appendix E
Integrated Implementation and Evaluation Plan
Implementation and Evaluation Framework
The New World Kirkpatrick Model of implementation and evaluation is based upon four
levels, each targeting a different aspect of the outcome (Kirkpatrick & Kirkpatrick,
2016). Beginning with the end in mind, targeted outcomes will be identified and supported by
both metrics and methods through which to track and achieve desired results. The importance of
the four-leveled training is to view the outcome process as equally as important to the outcomes
themselves (Kirkpatrick & Kirkpatrick, 2016).
As defined by Kirkpatrick and Kirkpatrick (2016), each level serves a distinct and
important purpose, lending to the overall ability to evaluate and achieve goals for training and
organizational change. Level 1, the most basic level in the process, evaluates a participant’s
level of satisfaction with the programming and/or training experienced. Level 2 measures the
degree to which the participant has acquired new knowledge through the training
experience. Level 3 works to evaluate applied behavior within the workplace as a result of the
new knowledge gained. Finally, Level 4 looks at the overall results of the training and works to
evaluate if the desired impact of the training has actually been achieved (Kirkpatrick &
Kirkpatrick, 2016).
Organizational Purpose, Need, and Expectations
As previously discussed, the senior assisted living industry is facing a 1.4 million worker
shortfall until 2025. Senior leadership within assisted living organizations need effective tools
and metrics to improve and track employee retention outcomes. The goals for expected
LEADERSHIP AND SENIOR ASSISTED LIVING 82

outcomes are to increase employee retention, increase continuity of care for senior residents, and
promote long-term career paths for employees working within senior assisted living.
Level 4: Results and Leading Indicators
Kirkpatrick’s Level 4 results take a close and discerning look at the overall effectiveness
of the implemented efforts by examining both internal and external outcomes and the various
metrics and methods used to achieve them (Kirkpatrick & Kirkpatrick, 2016). Table E1
demonstrates the proposed outcomes for senior leadership and their organizations working to
improve employee retention.
Table E1

Outcomes, Metrics, and Methods for External and Internal Outcomes

Outcome Metric(s) Method(s)
External Outcomes
Seniors and their families
report increased satisfaction
with community employees
and continuity of care
100% of residents and their
families are satisfied with
employee continuity of care
Customer satisfaction
survey
Percentage of empty beds
drops as reputation for
excellent service increases
Facility vacancies consistently
decrease by organizationally
identified goal each calendar year
Annual facility
occupancy reports
Increase in quality and
quantity of applicants to fill
positions in all areas of
organization
100% of open positions have
ample applicants to interview for
placement
HR tracks position
postings and subsequent
application response
activity
Internal Outcomes
Increase in employee
retention/decrease in turnover
Employee turnover rates decrease
by 10% annually
HR tracks employee
turnover rates
Increase in employee
satisfaction and engagement
100% of employees report
satisfaction with working for the
organization
Employee satisfaction
survey
Increase in number of
employees who promote
internally into various
positions and levels of
responsibility
Minimum of 50% of new hires
promote into other positions
within the organization and/or
enter into a leadership
development track within first 6-
12 months of hire
HR tracks position
applicants who come
from within the
organization and who
enter formal leadership
training tracks
LEADERSHIP AND SENIOR ASSISTED LIVING 83

Decrease in employee
turnover costs related to all
aspects of new hires, training,
and costs related to
inconsistent resident care
Decrease in expenses year or year
related to employee hiring and
training of new employees
Finance department will
track all expenses
related to employee
turnover per department
heads and HR reports

Level 3: Behavior
Critical behaviors. Level 3 deals with critical behaviors defined by the extent to which
training participants apply learned knowledge. The stakeholders of focus are the senior leaders
within senior assisted living organizations. The first critical behavior that senior leaders must do
is set aside designated time to deeply reflect on employee retention efforts. This includes
consideration of the organization as a whole, as well as his or her own personal understanding of
the existing organizational retention challenges. These insights will then be shared with the
leadership team and/or key organizational management. The second critical behavior is for
senior leadership to know how to create and use key metrics to track the effectiveness of each
individual retention effort within the organization. The third critical behavior is for senior
leadership to increase self-efficacy on ability to successfully retain employees. The fourth
critical behavior is for senior leadership to develop a mastery goal orientation towards employee
retention efforts. The specific metrics, methods, and timing for each of these outcome behaviors
appears in Table E2.

LEADERSHIP AND SENIOR ASSISTED LIVING 84

Table E2

Critical Behaviors, Metrics, Methods, and Timing for Evaluation
Critical Behavior Metric(s)
Method(s)
Timing
1.Leaders designate
time to meaningfully
reflect on employee
retention efforts and
then share insights
with key
organizational
members
Amount of time
spent per week
engaged in
metacognitive
reflective practice
followed by group
discussion
Senior leadership
submit planned
“reflection
schedule” to
supervisor as a part
of ongoing
performance
evaluation
To be measured once
per month
2.Leaders create and
implement program-
specific metrics to
better evaluate
effectiveness of each
employee retention
effort
Each employee
retention effort
identified and
matched with an
accompanying
metric
Metrics are tracked
in coordination with
HR assistance via an
agreed upon
tracking system that
is part of the
employee retention
effort
To be measured
monthly by reviewing
every employee
retention program
effort or new launch
according to the
assigned metric per
program
3. Leadership develop
new and improved
employee retention
strategies
Improvement in
employee retention
numbers per
organizational goals
HR maintains
metrics of employee
retention data.
Initial training session
followed by practical
tools such as
journaling, observation
sharing, and other to
encourage viewing
retention through a
mastery goal
orientation lens
measured annually

Required drivers. Initiatives by senior leaders require support and encouragement to
promote innovative and new employee retention efforts. Required drivers provide the reward
and motivation to reinforce application of acquired knowledge and to encourage the critical
behaviors necessary to accomplish organizational goals (Kirkpatrick & Kirkpatrick,
2016). Table E3 identifies the required drivers necessary for senior leadership in assisted living.

LEADERSHIP AND SENIOR ASSISTED LIVING 85

Table E3
Required Drivers to Support Critical Behaviors
Method(s) Timing
Critical
Behaviors
Supported
1, 2, 3 Etc.
Reinforcing
Professional development seminars focusing on senior leadership
engagement with employee retention efforts
Monthly 1, 2, 3
Team meetings to evaluate, innovate, and implement program-
specific metrics for each employee retention program
Weekly 1, 2, 3
Access to internal on-line discussion board where senior
leadership and key department heads may openly question and
discuss employee retention challenges as they arise
Ongoing 1, 2, 3
Strategic communication efforts from HR including email
updates to senior leadership and key department heads on
monthly retention numbers as well as friendly reminders to
leadership to engage in their active reflection processes
Monthly 1, 2, 3
Encouraging
Collaboration with senior leadership team and key directors
during reflection meetings
Monthly 1, 2, 3
Establish mentoring partners among the senior leadership team
and key departmental heads
Ongoing 1, 2, 3
Rewarding
Performance incentive when employee retention numbers
increase by a chosen percentage
Quarterly 1, 2, 3
Public acknowledgment of key benchmarks for organizational
and departmental employee retention numbers
Monthly 1, 2, 3
Monitoring
Senior leadership team participate in shared Google doc to record
and comment on all development of employee retention programs
and corresponding metrics
Ongoing 1, 2, 3
Key department heads report to senior leadership team
on creation and implementation of employee retention programs
and experienced outcomes from those behaviors
Ongoing 1, 2, 3

Organizational support. To effectively implement critical behaviors and required
drivers, the organization will be required to support senior leadership and other relevant
stakeholders in their processes towards improved employee retention. Senior leadership will
need to be given the flexibility and time to implement a strategic and consistent reflection
LEADERSHIP AND SENIOR ASSISTED LIVING 86

process that can be shared with the entire leadership team. Leadership at various levels will need
access to proper training and professional development organized by the human resources
department. All key stakeholders must have the necessary information and programmatic support
to launch and measure the efficiency of various employee retention efforts. The organization
will also need to provide the proper level of financial and technical support as necessary to create
any new programs, online portals, or other costs necessary to support senior leadership in their
efforts to increase employee retention.
Level 2: Learning
Learning goals. The learning goals for the stakeholders, senior leadership, are as follows:
1. Know how to design and implement new employee retention efforts
2. Know how to revise and improve existing employee retention efforts based upon
feedback from appropriate metrics for those programs
3. Know how to design appropriate metrics for each employee retention program and
analyze and use the data that comes from them to inform future decisions
Program. Although active reflection is identified as an important metacognitive
knowledge influence, that influence will be supported through job aids and will not be discussed
in this section. The procedural knowledge influence of the leadership need to know how to
effectively retain employees is one that should be supported through leadership training and
workshops that address both employee retention programs and the accompanying metrics for
each program. It is recommended that a pre-training survey be sent out one week prior to
training to gauge leadership interest in and willingness to engage with employee retention
program evaluation and development. The survey should measure how leadership feel about
their own abilities to engage with said activities, as well as their views on how necessary they
LEADERSHIP AND SENIOR ASSISTED LIVING 87

feel this type of training is. Senior leadership may wish to invite key department heads and
human resources leadership to join in these events.
The training for this knowledge influence should take place in two phases, with the first
phase focusing on existing retention programs and metrics and the second phase focusing on the
development of new retention programs and metrics. The training/workshops should begin with
instruction on what elements constitute an employee retention program, the goals of such
programs, and the value and benefit of positive outcomes if the program is effective. Once
leadership have developed a consensus on retention program goals and definitions for, phase one
of the training will involve current organizational retention programs being reviewed with
discussions on how effective the current programs are, including cost/benefit ratio. If metrics are
currently tied to a retention program, they should be reviewed for effectiveness. If there are no
metrics for a program, they should be created with group consensus based on what outcomes
should be measured. Once existing retention programs have undergone review and revision,
phase two of the training will include the discussion and development of new employee retention
programs with corresponding metrics for measuring outcomes. Both phase one and phase two
may take place over the course of several sessions and several weeks, or may take place in an
intensive two- or three-day workshop format. All retention programs and metrics that result
from the training should be reviewed on a monthly basis for program effectiveness via leadership
discussion and metrics outcomes. If necessary or deemed desired, leadership should engage in
these trainings and workshops every six months to build momentum towards effective employee
retention, and consistently revise and improve programs with leadership support and consensus.
LEADERSHIP AND SENIOR ASSISTED LIVING 88

Evaluation of the components of learning. Effective evaluation of all learning
programs is essential to the efficiency and relevancy of all training and workshop efforts. Table
E4 demonstrates key aspects to gauge participant learning.
Table E4
Evaluation of the Components of Learning for the Program
Method(s) or Activity(ies) Timing
Declarative Knowledge “I know it.”
Knowledge checks on how to create and
evaluate retention programs
Survey sent prior to training and then at the end
of the training
Submit draft of potential metrics to
measure effectiveness of retention
programs
To be submitted after group work during
workshops and training
Procedural Skills “I can do it right
now.”

Active engagement by leadership in
evaluation of existing employee retention
programs
During the workshop to evaluation existing
programs
Active engagement by leadership in
retention program development and
metrics design
During the training addressing retention program
and metrics design
Submit draft of proposed changes to
existing retention programs along with
draft of potentially new retention programs
To be submitted after group work during
workshops and training sessions
Attitude “I believe this is worthwhile.”
Discussion on the value of being asked to
evaluate and create employee retention
programs
Discuss led by instructor during workshop and
training
Observation by instructor on participant
comments and attitudes
During all group sessions
Confidence “I think I can do it on the
job.”

Evaluate self-efficacy and confidence of
leadership to engage in evaluation of and
development of retention programs
Survey given before, during, and after training or
instructor observation of participation and
participant comments of confidence during
exercises
Commitment “I will do it on the job.”
Pre- and post-commitment assessment on
how senior leadership intend to implement
retention efforts
Before and after training
LEADERSHIP AND SENIOR ASSISTED LIVING 89

Follow up reporting on senior leadership
actions taken
One month post training via survey of senior
leadership and possibly a focus group with
senior leadership

Level 1: Reaction
Level 1 measures how participants have experienced the learning events. Table E5
describes ways to effectively measure participant experience in order to ensure their learning
experience was as expected and/or desired.
Table E5
Components to Measure Reactions to the Program
Method(s) or Tool(s) Timing
Engagement
Instructor observation of participant
engagement
Throughout learning event
Attendance At each event
Course evaluation At the end of each event session
Brief Q and A to test active listening Ongoing throughout training at the conclusion of
each important segment of learning
Relevance
Instructor checks in with participants to
gauge interest in the learning
Every 30 minutes during instruction and
engagement time
Customer Satisfaction
Brief survey of participants either online,
in person, or via discussion
At the conclusion of each learning event

Evaluation Tools
Immediately following the program implementation. As a means to evaluate Levels 1
and 2, the evaluation instrument included in Appendix A may be used. This instrument will
address the knowledge, motivation, and organizational elements tied to the learning goals. The
purpose of Level 1 and Level 2 evaluation is to gain insight into participant experience and basic
knowledge learned. This survey would be given immediately following the learning event.
LEADERSHIP AND SENIOR ASSISTED LIVING 90

Delayed for a period after the program implementation. As a means to evaluate the
entire learning experience after a one-month period of time, the evaluation instrument in
Appendix B may be used. The purpose of this evaluation instrument is to gain further insight
into the Level 1 and Level 2 experience, plus add the dimensions of any changed behaviors and
results that may have stemmed from the learning experience. It is recommended to wait one
month prior to administering this evaluation tool so participants have time to process, integrate,
and apply the learning in their daily work within their organizations.
Data Analysis and Reporting
Data analysis and reporting should be a consistent and ongoing process with both
formative and summative evaluation results of participant engagement and measured outcomes
from all learning events. Surveys and results should be presented in concise, digestible pieces of
information that include both qualitative and quantitative data (Kirkpatrick & Kirkpatrick, 2016).
Quantitative data may be presented in a format such as seen in Table E6. Qualitative data may
include things such as quotations or comments from stakeholder participants that capture themes
about the learning event and application of learning.
Table E6
Sample Data Analysis and Reporting, Quantitative
Action/Result Target Actual Previous
Month
*Rating (see
scale below)
Critical Behaviors
Leaders who designated reflection time
towards retention issues and shared
insights with leadership team
100% 73% 66%
😊
LEADERSHIP AND SENIOR ASSISTED LIVING 91

Leaders who engaged in reviewing
existing retention programs and metrics
100% 100% 100%
😃
Leaders who engaged in developing new
retention programs and metrics
100% 81% 95%
😣
Leading Indicators
Percentage of residents and families
reporting satisfaction with employees and
continuity of care
100% 95% 82%
😊
Employees who engaged with career path
plans within the organization
80% 50% 32%
😐
Employees who expressed satisfaction and
demonstrate job engagement
100% 72% 71%
😕
Percentages of employees who left within
first six months
10% or
less
32% 47%
😊

😃 =Great work 😊 =On the right track 😕 =Needs work 😣 =SOS
Summary
The implementation and evaluation plan outlined in this section utilizes the New World
Kirkpatrick Model to organize and articulate critical behaviors, leading indicators, and
appropriate learning events to support organizational goals and outcomes (Kirkpatrick &
Kirpatrick, 2016). In addition, it provides means and methods for how to present data analysis
and reporting to effectively share outcomes with key stakeholders to drive future performance
and action. The plan outlines four levels of engagement and metrics to determine if participants
LEADERSHIP AND SENIOR ASSISTED LIVING 92

learned and applied knowledge from the trainings and workshops offered. Level 4 results
provide the most in-depth look at the impact learning has had on actual job performance and
desired outcomes. Level 3 examines the behaviors resulting from participant engagement and
retention and application of new knowledge. Level 2 is the actual learning that takes place,
which is followed by feedback to the instructor and program creators as to how the participants
felt about various aspects of the learning event in Level 1. These levels and the corresponding
tools for data analysis and presentation will support senior leadership in the implementation and
evaluation of the study recommendations.

LEADERSHIP AND SENIOR ASSISTED LIVING 93

Appendix F
Training Survey Immediately Following Learning Event
(Levels One and Two Evaluation)
Employee Name (Optional)______________________________ Date: ___________________

Event title: ______________________________________ Instructor: ____________________

Please rate the following: Strongly
Agree
😃
Agree
😊
Disagree
😕
Strongly
Disagree
😣
This program was interesting

The training environment was
conducive to learning

The instructor was engaging and
encouraged my participation

The learning was of value and I will
take what I learned and apply it to my
work

I am clear on how to apply my new
knowledge to my job

I would recommend this training to my
coworkers

I feel confident that I will retain and
apply what I have learned

The organization seems supportive and
I anticipate being personally supported
as I implement this new knowledge

I am fully committed to applying what I
have learned

I see value in the training provided to us

The training environment could have been improved by:

LEADERSHIP AND SENIOR ASSISTED LIVING 94

My favorite content learned in the training is:

The most applicable content learned in the training to my work is:

The support I will need in order to fully integrate and apply this knew knowledge is:

The knowledge I am most excited to begin applying is:

The outcomes I am hoping to achieve as a result of applying the learning today are:

LEADERSHIP AND SENIOR ASSISTED LIVING 95

Appendix G
Delayed Training Survey Form
Employee Name (Optional)______________________________ Date: ___________________

Event title: ______________________________________ Instructor: ____________________

Please rate the following: Strongly
Agree
😃
Agree
😊
Disagree
😕
Strongly
Disagree
😣
The information shared in the training
has been helpful in my job.

I have applied what I learned since the
training took place.

In hindsight, the training was very
valuable.

I have received plenty of support in
follow up to the training.

My efforts have lent to contributing
towards improved employee retention

The knowledge that I apply most often in my work as a result of the training is:

I believe the following to be the most important outcome of the training:

I am still needing the following in order to fully maximize the learning from the training:

LEADERSHIP AND SENIOR ASSISTED LIVING 96

I have encountered the following challenges while trying to implement what I had learned:

I believe the following would be the best next course of action to support organizational goals
towards the learning:

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Asset Metadata

Creator Adler Ozair, Mia Sharon (author)

Core Title Leadership engagement to promote employee retention and career paths within the senior assisted living industry

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Publication Date 09/20/2019

Defense Date 07/03/2019

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag OAI-PMH Harvest,senior assisted living, employee retention, attrition, leadership, baby boomers, quality of care, employee development, retention strategy, senior care

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Hirabayashi, Kimberly (committee chair)

Creator Email adleroza@usc.edu,miaadlerozair@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-219422

Unique identifier UC11675002

Identifier etd-AdlerOzair-7832.pdf (filename),usctheses-c89-219422 (legacy record id)

Legacy Identifier etd-AdlerOzair-7832.pdf

Dmrecord 219422

Document Type Dissertation

Rights Adler Ozair, Mia Sharon

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA