Emerging from Chaos to Calm: Leadership in Assisted Living and LTC

Effective leadership is critical to the success of any business or organization. In fact, many experts believe it to be the single most important factor in achieving success. Assisted living and long-term care are not exempt, equally dependent upon effective leadership for success as highlighted for decades in business literature.

The leader sets the tone in every community, determines the culture and impacts the outcomes for residents and families. The leader of an organization, whether their title is administrator, director or CEO is ultimately responsible for everything that occurs in their facility and every single person under their care.

Turnover of leaders in assisted living, like others in long-term care, ranges from 43-70% annually.1 translating into an annual loss of thousands of facility leaders. Stated reasons for this exodus revolve around tangibles such as regulatory surveys, regulations, corporate interference, inadequate salary, and staffing, etc.2 However, are these often cited reasons the real cause these leaders leave?

The resulting cost of leadership turnover is very high financial and otherwise. Research indicates that an administrator departure begins a cycle of negative events. Typically, the facility experiences increasing resident care concerns. Difficulties include increasing pressure ulcers, use of behavior controlling medications, increased catheters, more regulatory deficiencies and citations, and staff turnover more than twice the experienced norm. Given this data and current salaries, such turnover can cost close to a million dollars per year for every 200 residents accommodated.3 With declining reimbursement and increasing competition for employees, this phenomenon can no longer be ignored.

Perhaps the real reason for leadership turnover is the lack of leadership training and an inability to effectively handle the multitude of daily responsibilities and tasks. Leaders acquire training and licensure in assisted living and long term care with a desire to care for older adults, but find little mandates in relationship to the development of prior leadership skills. Hence, many well meaning leaders lack the knowledge, experience and skills required to lead and find the roles and responsibilities overwhelming.

Leadership models exist and when practiced enhance outcomes.4 Existing models in business and health care speak to the importance of the key elements of quality and service, education, modeling, inclusion, caring and communication.

This article is the first in a series to examine a contemporary model of leadership and outcomes indicating visionary and dedicated qualities that will move a facility from a crisis management, disorganized mentality, what we call chaos, to a calm, effective, exemplary organization.


1. Castle, NG; Engberg, J; Anderson, RA: Job satisfaction of nursing home administrators and turnover. Medical Care Research and Review 2007;64(2):191-211.
2. Tellis-Nayak V. The satisfied but disenchanted leaders in long-term care: the paradox of the nursing home administrator. Senior Housing & Care Journal 2007;15(1):4-18.
3. Gilster, SG; Dalessandro, JL: From chaos to calm. Advance for Long-Term Care Management 2008; July/August:55-57.
4. Gilster SG. Changing Culture, Changing Care: S.E.R.V.I.C.E. First. Cincinnati: Cincinnati Book Publishing/Jarndyce & Jarndyce Press; 2005.