In early 2021, the owners of an assisted living and memory care senior living community in Appleton, Wisconsin, sought to bring in a new management company to oversee operations of an 80-unit property with a history of poor operational and financial performance. Thus, Health Dimensions Group (HDG) took over operations of what is now known as Dimensions Living Appleton in March of 2021.

One of the first steps that HDG took toward improving results was to bring in new leadership. However, the new team faced a significant challenge.

The culture at the community was described as “challenging,” with employee turnover at 140 percent and 90 percent of the staff being agency. Those that were employed at the community were resistant to change. In fact, they undermined the authority of both the new leadership team and Health Dimensions Group and were encouraging residents to do the same. The community suffered from a bad reputation in the city of Appleton, as both an employer and a provider. Residents were moving out because of dissatisfaction. Occupancy was at 66 percent, and net income percentage was at -55. Last but not least, the community had used 10,366 hours of agency staffing time at a cost of about $375 thousand dollars.


With HDG’s guidance, the new leadership team began implementing changes. Still to this day, they share HDG’s Caring Above and Beyond® commitment—they put residents first and strive for Dimensions Living Appleton to be the best senior care provider in the area. This new energy caught on with the department heads, and soon, every employee could see the community’s full potential. Each team member understood the direction in which Dimensions Living Appleton was headed and knew how their roles impacted the overall success of the community.

In addition to communicating the vision and obtaining buy-in from all stakeholders, the leadership team embraced HDG’s core values of hospitality, stewardship, integrity, respect, and humor, which were used to build relationships and make decisions. These core values were also used to hire the right people for the right seat and reward employees who lived out the values through the Values Ambassador program.

HDG’s people/culture core processes were implemented to chart the course for culture change. This formalized program includes: a well-developed new-hire orientation; mentorship program; new-hire and manager check-ins at seven, 30, and 60 days; leader stand-up meetings; small group meetings; and the values ambassador program. The core processes also include shift huddles, and at Dimensions Living Appleton, the leaders participated to share information with the caregivers about resident move-ins and levels of care. In addition, this time was used to recognize team members and give them the opportunity to share concerns or provide feedback.

In addition, the leadership team led by example, working in dietary, laundry, or wherever there was a need to model the behavior they wanted to see in everyone and to demonstrate excellence. The staff members were united through consistent praise, recognition, and encouragement by leadership.


With great leadership, and by implementing and committing to HDG’s people/culture core processes, Dimensions Living Appleton was able to accomplish the following:
  • Lower agency expenses from $375 thousand at the end of 2021 to zero by July of 2022.
  • Increase staffing from eight employees in December of 2021 to over 50, with only five positions currently open.
  • Achieve high team member engagement scores—82 percent on a benchmark of 80, with 75 percent of team members participating in the survey.
  • Reduce turnover from 140 percent to 95 percent.
  • Increase occupancy from 66 percent in 2021 to 82 percent YTD 2023.
  • Establish a high quality of life for the residents—100 percent of residents surveyed either agreed or strongly agreed that Dimensions Living Appleton provides them with a high quality of life.
  • Improve earnings before interest, taxes, depreciation, amortization, and restructuring or rent costs (EBITDAR) from -5.6 in 2021 to 25 percent YTD 2023.
  • Recognition as a 2023 recipient of the Bronze – Commitment to Quality Award by the American Health Care Association and National Center for Assisted Living (AHCA/ NCAL).

HDG’s people/culture core processes provides senior living communities with the means to improve communication, enhance culture, and increase employee engagement. In addition to our core processes, HDG can help organizations emerge stronger than ever through a variety of other workforce solutions that help optimize your staffing and drive operational success in the following areas:

  • Workforce strategy development
  • Talent optimization
  • Workforce demographic assessment
  • Labor management assessments
  • Compensation & total reward strategy
  • Employee engagement advisement
  • Leadership & professional development
  • HR assessments, audits, & policy development
  • Centralized workforce management, recruiting and payroll

About Health Dimensions Group

About Health Dimensions Group Minneapolis-based Health Dimensions Group (HDG) is a leading management and consulting firm, providing services to senior living, post-acute, and long-term care providers, as well as hospitals and health systems across the nation. To explore how HDG’s management services can help improve your workforce and operations challenges, please contact us at or 763.537.5700.

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