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Research

What over 200,000 conversations tell us about why residents stay and leave

Most resident research is a once-a-year online survey of whoever chooses to answer. Ours comes from phone conversations held all year with residents, their families, prospects who toured, and families who just moved out. This page covers what it shows and what we think operators should do about it.

Last updated October 2026. We have held over 200,000 conversations. The charts on this page use the 51,810 interviews from April 2021 to October 2026 that have complete data. How we did this analysis

The short version

  1. Move-outs are rarely a surprise to the family. Four in five still had an unresolved problem when they left.
  2. Low check-in scores come before move-outs. Residents who rated us 3 stars or lower were 2.5 times as likely to leave within a year.
  3. Unfixed problems are what turn families against you. Each one costs about 20 points of Net Promoter Score.
  4. The loudest complaint is not the deciding one. Dining draws the most complaints. The management team and the sense of value decide recommendations.
  5. "Worth it" is about comfort, not price. Families who doubt the value say the place does not feel comfortable ten times as often as they mention price.
  6. Each community sets its own experience. Inside one operator, community scores ranged 69 points apart.
Part 1

Why residents leave

Operators usually learn why a resident left from the move-out paperwork: a higher level of care, closer to family, finances. We call the family after the move and ask. The paperwork is usually accurate, but it leaves things out.

Finding 1

Four in five families who moved out still had an unresolved problem

When we interview a family after a move-out, 80% describe at least one problem that was never fixed, and the average is 2.5. Compare that with move-in, when 55% mention one. Problems build up over a stay, and the families who leave have the most.

A common view in the industry is that very few move-outs are about dissatisfaction. One large operator has put it at under 1% (Senior Housing News, 2025). Families who have moved out tell us otherwise.

What it means

Treat every move-out interview as a list of fixable problems for the residents who are still there. The same issues are usually open for them too.

Interviews with at least one unresolved problem
At move-in55%
At check-ins71%
After move-out80%

Average unresolved problems per interview: 1.1 at move-in, 1.7 at check-ins, 2.5 after move-out. 39,315 interviews, 2023 to 2026.

Finding 2

Low check-in scores come before move-outs

We followed residents from a routine check-in call forward one year. Those who rated the community 3 stars or lower were 2.5 times as likely to move out in the next twelve months as those who rated it 4.5 or higher. Every step down in the rating raised the odds.

What it means

A low check-in score tells you which family is unhappy while there is still time to fix it.

Moved out within 12 months, by check-in rating
4.5 to 5 stars3.5%
4 to 4.4 stars4.3%
3.1 to 3.9 stars5.0%
3 stars or lower8.7%

17,064 check-in interviews from March 2023 to September 2025, each followed for a full year. We count a move-out when we later interviewed that family about it, so these rates undercount every move-out; the gap between the groups is the point.

Finding 3

Families like the community less the longer they stay

New residents and their families are the community's biggest fans. Net Promoter Score is +22 at move-in, about +12 between six months and a year, and close to zero after two years. By the time a family moves out, it is -21.

The biggest drops between move-in and move-out are in how families feel about the value for the money and the management team. Maintenance, activities and transportation barely move.

What it means

Most of the drop happens in the first year. Watch how families rate the management team and the value during that year.

Net Promoter Score over a resident's stay
At move-in+22
6 to 12 months+12
1 to 2 years+8
2 years or more+2
After move-out-21

Net Promoter Score is the share of 9 and 10 ratings on "would you recommend" minus the share of 0 to 6 ratings, from -100 to +100. Time since move-in comes from residents we interviewed at move-in and again later.

Part 2

What makes a family recommend you

Referrals from current families are the cheapest move-ins a community gets. So we asked what separates the families who recommend a community from the ones who warn people away.

Finding 4

Every unfixed problem costs about 20 points

Families with no open problems give a Net Promoter Score of +39. With one, it falls to +17. With two, it is about zero. With four or more, it is -56.

What it means

To get more referrals, close the problems families have already told you about.

Net Promoter Score by number of unresolved problems
None+39
1+17
2-1
3-22
4 or more-56

39,315 resident and family interviews at move-in, check-ins and move-out, 2023 to 2026.

Finding 5

The loudest complaint is not the deciding one

Dining draws a quarter of all complaints, more than any other area. But a family's dining rating has one of the weakest links to whether they recommend the community. The areas that track most closely with recommending are value for the money, the management team and care.

What it means

Dining still needs fixing. But for referrals, how the management team treats families matters more.

Share of all complaints
Dining25%
Housekeeping17%
Management14%
Care13%
Value11%
Link to recommending (0 to 1)
Value0.92
Management0.47
Care0.46
Dining0.36
Housekeeping0.33

The link is the correlation between each area's 1 to 5 rating and the family's 0 to 10 "would you recommend" answer, across about 39,000 interviews. Complaint shares are from 65,022 unresolved problems.

Finding 6

"Worth it" is about comfort, not price

We ask every family to rate the services against the monthly fee. That one answer tracks almost perfectly with recommending: across 212 communities, the correlation is 0.96. When families explain a low value rating, they say the place does not feel comfortable ten times as often as they mention the price.

What it means

Discounts will not fix a value problem. Families judge value by how their parent is treated and how at home they feel.

What families cite when they rate value low
Does not feel comfortable8,309
The apartment and building2,982
Does not make them feel good1,250
Price840
Service802

Negative comments about value, tagged by theme by our interview team.

Finding 7

A good management team is not good enough

Families who rate the management team 5 out of 5 give a Net Promoter Score of +28. Families who rate it 4, which most people would call good, give -7. The gap between "good" and "great" is 35 points.

What it means

Treat a 4 as a warning. Families who give one are already lukewarm about recommending the community.

Net Promoter Score by management team rating
Rated 5+28
Rated 4-7
Rated 3-33
Rated 2-55
Rated 1-73

38,782 interviews. The question asks how satisfied the resident or family is with the management team.

Part 3

Where the experience is decided

The last two findings are about the community itself: the first visit, and the people who run it.

Finding 8

A great tour is worth 2.6 times a good one

We call prospects a few days after they tour. Those who rated the tour 4.5 stars or higher were 2.6 times as likely to move in within six months as those who rated it between 3.5 and 4.4. Of the few who rated it below 3.5, none moved in.

What it means

"Fine" tours lose move-ins. Asking every prospect how the tour went shows which ones can still be won and which parts of the tour need work.

Moved in within six months, by tour rating
4.5 to 5 stars9.5%
3.5 to 4.4 stars3.6%

1,494 post-tour interviews through April 2026. We count a move-in when we later held a move-in interview with the same prospect, so these rates undercount every move-in; the gap between the groups is the point.

Finding 9

Communities in the same company score very differently

Inside our largest operator, 48 communities share the same brand standards, policies and systems. Their Net Promoter Scores range from -23 to +46. Across operators, the gap between a company's best and worst community averages 52 points.

Since they share the same brand and policies, the difference points to how each community is run. That is why we built the ResidentCare Executive Director Leadership Model from this same data.

What it means

Don't judge a portfolio by its average. Compare communities inside the same company, then look at what their leaders do differently.

Net Promoter Score range inside one operator

Communities with at least 40 interviews since January 2025.

Why this data is different

Most surveys only hear from the families who choose to answer

The best-known national study of senior living satisfaction collected 2,917 responses in 2025 (J.D. Power). Annual online and mail surveys hear from the families who feel like replying, once a year, and almost never from the families who left.

Typical annual survey
Senior Living Alliance
How people are reached
An online or mailed form
A trained interviewer on the phone
How often
Once a year
All year, at move-in, check-ins, after tours and after move-outs
Who is heard
Residents or families who choose to reply
Residents, families, prospects and families who moved out
What you learn
A score
The score, the reason, and the unresolved problems behind it

How we did this analysis

Data. 51,810 phone interviews held by Senior Living Alliance's interview team from April 2021 to October 2026, across 248 communities run by 15 operators in assisted living, independent living and memory care. Findings 1 to 7 use resident and family interviews at move-in, routine check-ins and after move-out. Finding 8 uses post-tour interviews with prospects.

Ratings. Overall experience is rated 1 to 5 stars. "Would you recommend" is rated 0 to 10. Each area (value for the money, management team, care, dining, housekeeping, activities, maintenance, transportation) is rated 1 to 5. Shortened interviews that skip questions are left out of rating analyses.

Unresolved problems. Problems the resident or family describes that have not been fixed, coded by department by our interview team.

Following people over time. Findings 2, 3 and 8 match the same resident or prospect across interviews in the same community. A move-out or move-in is counted only when we later interviewed that family about it, so absolute rates are lower than real ones. Comparisons between groups are the finding.

What this is not. These are observed patterns, not controlled experiments. A low score does not cause a move-out by itself; it signals a family whose experience has gone wrong while there is still time to act.

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