Long term care is one of the most regulated, emotionally demanding, and operationally complex areas in healthcare.
The Challenge
Long term care is one of the most regulated, emotionally demanding, and operationally complex areas in healthcare. Within this high pressure environment, many leadership teams are not functioning as cohesive units. They are fractured, stretched by constant change, regulatory demands, and ongoing personnel instability.
Survey Citations Tell the Story
Recent CMS data continues to show that the most frequently cited F Tags in long term care facilities include:
F689 Free of Accidents Supervision Devices
Lack of a shared playbook for supervision during high risk times and an unclear sense of ownership after incidents.
F684 Quality of Care
Care planning is not driving daily huddles and cross checks on follow through are inconsistent.
F880 Infection Control
Rounds lack accountability partners and gaps remain unaddressed.
F656 Comprehensive Care Plans
Interdisciplinary team meetings occur, but roles and next steps lack clarity.
When leadership teams are not aligned, critical handoffs are missed, priorities become unfocused, and residents experience the consequences. These citations are not simply clinical breakdowns. They reflect deeper issues in leadership communication and coordination. Missed care planning meetings, inconsistent follow up on infection control rounds, and vague responsibilities in fall prevention are all signs of leadership dysfunction.
Turnover at the Top
Leadership turnover in long term care is significant and disrupts every aspect of operations. According to the American Health Care Association:
Administrator turnover exceeds forty percent annually.
Director of Nursing turnover is even higher in many areas, with average tenure of less than two years.
Frequent leadership changes disrupt culture, reset priorities, delay training, and create confusion around which policies remain in effect. Accountability becomes inconsistent and trust across the team begins to erode.
Without stable leadership, morale declines, processes break down, continuity of care suffers, and overall resident safety is weakened.
Residents Feel It Too
Resident dissatisfaction has been rising across the sector. Common themes from resident surveys and ombudsman reports include:
“No one follows through.”
“I told several people and nothing changed.”
“They do not communicate with each other and my care gets missed.”
These frustrations reflect a leadership team that is not aligned in communication, priorities, or resident centered care values.
Warning Signs of a Broken Leadership Team
Department heads only meet briefly during morning stand up, if at all
Clinical and operational goals are not shared or connected
Leaders attempt to solve problems by email instead of conversation
Staff report receiving conflicting messages from different supervisors
One or more leaders consistently avoid conflict or accountability
What Can Be Done
Improving leadership team performance does not require a new roster of staff. It requires new habits. Facilities can begin with the following steps:
Rebuild trust through honest communication and acknowledgment of past challenges.
Train on team dynamics using models such as The Five Dysfunctions of a Team to create shared understanding.
Align on purpose by recommitting to the collective goals of resident safety and quality care.
Meet with intention by discussing barriers, solving problems collaboratively, and holding each other accountable.
Stay when possible, since leadership stability is the foundation of culture change. Leaders who remain can drive meaningful improvements from within.
Final Thought
A fractured leadership team is not a sign of failure. It is a reflection of the significant strain facing long term care providers. The good news is that healing is possible. Rebuilding a strong leadership team is the first step toward improving the culture, strengthening regulatory compliance, elevating staff engagement, and enhancing resident outcomes.
When leadership is unified, every measure improves. Staff retention rises, regulatory citations decrease, communication strengthens, and residents experience more consistent and compassionate care.
For more information on how a Polaris Consultant can support team building education and role playing exercises, please contact Polaris Group.
