Marleah Kueler-Grahek

Long-term care organizations need to act purposefully to recruit and retain quality frontline leaders. While the lack of caregivers and nurses is a well-known problem, an increasing number of individuals in leadership roles are choosing to leave this industry to pursue opportunities outside of the field.

The line of thought that, in long-term care, “that’s just the job”, just isn’t cutting it anymore.

Our leaders are talented, caring and innovative – let’s explore some strategies to better care for them and retain them, including work-life balance alternatives, work efficiencies, outsourcing resources and supporting emotional well-being.

Long-term care leaders: One person’s shoulders are only so big

We know the heavy load that leaders in this industry carry, often taking on more to prevent their team from becoming overworked in fear of losing them. This is a critical contributor to the burnout common in these positions.

Share the responsibility

  • It is very common for our leaders to be on call 24 hours a day/7 days a week/365 days a year. There are not many jobs where that is the expectation, and yet we normalize this in our industry. Organizations should consider looking at how to share this “on-call” responsibility.
  • Implementing a “Weekend Manager” program where the leadership/management team forms a rotation to reduce off-hour phone calls to the administrator/director, as well as the need for them to come in unexpectedly on a weekend.
  • Outsourcing some services may be an opportunity to lighten the load for your front-line leaders, including services such as dietary, housekeeping, laundry, therapy, IT and some HR functions (e.g. FMLA and unemployment administration).

Empower employees

  • In order for the aforementioned items to be successful, effective delegation and cross-training need to occur. Organizations may need to provide training, tools, and resources to help leaders practice this skill.
  • Employees can be empowered to handle many concerns without escalation to a supervisor or administrator/director. Instilling trust and clear expectations with front-line employees can minimize formal resident/family complaints or grievances, in turn reducing the workload for front-line leaders.

Get involved

  • C-Suite visibility, involvement and support are essential to retaining long-term care leaders. Oftentimes, CEOs, COOs and other high-level leadership take more of a “hands-off” approach in an attempt to give front-line leaders freedom and space to perform. However, C-suite executives need to know how to support those who are on the front lines and be ready to jump in when needed.

Cut the fat

Long-term care leaders have a hard time answering, “What does your typical day look like?” These individuals really are jacks of all trades, masters of some. Organizations should take a look at everything that administrators/directors are responsible for and assess whether certain tasks can be delegated elsewhere or eliminated altogether.

Instill a “minimal meetings” culture where the preferred method of communication is a phone call or face-to-face conversation. It’s okay to break norms if it means fostering a happier, more productive team.

Care for the person inside of the leader

To curb the number of long-term care leaders leaving, and attract talented individuals into the field, organizations should consider actions that address the mental health and work-life balance of their leaders:

  • Ensure leaders are using paid time off (PTO). Consider an organizational policy for these individuals that mandates a “PTO lockout” in which they must take at least an entire workweek away with their e-mail disabled and no on-call responsibility.
  • Provide a multiple-month sabbatical as an option to administrators/directors for professional development, education, or mental health purposes. With extremely high-stress roles, one to two weeks is often just not enough time to reset and recharge. 
  • While we know front-line leaders need to be physically present at their facilities the majority of the time, there is still an opportunity to provide options for working remotely. If the long-term care industry does not incorporate remote work to some degree, leaders will continue to leave for positions where it is an option. 
  • Long-term care staff and leaders have persevered throughout the pandemic when our society has needed them most. Incorporating resilience training and exercises in work assignments have proven to improve employee morale. 

Great leaders will continue to leave the long-term care industry if things do not change. Taking care of your employees and prioritizing burnout prevention will translate into better care for the residents/clients of your organization.


Marleah Keuler Grahek is a risk manager at M3 Insurance, and former nursing home administrator. In her current role, Marleah works with long-term care providers to identify and develop risk management programs surrounding workers’ compensation and liability exposures.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.