Alice Turing
Nobody calls to tell you. You find out sideways, when an aide mentions that the director is “no longer with the community,” or when the office that had a name plate on it last month has a corporate badge sitting on the desk instead. Then the small things start. The activity calendar doesn’t get flipped at the start of the month. A shower gets skipped and nothing goes in the chart. The aide who knew your mother takes her coffee with three sugars is gone, and the new one keeps bringing it black.
A leadership vacancy in a memory care unit isn’t an internal HR matter that families should politely ignore. For several months at a stretch, the systems protecting your relative run without the person responsible for maintaining them. Here’s how to advocate through it.
Why a Leadership Gap Lands Harder in Memory Care
Every long-term care setting suffers when leadership churns. Memory care carries a specific vulnerability on top of that, because the residents can’t reliably report what’s happening to them. Someone in mid-stage dementia may know they’re frightened or in pain without being able to say when it started, who was involved, or whether it has happened before. The feedback loop that catches problems in other settings barely functions here, which puts an unusual amount of quality control in the hands of whoever runs the unit.
That population isn’t small. Analysis of 2022 data from the National Post-Acute and Long-Term Care Study, published by AARP, found that 44% of assisted living residents live with Alzheimer’s disease or another dementia, up from 40% a decade earlier.
The research on what turnover does to care is direct. A 2023 study in JAMA Internal Medicine led by Karen Shen of the Johns Hopkins Bloomberg School of Public Health analyzed 1.06 billion staffing shifts across 15,869 nursing homes and found a measurable link between staff turnover and inspection citation rates within the same facility over time. The researchers tracked administrator turnover alongside direct care nursing turnover, and reported that in an average week, 11.6% of administrator hours were worked by someone hired within the previous 90 days.
Departures at the top are routine rather than exceptional. Research published in The Gerontologist put average annual nursing home administrator turnover at 43%, and a 2024 analysis in Risk Management and Healthcare Policy found the rate has held near 40% since the 1990s. If your relative lives in memory care for three years, you should expect to go through this at least once.
Start Writing Things Down Before You Know What You’ll Need
The most useful thing you can do in the first week costs nothing. Open a notebook or a note on your phone and start logging dates, names, and specifics every time you visit. What time you arrived, who was on the floor, what your relative was wearing, whether they’d been changed, what they said, what staff said.
This matters because vague concerns get vague responses. “The care has gone downhill” invites reassurance and nothing else. “On June 3, June 9, and June 14, my father’s morning medication was given after 10 a.m. instead of the 7 a.m. time on his care plan, and the aide told me the cart was short two people” invites an answer, and it survives being passed up to a regional director who wasn’t in the room.
Get copies of the current care plan, the medication list, and the most recent assessment, and ask for updated versions in writing whenever anything changes. During a leadership gap, care plans get revised by people who never met your relative at baseline. You may end up being the only person in the building who remembers what the plan said in March.
Find Out Who Actually Holds the Director’s Authority
Ask plainly, and ask for a name: who is making memory care decisions right now, what is their title, and is the arrangement permanent or temporary? The answer tells you a lot about how seriously the operator is treating the gap. Some communities quietly hand the unit to an executive director who’s already running a full building, or split the duties across department heads until a permanent hire appears. Others bring in a credentialed temporary leader whose only job is stabilizing the unit. Senior living search firms can place experienced interim memory care directors within one to two business days, with assignments that typically run 60 to 90 days while the permanent search continues, which is why a community still saying “we’re covering it internally” four months in has told you something about its priorities.
If the answer is that nobody in particular is responsible, that’s your finding. Write it down with the date and the name of the person who said it.
Put Your Care Conference Request in Writing
Federal law guarantees residents and their representatives a role in care planning in nursing homes, and most licensed assisted living communities have a care plan process governed by state rules. Either way, ask by email rather than in the hallway. Name a specific window of dates, say who you want in the room, including the nurse and the person now covering the director role, and copy the regional or corporate contact if the community belongs to a chain. An email creates a record of when you asked and how long it took to get a meeting, and that record does real work later if you need to escalate.
Track the Staff, Not Just the Care
Direct care turnover is the mechanism through which a leadership gap actually reaches your relative’s day. The Alzheimer’s Association’s 2026 Facts and Figures report estimates annual turnover among nursing assistants in nursing homes at roughly 99%. That churn has causes far bigger than any single director’s exit, and the direct care caregiver shortage driven by poverty-level wages accounts for most of it. But a unit without a director has also lost the person who was recruiting, building the schedule, covering call-outs, and giving aides a reason to stay.
So pay attention to faces. When three aides you knew by name disappear inside a month, ask who’s covering their shifts and whether the community is using agency staff. Agency workers can be excellent, and they also arrive knowing nothing about a resident who can’t explain herself. That gap is one you can partly fill by writing a one-page profile of your relative and asking that it be kept in the room: what they answer to, what frightens them, what calms them, what they did for a living, which songs they know all the words to.
Call the Ombudsman Sooner Than You Think You Should
Every state, plus the District of Columbia, Puerto Rico, and Guam, has a free and confidential advocate for people in long-term care, and the service covers assisted living and board and care homes rather than nursing homes alone. You don’t have to exhaust the community’s internal channels first, and you don’t need the facility’s permission. In federal fiscal year 2023, the long-term care ombudsman program worked to resolve 202,894 complaints and resolved or partially resolved 71% of them to the satisfaction of the resident or complainant, according to the Administration for Community Living.
Ombudsmen work at the resident’s direction, which means they won’t take action you and your relative haven’t consented to. They can explain which of your concerns are regulatory violations and which are quality issues, and they can attend a care conference with you. Having one in the room tends to change how the room behaves.
Pace Yourself, Because This Will Take Longer Than It Should
A permanent director search in senior living routinely runs three to four months, and that clock often doesn’t start until well after the previous director walked out. Treat your advocacy as something you’ll be doing for a season rather than a week. Rotate visit times so you see the unit on evenings and weekends, when staffing is thinnest. Bring a second person to important meetings so somebody else hears what was promised. The same self-advocacy skills for disabled adults that work in any medical system apply here, including putting requests in writing, being polite and specific, being persistent, and appealing rather than accepting a first no.
Advocating this hard can make you feel like the difficult family, and that worry is worth setting down. A person with dementia still has preferences, a history, and a sense of dignity, and all three deserve respect from whoever happens to be running the building this month. During a leadership vacancy, you may be the only one holding the through line. That’s worth doing carefully, and worth doing on the record.
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I'm Alice and I live with a dizzying assortment of invisible disabilities, including ADHD and fibromyalgia. I write to raise awareness and end the stigma surrounding mental and chronic illnesses of all kinds.
