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Great Leadership Is Not Magic or Myth, But It Takes Special Skills, Talents, Passions


Leadership in assisted living isn’t one-size-fits-all; and more than ever, leaders come from different backgrounds and training to bring fresh ideas and strategies to their work. There are many leadership styles, but the most successful leaders are innovators, risk-takers, mentors, teachers, students, listeners, communicators, collaborators, team players, realists, and dreamers.

With staffing shortages still impacting communities, razor-thin profit margins, and stiff competition to attract new residents, leaders at all levels need some combination of these traits, and at the same time they must be prepared to evolve and upskill to meet any and all challenges.

Modern Styles for Leadership Success

There are several defined leadership styles. In today’s market, the most common include:

  • Servant leadership. This concept has been around since the 1970s, but it has grown in popularity over the years. The philosophy is that the leader is a servant first who focuses on the growth and well-being of the people and community they work in. They put the needs of others first and prioritize helping their teams develop and perform. Servant leaders share power with others.
  • Transformational leadership. This style focuses on change and transformation, so it’s not surprising it is popular in the post-pandemic world where long-term care leaders are faced with the need to grow and apply lessons learned to reinvent the future. Transformational leaders seek to encourage and enable their teams to look ahead, and they identify and strategize for change. These leaders are very goal-focused, with an eye on long-term change, and they encourage their staff to follow suit. They work to help their teams develop the strengths and abilities they will need to be effective in the long term.
  • Delegative leadership. The focus of this style is delegating various tasks, projects, and initiatives to various team members. These leaders prioritize giving their teams the skills and tools they need to be effective and then trusting them to do their jobs and make decisions. Instead of micromanaging or closely overseeing day-to-day work, delegative leaders encourage their teams to use their creativity, resources, experience, and insights to meet their goals.
  • Empathetic leadership. These leaders focus on understanding everyone’s viewpoints and feelings. They express a real interest in their individual team members and seek to appreciate how staff think and what motivates them. This style has become increasingly popular in recent years, as it can help build trust, improve communication, and promote engagement and loyalty.
  • Authentic leadership. This is another style that has become more in vogue in recent times and focuses on transparency and ethical behaviors and openly and honestly sharing information with the team. The characteristics of these leaders include self-awareness, leading with heart, focus on long-term results, integrity, vision, listening skills, transparency, and consistency.
  • Authoritative (visionary) leadership. These leaders think of themselves as mentors to their teams. They aren’t dictators; instead, they set the path for others to follow. They work to promote a sense of accomplishment among their teams by providing direction, guidance, feedback, and motivation.
  • Transactional leadership. This leadership style emphasizes reward and punishment. This is less common in most assisted living settings, as cultures have evolved to focus on systems change, root-cause analyses, and avoiding blame and finger-pointing. Transactional leaders emphasize structure and rewards for meeting goals or completing tasks.
  • Participative leadership. These leader focus on listening to their employees and involving them in change and decision-making. They are inclusive, good communicators, and able and willing to share responsibility and accountability. As this type of leadership relies heavily on personal relationships and interactions, it can be challenging with remote and hybrid teams.

Whatever style leaders identify with, most agree that engaging and including teams is essential. As Tim Nelson, a principal at Olympus Retirement Living in Arizona, said, “When everything gets dictated from the top, people aren’t empowered to make decisions. Telling people what to do discourages creativity and innovation I believe in giving people ownership in the organization.”

This can be tricky, Nelson admitted, “We need to find out what motivates people and help them see the impact of their role in decision-making,” he said, adding that it’s always important to identify rewards that will resonate with each person, such as a new office, time off, or a trip to an educational conference.

The Recipe for Great Leaders

There is scant literature about leadership in assisted living, but studies involving nursing homes and long-term care in general suggest:

  • Servant leadership practiced by managers enabled them to engage the entire time to problem-solve and enable quality improvement.
  • Passive-avoidant leadership styles are “excessively present” in long-term care, suggesting a need to invest in leadership development in this care sector.
  • Relationship-oriented leadership contributes to higher job satisfaction and organizational commitment, as well as higher productivity.
  • Leaders should focus on active leadership, especially task-oriented behaviors such as structure, coordination, and clarifying staff roles.
  • Organizational performance is more closely connected to leadership experience than formal education.

The variety of studies make it clear that leaders don’t fit into one set mold or box, but they share various characteristics. These include, suggested Dave Creal, regional area director at Nebraska-based Hillcrest Health Services, critical/strategic thinking skills, emotional intelligence, active listening and strong communication skills, innovative spirit, empathy, resilience, integrity, honesty, self-confidence, self-motivation, self-discipline, vision, decision-making and problem-solving abilities, and a passion for their work.

Some people possess some of these traits naturally. However, although they generally aren’t taught in schools, many such “soft skills” can be learned. As Creal noted, “When I entered health care, I didn’t have a lot of these skills. I wasn’t a strategic thinker, and my emotional intelligence wasn’t what it should be. I learned a lot of these skills from the people I worked with.”

Today, he said, “Our company has a leadership training program and put people through a leadership boot camp where they learn much of this. We also have Leadership 101 and 102 programs that we put aspiring leaders through.”

In some organizations, leaders are encouraged to help each other upskill and grow. Collette Gray, president/CEO of Integral Senior Living and Solstice Senior Living, said, “We always encourage our leaders to share best practices and focus on providing avenues for our teams to do this easily. This creates a team of leaders who are all striving for the same goals and helps build camaraderie and culture within our organization.”

She added that leaders must understand how to build and maintain a healthy, viable culture. “Building a culture within your organization that supports leadership development is critical and creating clear leadership paths that help formulate goals and opportunities for advancement,” Gray explained. It is essential, she said, to build an environment where leaders are empowered to make decisions in a timely and effective manner. “We provide the training to support this effort, and this was key to our success during COVID,” she observed.

The Uniqueness of Assisted Living Leaders

While someone may lean toward one style or another, leaders in assisted living are a special breed. “We have to deal with creating a balance between maintaining a social model and caring for an increasingly medically complex resident population,” said Sarah Howd, MD, CMD, assistant professor of medicine and geriatrics at the University of Rochester, associate medical director of the Senior Living Practice at UR Medicine Geriatrics Group, and chair of AMDA—The Society for Post-Acute and Long-Term Care’s assisted living subcommittee.

“I think the best leaders in this sector are those who are realistic about what we can and can’t do and make decisions thoughtfully,” she said. “Leaders in assisted living need to promote clarity with staff, family, residents, and others.”

Kevin O’Neil, MD, CMD, chief medical officer at ALG Senior in Florida, noted, “As we transition to value-based care, it will be important for assisted living leaders to be part of the solution. We have to recognize that our residents have many health conditions; and while we can’t accommodate them all, we need to be conveners and bring services together to meet seniors’ health needs and avoid hospitalizations and ER visits.”

One challenge for leaders in assisted living is that data isn’t always consistent or extensive. “I am data-driven, but our business is a little more complicated because there sometimes is a lack of transparency from a data perspective. We often have to rely on self-reported data on issues such as occupancy,” said Joe Jedlowski, chairman and chief executive officer at Distinctive Living, a New Jersey-based senior housing operator and developer.

Instead of making decisions based solely on data, he suggested, assisted living leaders need to get out in the field, talk to their people, and engage experts to validate data points and make well-rounded decisions.

Nelson observed that in his own role as a leader, he needs to wear multiple hat…and he sees that as a good thing. “I get to do marketing, customer service, and team building. I see these things as the leader’s job, and you must be good at all of them.”

Building the Team

How leaders define their style impacts how they build their teams. For instance, Nelson said, “I see myself as an empowering leader. The people I’m looking for thrive on knowing they can have an impact and make a difference.”

Jedlowski on the other hand said he pictures himself as an innovative leader, tearing down walls. “I want people who aren’t afraid to challenge the status quo and don’t have the mindset of ‘we’ve always done it this way.’” He said that building his team was easy. “I chose people I have known for years. We’ve worked together for a long time, and we know each other’s strengths and weaknesses, and our values are aligned.”

When it comes to keeping a good team, Jedlowski said it’s important to realize that people don’t leave because of systems or processes but more likely because the culture is toxic. “This means faulty promises, lack of communication, and no transparency. We let people know from the start that we’re invested in them. We know what their goals are, and we set a clear direction for them to reach them,” he said.

Gray said her company’s philosophy for success when it comes to leadership is to provide community leaders with the autonomy to manage their business while providing them with ample resources, training, and support. “This philosophy has proven successful in our entire business approach and has resulted in our ability to be able to grow people from within, thereby promoting them and creating a deep bench strength.”

Leadership is an art, and sometimes this means things aren’t necessarily black and white. “Sometimes we learn by trial and error. The pandemic shone a light on how adaptable and agile leaders need to be. Those who weren’t able to adapt and adjust weren’t able to continue in their leadership roles,” says Creal.

“We learned that you can’t panic or overreact. You have to stay calm and model this for our teams.” Gray said, “Develop your leaders to be flexible and understand the need for change – innovation stems from change and ultimately will drive the future success for our industry.”

On top of everything else, O’Neil stressed that leaders need their values in the right order. Of course, work is important, and it’s especially satisfying when you love what you do.

“But as a physician, I’ve found that when people always put their work above everything else, they are not happy in their lives and often have health issues. We need balanced lives and people and activities outside of work that bring us joy and a sense of purpose.”