In senior living and post-acute care, your executives shape everything—culture, revenue, census, clinical outcomes, staffing stability, and survey performance. When the wrong leader is in the wrong seat, the entire organization feels it.
But firing an executive is one of the most stressful decisions a leader can make. The real danger? Waiting too long—hoping things will improve, tolerating excuses, or avoiding conflict, all while the building declines.
Here’s how to know when it’s time to take action.
1. You’re Managing Them More Than They’re Leading
Executives are supposed to reduce your workload, not increase it.
If you find yourself:
• Re-explaining expectations
• Fixing basic mistakes
• Doing their job for them
• Repeating deadlines
• Chasing them for updates
…then you don’t have a leader; you have a liability.
Executives should create clarity, not consume your time.
2. They Can’t Build or Keep a Team
Nothing tanks census or survey outcomes faster than turnover.
Warning signs:
• Good employees quit directly because of this leader
• There’s constant drama, grievances, or internal conflict
• Staff avoid them, fear them, or work around them
• They blame “the market” instead of owning retention
A strong executive stabilizes the building.
A weak one fractures it.
3. Results Aren’t Improving — and the Excuses Never End
Every building has challenges. But elite executives show traction, even early.
Look for patterns:
• Metrics flat or declining
• Same excuses quarter after quarter
• Goals missed without corrective plans
• “I’m working on it” becomes the default response
If they can’t produce results in a reasonable timeframe, they’re not the right fit.
4. They Don’t Drive Accountability
Executives must hold their teams to standards. If they avoid tough conversations, tolerate underperformance, or allow inconsistency, the building loses discipline.
Signs they lack accountability:
• No follow-through
• Policies applied inconsistently
• Mediocre performance accepted as “fine”
• Chronic lateness or absenteeism on their team
Where there is no accountability, culture collapses.
5. They Create More Problems Than They Solve
Executives are hired to remove obstacles, not create them.
Red flags include:
• Constant conflict with peers
• Emotional volatility
• Poor judgment
• Resistance to change
• Overcomplicating simple issues
• Becoming the “exception” to every rule
If every week comes with a new crisis—caused by your leader—it’s time to move on.
6. You Don’t Trust Their Ethics or Integrity
This is non-negotiable.
If you suspect:
• Dishonesty
• Hidden data
• Manipulated reports
• Compliance shortcuts
• Inappropriate relationships
• Ethical gray areas
The conversation is already over.
Healthcare is too regulated—and too mission-driven—to tolerate integrity issues at the top.
7. The Building Feels Better When They’re Gone
The team’s behavior tells you the truth.
If morale noticeably improves when the executive is on PTO, in meetings elsewhere, or out of the building, that’s not a coincidence.
People vote with their energy.
8. You Know in Your Gut — but You’re Delaying the Decision
Leaders rarely regret firing too early.
They almost always regret firing too late.
If you’ve:
• Recoached
• Re-aligned
• Given support
• Set expectations
• Provided reasonable time
…and nothing has fundamentally changed, then the decision has already been made.
According to recent executive accountability research, top-performing leaders show meaningful traction within their first 60–90 days.
Before You Fire: A 3-Step Safety Check
These steps protect your organization legally and operationally:
1. Document the Issues
Dates, behaviors, missed expectations, corrective actions, coaching notes.
2. Align With HR & Legal
Ensure the process is compliant and defensible.
3. Have a Transition Plan
Communicate internally. Maintain stability. Protect culture and operations.
The Real Lesson: You Deserve a Leader Who Makes Your Life Easier
The right executive:
• Improves census
• Reduces turnover
• Strengthens compliance
• Instills accountability
• Solves problems independently
• Stabilizes the building
• Makes your days calmer, not harder
If your current leader isn’t doing that, it may be time to act.
Need a Stronger Executive?
Premier Search Inc. specializes in placing high-impact leaders in:
• Skilled Nursing
• Assisted Living
• Memory Care
• Post-Acute & Senior Living Networks
Whether you need a new Executive Director, Administrator, DON, VP of Ops, or Regional, we can help you replace underperformance with leadership that stays and elevates your entire building.
👉 Learn more about our executive recruiting services:
https://premiersearch.com/services
👉 How to hire a Director of Nursing (related article):
https://premiersearch.com/insights/how-to-hire-a-director-of-nursing
👉 See more Insights for healthcare leaders:
https://premiersearch.com/insights
Call or text Bernie Reifkind at (310) 247-8900
Email: bernie@premiersearch.com