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Blood on the RUGS; Leadership Turnover Hurts Long Term Care

Blood on the RUGS; Leadership Turnover Hurts Long Term Care May 20, 2017

Marketing, research and business development consultant in healthcare, human services and senior living.


Blood on the RUGS: Leadership turnover is hurting long term care

Paper, or plastic? We need more choices!

Rapid leadership turnover is hurting long-term care providers. The churn is the result of changes in the markets over which managers have little or no control.  While the some changes in leadership are inevitable, rapid leadership turnover is unnecessary and counterproductive, and is hurting long term care.

An all too common story

Several months ago, Stackpole & Associates was asked to develop a proposal for market analysis and strategic plan for a skilled nursing center which, while delivering excellent care, was struggling with low occupancy and poor payor mix. This is a common problem among long term care providers. After several meetings and conversations with the Executive Director who had been in his job for about 12 moths, we developed a scope of work and submitted it. After following up several times, we learned that the executive director had been replaced. I contacted the new Executive Director, suggesting that, after a suitable time to “get her feet under her”, I would reconnect. When I contacted the nursing center again I discovered that the “new” Executive Director had been replaced with, and even newer Executive Director. And so it goes.

The occupancy? As far as I can tell, even worse than when the leadership turnover started.

Stagnation is bad; “churn” is worse

Missing targetsEdwards Deming, the father of modern quality improvement science, insisted that only ~15% of management termination is warranted. The rest of the leadership turnover is due to poor systems, inadequate training and inappropriate recruitment. I would add to this list – unrealistic expectations. Recruiting and on-boarding of mangers and key staff must be salted with heavy doses of realistic goals, objectives and expectations. If targets are missed over and over again, could the problem be the targets?

Long term care is undergoing the most disruptive regulatory change in decades.

What are the choices?

Boards and organizations which are thinking about changes, or are recruiting to replace long term care managers must consider market turmoil and accept three key principles:

#1 – There’s no “quick fix”

#2 – Patience is an absolute necessity

#3 – Turnover at the top leaves everyone unsure

The level of leadership turnover occurring in long term is bad at many levels. Before reaching for the “change” solution, a host of other options might be considered and tried.

Market Forces

Declining occupancy, poor payment mix and losses of key referral sources may not be due to the Executive Director. Occupancy may be due to declining demographics in the marketplace area or, possibly, newer and more attractive competition. The payer mix may be the result of strategic relationships, shifting in the marketplace area between and among hospitals, physician groups, and post-acute care providers. There’s a wide spread assumption that the market is abundant, and growing. Nothing could be farther from the truth. In most places around the country, the demographics, intermediaries and the government are colliding to create the “perfect storm”.

 The baby & the bathwater

When responding to challenges in today’s long-term care markets, boards must look at how to survive and thrive in very difficult circumstances. Seldom (referencing Dr. Deming), or about 15% of the time, is a change in leadership necessary. When tossing the baby out with the bathwater, so to speak, the organization suffers, and the time to recover is lengthened.

Alternatives – New Choices

There may be entirely more appropriate, constructive and less costly alternatives. If you and your organization are searching for such options, we would welcome the opportunity to talk with you and to share some of our experiences.

Stackpole & Associates is a marketing, training and market research firm with experience and focus on the healthcare, human service, long term care and seniors’ housing markets.

Irving Stackpole RRT, MEd is the President of Stackpole & Associates, marketing, market research and training firm at He can be reached directly at:


Marketing, research and business development consultant in healthcare, human services and senior living.

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