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Advocating for Stronger Leadership in Long-Term Care

In a critical move towards enhancing the quality of long-term care for older adults, the National Association of Long Term Care Administrator Boards (NAB) and the American College of Health Care Administrators (ACHCA) have made a significant appeal to the World Health Organization (WHO). Their joint recommendation urges the inclusion of Leadership for Quality Long-Term Care as a distinct standard in WHO's proposed Global Standards for Long-Term Care framework.

The WHO's draft is an ambitious initiative aimed at establishing adaptable standards for the planning, delivery, monitoring, and improvement of long-term care systems globally. While this framework already addresses essential elements such as workforce training and governance, NAB and ACHCA believe it is equally crucial to directly acknowledge the competencies and responsibilities of leadership that are necessary to transform these standards into effective daily practices.

Eric Hadley, Chair of NAB, articulated the importance of this recognition, stating, "Competent leadership is a critical part of building and sustaining quality long-term care and services to older adults." He advocates that recognizing leadership as a global standard would underscore the necessity for clear expectations, ongoing professional development, nurturing organizational cultures, and stability in leadership roles tasked with providing care.

As part of their submission, NAB proposed the introduction of a new Standard 17 that focuses on workforce dynamics. This new standard would consist of three key quality statements: the definition of leadership competencies, the role of leadership in shaping organizational culture, and the importance of leadership continuity and resilience. Their insights stem from NAB’s extensive experience in establishing professional competencies, which emphasizes leadership and organizational strategy as distinct yet interlinked domains.

Mark Prifogle, FACHCA, and National Board Chair of ACHCA, reinforces this viewpoint, highlighting that effective leadership is essential in linking workforce support, ethical decision-making, resources, and quality improvement to the everyday experiences of care recipients. He asserts, "Quality standards do not implement themselves," thereby underscoring the need for leadership to take ownership of quality care and operational decisions within long-term care systems.

Both NAB and ACHCA support these leadership competencies with robust recommendations. These include not only maintaining accountability and decision-making authority at the organizational level but also ensuring that leaders possess the professional judgment necessary to foster ethical stewardship in their practices. Additional focus was placed on providing actionable guidance related to demonstrated leadership capabilities, effective escalation of care-quality issues, and monitoring outcomes that prioritize resident needs and workforce conditions.

In their commentary, ACHCA suggested that accountability must be matched by the authority to act and the capability to voice concerns. This balanced approach seeks to enhance professional practice without imposing any singular national licensing or organizational model on long-term care frameworks across different countries.

The collaborative effort by these organizations signifies a critical step towards improving the quality of care offered to older adults globally. They firmly believe that the proposed leadership standard should be versatile enough to apply to various care settings—such as nursing facilities, assisted living, and home-based services—while also adapting to countries with differing resources and regulatory systems.

Notably, the public consultation phase conducted by WHO closed on October 30, 2026. The feedback gathered is set to play a vital role in revising the proposed standards ahead of their finalization and publication. The anticipation is that WHO will heed the recommendations of NAB and ACHCA, thereby integrating organizational leadership as a key component into the future framework of global long-term care standards.

About NAB
The NAB is dedicated to enhancing public safeguarding through the establishment of professional standards, licensure, credentialing resources, and continued education for long-term care professionals. With member boards spanning across the United States, NAB remains a pivotal force in shaping long-term care administration.

About ACHCA
Established in 1962, ACHCA is a nonprofit organization focused on fostering excellence in leadership across post-acute and aging service sectors. The organization plays a key role in promoting ethical practices and professional development across the long-term care continuum.

For further details on this initiative, visit NAB’s website and ACHCA's website.