As chief operating officer of The Evangelical Lutheran Good Samaritan Society, the largest not-for-profit provider of nursing homes and senior housing, Aimee Middleton understands that staffing will remain the top operational challenge in 2025, and while conquering labor problems will be no easy task, some solutions are already paying off.

Middleton sat down with Skilled Nursing News to discuss an array of workforce initiatives that are working for Good Sam as it looks ahead to the upcoming launch of a new campus – Founders’ Crossing – in 2026.

The organization’s workforce programs emphasize leadership retention through employee engagement surveys, an administrator council, a policy of prioritizing internal promotions, and an annual conference along with an in-house excellence awards program.

Good Sam is also focusing on succession planning and empowering young leaders, particularly members of Generation Z, through a special focus on this group in its Administrator-in-Training (AIT) program, she said.

“It’s not a question of whether a Gen Z staff member will be leading our industry. It’s a matter of how we’re going to support them and that’s why we’ve reimagined that program,” Middleton said.

Good Sam’s administrator council, which started two years ago, provides monthly feedback from field leaders. Meanwhile, an interim leader program underpins the organization’s policy to promote from within the organization.

In order to reduce turnover and increase the number of administrators and frontline workers, Good Sam also operates a program called Impact Your Retention. This has helped Good Sam’s leaders to recruit and retain team members, achieving a 10% increase in its 90-day retention rates, she said.

And finally, Good Sam is exploring AI tools and using technology to enhance efficiency and care quality for its residents with efforts aimed at cutting the burden on its workers, who are particularly difficult to come by in rural locations, Middleton said.

“[We’ll be] trying to focus on making all of our roles across our organization as efficient as possible. What we do now, it’s not going to change. But, it’s how we do that work that is really going to change,” she said.

The Sioux Falls, S.D.-based Good Samaritan Society has 200 locations in 17 states currently.

The following transcript has been edited for length and clarity.

SNN: What efforts is Good Sam making to ensure administrators stay in their roles for a long time?

Middleton: We engage in employee engagement surveys. Really proud of our results there. Last year as an organization, we had over 75% of our team members participate that in that gives us a really good poll for what is going on in all of our locations, and really to empower that leader, not to get just get people to take the survey, but then what do we do with that information afterwards. We also have an administrator council that I started a little over two years ago from a group of administrators from each of our geographical regions, if you will, that participate in a monthly one-on-one meeting with me. It can be the opportunity to highlight a lot of things that are going on with our organization, and for me to get that feedback directly from the field and our leaders

We also started this year, our location-based excellence awards. So we took several different quality metrics, people metrics, and we put all of that together so that locations could be empowered to create the culture and really get that entire team excited about the work that they’re doing and to be recognized for it.

We have an annual conference with leaders. We bring in all of our administrators [and] directors of nursing (DONs) knowing that those two roles impact so much in a building. We are really investing in them. This year’s conference [allowed] our leaders to take what they learned at this national conference back to their building. So how are they learning different leadership techniques, maybe using things like the strengths finder to then have those conversations and in their locations?

We’ve also tried to empower our leaders at the local level and create flexibility and encourage independent decision making.

SNN: How are you cultivating younger leaders?

Middleton: We’ve seen tremendous interest from young professionals who are interested in pursuing a career in long-term care, and we want to make sure that we’re setting up those leaders for success. So we’ve also been intentional about creating a better experience for Gen Z leaders, empowering them to be able to make decisions [and] also thinking through work life efficiencies and and hard wiring the support that they’re going to need.

And so we’ve worked on a lot of different things here as we think about bringing those AITs. So we have 10 in the program, and we’ve always had a really solid AIT program, but we’re changing it to really meet their needs. It’s not a question of whether a Gen Z staff member will be leading our industry. It’s a matter of how we’re going to support them and that’s why we’ve reimagined that program. So most of our participants are Gen Z.

We’re really excited about the perspective that they’re going to bring to our locations. So part of our AIT program is that they have a hands-on project that they complete, and I had the opportunity to listen to all of them last week go through all of their projects and what they’ve learned, and I could not be more proud of what they’ve come up with.

SNN: What are the short and long term implications of not having enough leaders at SNFs?

Middleton: We have everything to gain and nothing to lose by continuing to embrace leaders really talking to them about our industry, we have to really embrace that, that growth and innovation. Otherwise, you’re right, we will see a leadership crisis. And so really thinking about that administrator and that director, these two leadership positions are a major driver for the continuity in our locations, and we see that stability in these positions is really going to have that positive impact on our retention and our quality of life that we bring for our residents. And so we have a robust internal interim program. We have our own interims [leaders] when we have a leader leave, and we’re really working on training those new leaders, and making sure that we are filling that with an experienced, quality person that knows our culture and our policies. And that’s why we’re focusing so heavily on leadership development and training. You think about growing our workforce, we have an opportunity with our department heads in our locations already our leaders in dietary activities, nursing, maintenance, they really represent our future leader pipeline as well, and these are positions that are training and will be able to identify some top talent. Many of our positions today have been people that have gone on from these roles, and so thinking about career laddering and the mentorship opportunities will be crucial to how we continue to grow

SNN: What were some of the main operational challenges for Good Sam in 2025?

Middleton: Staffing and workforce really are the biggest challenges that have been there for

2024 and these impact everything that we do. I do anticipate that will continue, and I think we have to look for new, creative ways we’re going to need in the future.

And so [we’ll be] trying to focus on making all of our roles across our organization as efficient as possible. What we do now, it’s not going to change. But, it’s how we do that work that is really going to change.

And so we have a new campus – Founders’ Crossing – here in Sioux Falls, South Dakota, and it is going to be a new state-of-the-art-campus. We’re really excited about what that looks like and the opportunity to try and make care as efficient and possible.

So we are being very, very intentional, and what does that look like? So we are considering some robots in our dietary department, our kitchen, our housekeeping department, thinking about how we can serve people doing the same task, but in a different way, so that we have more of the workforce that we need to do the actual caregiving – somebody that might today work in the housekeeping department.

At this campus, those people who would have filled some of those roles [will] now fill caregiver roles. We [will] give them the opportunity to get their certification for a nursing assistant and be able to provide care.