Director of Business Development, Andrea Hunt explores why she believes Executive Search should be a greater priority for US Senior Living organisations.
Ask a senior living CEO if they’d bring in an outside firm to find their next COO or VPO, and watch the hesitation land. Ask the same question of a UK operator, and there’s no hesitation to watch – it’s simply how the job gets done. “Recruiter” has become a dirty word in US hiring. Say it in a boardroom here and people brace for a sales pitch instead of a search.
That gap isn’t a values difference. It’s a pricing problem – companies have decided the fee is the risk, when the real risk is assuming any recruiter, at any level, can do this work equally well.
A room full of AI, and an empty one on workforce
I attended the LeadingAge California BOLD Annual Conference & Expo in Palm Desert this past May. AI dominated the agenda — session after session, hallway conversation after hallway conversation. Meanwhile, the strongest sessions on the schedule, the ones addressing workforce and what actually drives today’s long-term care applicant, ran to sparse rooms.
Worth asking directly: is the AI focus partly avoidance? AI in this space is changing every quarter. Whatever gets presented as cutting-edge in May is a baseline assumption by the time the next conference rolls around. Workforce and leadership pipeline problems, on the other hand, are durable, unglamorous, and solvable with the right partner — which may be exactly why they get less stage time. It’s easier to talk about a tool than to admit the process for finding your next leader hasn’t changed in a decade.
Nobody was talking about executive search recruitment. Not once. In a room full of people worried about who will run their communities, the conversation never turned to how you actually go find that person.
I’m ready to talk about it.
“We have TA for that.”
Here’s the response I hear most often when I raise an open community-level, regional, VP, or C-suite role with a CEO: we have TA for that.
They’re not wrong — for part of it. Since around 2022, many larger senior living providers have built strong in-house recruitment teams, and those teams have earned their place handling community-level searches, including Executive Directors and department heads [1]. That’s real progress.
But the question that response glosses over: does the recruiter who filled your last ED role have the market intelligence, network, and compensation data to approach a sitting VPO or COO at a competitor who isn’t looking for a job? Has that recruiter built relationships with the handful of people in the country who could actually step into the VP-level or C-suite role you’re trying to fill? Internal recruiting functions are increasingly capable generalists – but the data on how in-house executive search actually matures points the same direction every time: external partners take on the specialist, senior-level work precisely because it isn’t the same discipline as high-volume hiring [2].
Every organization in this industry will say leadership is its most important investment. Far fewer put money behind finding it at the level where it matters most.
The network trap
The other answer I hear, less often out loud but just as common in practice: we’ll go to our network. Someone we know, someone we’ve worked with.
That’s not a search. That’s a shortcut, and it carries its own risk.
When was the last time that person was actually screened – thoroughly, not socially? They may have been a top performer three years ago. Has anyone looked at their metrics since? Their current numbers, not their reputation from the last job? Any licensing issues since then? Any reputational flags that wouldn’t surface in a friendly reference call from someone who already likes them?
A warm relationship is not due diligence. It’s the opposite of it – it’s the condition under which due diligence is most likely to get skipped.
Screening should be more than matching keywords
Wouldn’t you want someone in your corner with the tenacity, skill, and network to represent your organization when approaching a candidate who is well situated, with no intention of moving – until someone presents an opportunity that changes their professional and personal trajectory?
That’s not a skillset you post your way into.
When my team runs an intake on a new role, we get into the specifics: the challenges, the numbers, why the role is open, how long it’s been open, and why the current approach to filling it isn’t working. Posting on LinkedIn or Indeed and hoping the right person applies isn’t a strategy at the leadership level. It’s a bet.
Screening a leadership candidate isn’t a keyword match. It’s listening to voice, pace, hesitation, and the jargon people reach for when an answer is thinner than it sounds. Those are the signals that decide whether we stand behind a candidate and put our name on the introduction. That judgment is the job, and it’s the part that doesn’t scale down to a job board or up from a warm intro.
Let’s do the math here
Take an open VP of Operations seat as an example.
The seat itself. Senior-living-specific vacancy research puts the cost of an open leadership role at two to five times the position’s annual salary – not the salary saved, the cost incurred [3]. For a regional VP Ops role at a 25–40 community portfolio, comp typically runs $190K–$284K [4]. That’s $440K to $1.1M gone before anything else happens, and it isn’t an abstract multiplier. It’s four things stacking on top of each other the moment the seat empties:
- Interim coverage. Someone still has to run operations – a promoted-from-within stopgap, a fractional COO, or a consultant. Fractional COO retainers alone run $8,000–$16,000 a month against a full-time COO’s true employer cost of $280K–$320K a year once benefits and overhead are counted [6], and agencies placing interim executives typically add a 40–60% markup on top of the individual’s day rate [7]. Coverage is never free; it’s just billed differently.
- The search itself. Executive-level searches run months, not weeks. SHRM’s most recent benchmarking puts median executive cost-per-hire at $15,000 and median time-to-fill at 45 days [8] — and its broader average-based report puts executive cost-per-hire as high as $35,879, nearly seven times the cost of a non-executive hire [9]. Every week the seat sits open adds to that number, whether it’s agency spend or the fully-loaded cost of an internal team’s hours.
- Decision velocity. Capital approvals, vendor renegotiations, budget cycles, and portfolio-level initiatives stall without someone in the seat authorized to sign off. McKinsey’s research on executive decision-making found leaders already spend 37–40% of their time on decisions, and 61% call that time largely ineffective — costing a typical large company an estimated $250 million a year in wasted leadership time with every seat filled [10]. Pull one seat out of that equation and those decisions don’t vanish; they stall, or land on someone already stretched thin.
- Early disengagement. The leaders who report into that seat feel the instability first — before it ever shows up as an ED or DON resignation. Gallup’s research attributes 70% of the variance in a team’s engagement directly to its manager [11], and even in a stable market, manager engagement itself has fallen nine points since 2022 [12]. Pull the manager out entirely, and that’s the lever a portfolio loses first. This is the seed of what “the dominoes” describes next, not a duplicate of it.
The dominoes. A VPO’s job is keeping community-level vacancies from festering — pushing urgency on searches, staffing interim coverage, holding EDs and DONs accountable. Remove that person, and three open Executive Director seats and five open Director of Nursing seats stop being someone’s problem and start being everyone’s. Apply the same vacancy multiplier across those eight roles, and it’s another $1.5M to $4.5M a year.
The occupancy bleed. This is the part that should concern an owner most, because it’s the VPO’s actual job. Leadership vacancies slow tours, delay contact with families, and weaken referral relationships — the sales infrastructure a VPO exists to run. Current assisted living market occupancy sits at 87.9% [5]. A portfolio running 84% is leaving points on the table that a fully staffed operations layer typically recovers. Even a conservative 1–3 point recovery, on a 3,800-unit portfolio at $8K average rent, is worth $3.7M to $11M a year.
Add it up: an open VPO seat costs a portfolio this size somewhere between $5.6M and $16.6M annually. Call it $11M if you want one number for the boardroom.
Now the part that makes the fee conversation easy. A search fee at 25% of a $220K comp package runs $55,000. Against an $11M annual bleed, that’s not a cost. It’s the cheapest number on the page, and the only one that stops the bleeding.
The math doesn’t need embellishing. It just needs to be run.
Think about how this looks to a candidate
Look at the organizations in this industry with the strongest reputations – the ones consistently named as employers of choice, the ones with the occupancy and retention numbers everyone else is chasing. A striking number of them have a standing executive search partnership.
Coincidence? Possibly. Or an indicator that the organizations most serious about leadership treat finding it as a specialty worth paying for, not a task to absorb internally by default.
What it actually says about you
When a high-level candidate is approached by someone from an executive search firm, there’s a level of professionalism attached to it. It tells that candidate a company took the search seriously enough to bring in someone who specializes in finding exactly their profile.
That says something about the organization and its leadership: that they value expertise, trust the process, and expect the work to get done right – not the fastest, not the cheapest. Right.
Compass Associates has run executive search in elder care, behavioral health, and C-suite healthcare placements in the UK for over 16 years, well enough that we’re now PE-backed to build the same footprint here, starting with senior living. One of the starkest differences in moving into this market: in the UK, it’s nearly unheard of to post a VP or COO role on LinkedIn or Indeed. Here, it happens routinely.
Internal TA solved community-level hiring, and that’s worth recognizing. It was never built to solve this. It’s time senior living treated leadership search like the specialist function it is, before the next open VPO seat costs another portfolio $11 million to find out the hard way.
Looking for a specialist recruitment partner in US senior living?
Is your organization ready to talk about executive search? Meet me at the LifeSpan Network Annual Conference in Ocean City, MD, September 22–25, 2026. Coffee on me!
If you are planning growth, navigating succession, or looking for a recruitment partner who understands your market, I would welcome the conversation.
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Sources
[1] Compass Associates US, “What the US Senior Living Sector Really Needs to Fix Its Workforce Crisis,” 2026 [2] Buffkin/Baker, panel discussion on in-house executive search evolution featuring lululemon, Danaher, and TD Securities talent leaders, 2026 [3] The Visual Communication Guy, “The Real Cost of an Empty Corner Office,” 2026 [4] Salary.com, Regional VP Operations senior living compensation data, 2026 [5] National Investment Center for Seniors Housing & Care (NIC MAP), Q1 2026 occupancy data [6] Fractionus, “Fractional Executive Rates by Role: 2026 Benchmarks” [7] Kamyar Shah, “What a Fractional COO Actually Does in the First 90 Days,” 2026 [8] SHRM, 2026 Recruiting Executives Benchmarking (n=4,657) [9] SHRM, 2025 Benchmarking Report, released October 2025 [10] McKinsey Quarterly, “Decision Making in the Age of Urgency,” survey of 1,200+ managers [11] Gallup, State of the Global Workplace 2025 [12] Gallup, State of the Global Workplace 2026