LTC is one of the most regulated, emotionally charged, and operationally complex sectors in healthcare. What's behind the dysfunction?
Long-term care (LTC) is one of the most regulated, emotionally charged, and operationally complex sectors in healthcare. And yet, within this high-stakes environment, many leadership teams are simply not functioning as effective units. They are fractured, pulled in competing directions by constant change, regulatory pressure, and personnel instability.
What’s behind the dysfunction? The data paints a clear picture.
Survey Citations Tell the Story
According to recent CMS data, the most frequently cited F-Tags in LTC facilities consistently include:
- F689 – Free of Accidents/Supervision/Devices
- F684 – Quality of Care
- F880 – Infection Control
- F656 – Comprehensive Care Plans
These citations are not simply clinical failures—they’re symptoms of poor leadership coordination. Missed care planning meetings, lack of follow-up on infection control rounds, or vague roles in fall prevention point directly to a breakdown in team leadership and communication.
Inconsistent leadership often means missed handoffs, unclear responsibilities, or departments operating in silos. Surveyors notice—and so do residents and families.
Turnover at the Top
Leadership turnover in LTC is staggering. According to the American Health Care Association (AHCA):
- Administrator turnover exceeds 40% annually.
- Director of Nursing (DON) turnover is even higher in many regions, with average tenure under two years.
When leaders leave frequently, culture is disrupted. Priorities shift. Staff don’t know which policies are in effect. Training is delayed. Accountability fades. And most importantly, trust erodes.
Without stable leadership:
- Staff morale plummets.
- Processes fall apart.
- Continuity of care suffers.
Residents Feel It Too
Resident dissatisfaction is on the rise. Common themes from feedback surveys and ombudsman reports include:
- “No one follows through.”
- “I told three different people and nothing changed.”
- “They don’t listen to each other, so my care gets missed.”
These aren’t isolated complaints. They are a direct reflection of a team that is not aligned—on priorities, communication, or resident-centered values.
Warning Signs of a Broken Leadership Team
- Department heads only meet during morning stand-up—and rarely talk beyond that.
- Clinical and operational goals are not shared or aligned.
- Problems are addressed by email, not conversation.
- Staff complain they get mixed messages from different leaders.
- One or more team members consistently avoid conflict or accountability.
What Can Be Done?
Repairing a broken team doesn’t require new staff, it requires new habits. Start here:
1. Rebuild trust. Create safe spaces for honest dialogue. Acknowledge past missteps.
2. Train on team dynamics. Use models like “The Five Dysfunctions of a Team” to foster shared understanding.
3. Get aligned on purpose. Recommit to shared goals—resident care, not departmental survival.
4. Meet intentionally. Don’t just review schedules—discuss barriers, solve problems, and hold each other accountable.
5. Stay. Leadership stability is the first fix. If you’re in a role of influence—stay, grow, and lead change from within.
Final Thought
Broken teams are not a failure—they’re a reflection of the system’s strain. But they can heal. In long-term care, repairing leadership fractures is the first step toward healing the entire culture of a facility.
Facilities that make this investment don’t just avoid citations—they build stability that lifts staff morale, strengthens resident outcomes, ensures regulatory compliance, and drives financial performance.
With survey scrutiny and turnover at all-time highs, facilities can’t afford fractured leadership. Reach out to your Polaris Consultant to begin rebuilding trust, accountability, and culture—starting today.
