Organizational Health
(10 Minute Read)

The Long-term Care industry has a real talent problem. How can they adjust to attract and retain high quality employees?

The COVID-19 pandemic has impacted us all, but it has had a disproportionate impact on older adults and individuals with multiple chronic conditions or other health risk factors. While many measures have been taken to address the spread of the virus, its impact is highlighting a problem in the long-term care (LTC) industry that predates COVID-19: attracting and retaining employees.  

Demand for LTC is only going to keep climbing. It is projected that the proportion of the population over 80 years old will double by 2050, and that there will only be two people of working age for every person over 65 [1]. This increasing proportion of old age dependency will put a strain on the current talent pool and will make it critical that LTC organizations can recruit, train, and keep additional employees. Demand for care is rising, the supply of workers is decreasing. As more people live long lives, what can LTC companies do to overcome the industry’s talent shortcomings.  

Industry breakdown

There are some trends in the long-term care industry that need to be addressed. Over the two-year period from 2019 to 2021, the industry is on pace to lose $94 billion in the U.S. as expenditures on staffing and supplies have risen, while occupancy rates have decreased.  Talent remains at the epicenter, with nursing homes spending about $30 billion on staffing and personal protective equipment just last year. [2]  As margins decrease LTC organizations face difficult decisions on pricing their services and setting their wages.

The demographics of LTC staff are also worth noting. The Organization for Economic Co-operation and Development (OECD) conducted a world-wide study of the LTC workforce and found that across the board, staff were overwhelmingly women and mostly middle aged, and that 70% were personal care workers in homes or institutions with just 30% being nurses in those same settings. [1] One of the primary takeaways here is that the industry overall has a narrow talent pool to pull from and will need to expand if it hopes to cope with the need for staff in the coming years—the United States LTC industry is projected to need 60 to 70% more staff in the next 20 years.  

The third component worth looking at is the work itself. There are several dimensions of the job that could scare off qualified potential applicants. Generally, LTC workers are among the lowest paid for a given set of qualifications in the health care sector. There is also more job insecurity with non-standard employment (shift work, part-time etc.) being very common in the industry. Those who aren’t scared off at this point then face some of the most physically and mentally demanding work within the healthcare industry:

  • 60%+ have faced physical risk factors  
  • 46% have faced high psychological stress
  • 70% are undertrained or underqualified for the situations they face [1]

As you read what is basically a job description for long term care, it becomes easier to see why qualified talent is an issue within the industry. For many it is an unattractive prospect. Unfortunately, the need for talent will not slow down anytime soon. So how can an LTC company combat the industry trends and begin to attract new employees and retain their current team members?

Priority problem?

A brief search of “talent acquisition for elderly care” reveals something interesting. Many of the top searches are focused on recruitment tools or selling talent acquisition services or postings for the jobs themselves.

We conducted several searches that with spins on that same theme:

  • “Talent acquisition for nursing homes”
  • “Finding employees for long term care”
  • “Finding quality talent for elder care”

Across the searches, this theme of recruitment services persisted. The pervasive answer to the question LTC organizations are asking— “how do I attract and retain quality employees?”—seems to be to spend more on recruiting and get the company name in front of more people. Unfortunately, this doesn’t answer the question. Even if these tools and services get you in front of more potential candidates, and even manage to convert a few of them, how do you keep them with your organization? Among all these services and job offers there were a few articles here and there that focused on the underlying factor we believe will have far more long-term impact on your battle for talent—culture.

Culture matters

Culture is a hot topic in many industries and all too often it becomes this nebulous term involving a fun workplace with opportunities for team members to connect at happy hours, quirky benefits like free snacks, and giving employees more freedom to do things like work from home. This lack of definition tends to mean that there is a lack of concrete direction for an organization trying to improve their culture. We have set out to quantify culture along concrete dimensions of a company culture based on the modern adaptation of Maslow’s hierarchy of needs, along with some other foundational psychological theories, that will allow your team and your business to thrive.  

Long term care is no exception. A healthy culture will play a vital role for any LTC organization looking to rise above the challenges of talent acquisition, retention, and overall profitability. A healthy culture drives employee engagement, productivity, and can even become a competitive advantage in recruitment, attracting the best from your current talent pool and perhaps even expanding the limited talent pool that has become such a big part of the long-term care industry’s talent shortage. While every one of the dimensions is important, there are several that stand out that LTC’s should prioritize in their quest for a healthier culture: Feeling Valued, Safety, and Professional and Career Development.

Value your people

What does it mean to value your employees? A lot of people probably think it’s all about a dollar amount. However, value goes beyond compensation and benefits. In fact, financial compensation fits more squarely within our primal needs for food and shelter than it does within value. Value is based on our human desire to be esteemed. When thinking about how this applies in the workplace, your goal should be that employees can answer the following questions with a resounding yes:

  • Am I seen?
  • Am I heard?  
  • Am I valued?

How could this play out for a long-term care organization? Well, let’s get the topic everyone wants answers on out of the way: compensation and benefits.  

While pay is not the end all be all of valuing employees, it is connected. If employees feel that they are not fairly compensated for their work, how can they honestly answer the question “Am I valued?” with a yes? The OECD study mentioned above has demonstrated that across the LTC industry, employees are at a pay disadvantage compared to their peers. While this statement may make us unpopular, we stand behind it: examine what you are paying your people, compare it to the competition and then ask yourself if you are valuing your team members with your compensation packages.  

Seen, Heard, Valued

Valuing your team goes beyond money. Create an environment that focuses on recognizing your employees and giving them the ability to provide feedback on a regular basis. A Quantum Workplace study asked employees about their companies’ approach and found that only 12% believed that recognizing their efforts was a top priority, but 69% of them said they would work harder if they were appreciated more. [3] You could start an employee recognition program that rewards caretakers who go above and beyond. You can have regular check-ins with teams in order to let their voices be heard on everything from how to handle difficult patients, to how leadership could improve their daily work conditions.

Keep your people safe

When we reviewed industry specific research on workplace safety within long term care—what we found was appalling. Studies found that within the first year in LTC work, 61% of nurses had experienced workplace violence. They were also at high risk of verbal and psychological abuse. [4] As previously mentioned, 70% of LTC workers also reported they felt they were under trained or underqualified to deal with situations that arose at work. They face abusive patients, physically demanding tasks like moving handicapped individuals, and soft-skill intensive situations like angry family members. It is challenging and dangerous work.  

If you run an LTC organization this should bother you on multiple levels. First and foremost, from a desire to protect your team. Secondly as a business owner. Studies have repeatedly shown that employees’ perceptions of your intentionality toward keeping them safe has an impact on both their engagement at work, and their intention to leave. [5]

Unfortunately, many companies’ definition of safety starts and ends with injuries and incidents that could cost them employee productivity and money. A healthy culture will require you to create an environment that keeps your employees safe physically, and psychologically.  

Physical Safety

Like many medical industries, long term care presents significant risks that your company should have strategies in place to address. Some of the most common injuries LTC workers are at risk for include:

  • Strains, sprains, or slipped discs from physical overexertion
  • Bloodborne pathogens
  • Infections
  • Broken bones
  • Injuries as a result of assault

Carefully consider your organization with a focus on safety risks. You may want to bring in a safety partner to examine both your training protocols as well as how your safety strategy plays out in practice. The goal is to have buy-in across every level of your organization to ensure that instead of reacting to accidents when they occur, you are proactively preventing them.  

Psychological Safety

Often neglected by traditional safety programs, psychological safety is nonetheless a vital component of a healthy culture. Fundamentally, it is the employee’s belief that they are safe from punishment or humiliation for speaking up with ideas, questions, and concerns. There are 4 primary stages of psychological safety to consider.  

  1. Inclusion Safety—the ability to connect and belong, accepted for who you are  
  1. Learner Safety—feeling safe to exchange in the learning process through asking questions, giving and receiving feedback, and making mistakes
  1. Contributor Safety—feeling safe to use one’s skills and abilities to make a difference and contribute to the organization
  1. Challenger Safety—feeling safe to challenge the norm when you believe that it should be changed or improved [6]

What does this look like in practice? Make psychological safety a priority. Give everyone in the team opportunities to express opinions. Leadership will pave the way by modeling the compassion and open-mindedness to new ideas that will need to be encouraged. Create opportunities for your employees to share new ideas and collaborate on how they could be implemented. When mistakes are made, focus on how to learn from them instead of shaming. You want to encourage learning, not sabotage it.  

For LTC organizations special considerations will need to be taken. Your team members will often have to interact with patients and their loved ones. You only have so much control over their words and actions, and yet they can have a tremendous impact on your people. Consider creating regular check-ins to discuss difficult patient situations and make sure that you have your team’s back—doing everything in your power to protect them from shame, abuse, and embarrassment from patients and their families.  

Develop your people

We previously discussed some of the factors that make LTC positions unattractive to the talent pool like low pay, low job security, and the difficulty of the work. One other factor that many LTC workers are scared off by is the lack of promotion prospects and opportunities to develop. In fact, many LTC workers leave for opportunities at hospitals, which provide them with opportunities to advance their career. [1] Let’s pause for a second and ask an important question: why does development matter?

The days of holding down one job throughout most of your life are over. In fact, the average individual holds 11 different jobs from the time they graduate high school until the age of 46. [7] The important note here is that they aren’t leaving for a pay raise. Instead, they are pursuing a new challenge, a chance to develop, the opportunity to learn new skills. 42% of employees reported that learning and development was the most important benefit a job could offer, while 55% said they would move on if their current employer wasn’t helping them grow their skillset. [8] The reality is that developing your team is crucial to your organization’s ability to attract and retain talent. It will also have an impact on job satisfaction, work engagement, and productivity, and create a workforce that gives you a competitive edge in your industry. [7] With the limited demographic pool of workers (middle-aged women) entering the LTC workforce, it is vital to create a new dynamic that could pull in individuals who have not previously considered working within the industry.


Of employees would leave if their current employer doesn't help them grow their skillset.

It might be easy to think that with LTC employees, who seem to come and go frequently and often work non-traditional schedules, investing in learning and career advancement is a waste of time and resources. But LTC workers are just like other people. They need the chance to learn, grow, and advance in their field. Not to mention you will have a more skilled and engaged team. So, what does career development look like for LTC organizations?

Give your team opportunities outside of their job function. Maybe it’s sitting in on and contributing to meetings to determine a patient’s care plan. It could be supervising a wing of your facility. The goal is to avoid rigidity in your process and let your people explore and learn in new environments. Have your leadership team go beyond the investment of dollars and pour your time, focus, and experience into your team. Perhaps most importantly of all—know your employees. What do they find rewarding and interesting? What are their goals? What elements of your organization do they want to learn more about or be a part of? Start listening and investing in your team today and watch them thrive.  

A starting point

Valuing your team, keeping them safe, and developing them will serve as a starting foundation for a healthy culture. But long-term care organizations can’t stop there. There are other dimensions of a healthy culture that can’t be ignored. But don’t let that overwhelm you. The most important thing is to start investing in your culture and conquer challenges one at a time. Over time, and with some hard work, you can expect your culture to change, your employees to engage, and your talent attraction and retention to transform. If you have any questions about the dimensions of a healthy culture, or how to implement improvements, we would love to learn more about you and your organization. Just follow this link to contact us!


  1. OECD (2020), Who Cares? Attracting and Retaining Care Workers for the Elderly, OECD Health Policy Studies, OECD Publishing, Paris,
  1. Leventhal, R. (2021). Analysis: Long-Term Care Industry Expected to Lose $94B By End of 2021. Healthcare Innovation. Retrieved November 10, 2021, from  
  1. Stange, J. (2020). 20 employee engagement statistics that impact your business. Employee Success Software. Retrieved November 3, 2021, from
  1. Fasanya, B. K., & Dada, E. A. (2016). Workplace Violence and Safety Issues in Long-Term Medical Care Facilities: Nurses’ Perspectives. Safety and health at work, 7(2), 97–101.
  1. Beyond safety outcomes: An investigation of the impact of safety climate on job satisfaction, employee engagement and turnover using social exchange theory as the theoretical framework, Applied Ergonomics, Volume 55, 2016, Pages 248-257, ISSN 0003-6870,
  1. What is psychological safety at work? CCL. (2021, August 4). Retrieved November 10, 2021, from  
  1. Importance of Career Development in organizational success. Fors Marsh Group. (2021). Retrieved November 10, 2021, from  
  1. Davis, A. (2019, December 31). Why your employees want you to focus on career growth, not just engagement. Visual Workforce. Retrieved November 10, 2021, from