120 5.1 Leadership Model

Leadership roles and models may vary amongst LTC homes across Canada. All LTC homes will have leadership roles that include an Administrator & Director of Nursing role.^[1]

Administrator/ Nursing Home Administrator/ Executive Director

• In charge of the LTC home, responsible for overall management
• All departments report to this individual (e.g., director of care, recreation, housekeeping/maintenance, dietary)

Director of Nursing/ Director of Care

• RN designation
• Supervise and direct the nursing staff and personal care staff
• “Director of Care who provides critical day-to-day on-site clinical care leadership in collaboration with the Assistant Director of Care,      Nurse Practitioners, and/or Nursing Supervisors with expertise in geriatric medicine”^[2]

Medical Director

• Physician designation
• Advise the licensee on matters related to medical care in the LTC home
• Consult with the Director of Nursing and professional staff
• “During the recent experience with COVID-19 outbreaks, it has become apparent that there is a substantial degree of variability in how this role is carried out among homes across the province (Ontario). We recommend that the ministry clarify the role and accountability of the Medical Director position to bring greater consistency in medical leadership to the staff team. This role should work closely with the DOC, ADOC, NP, and/or Nursing Supervisors”^[3]

Nurse Practitioner

• “NP augments the clinical leadership present in a home and may provide an effective link with the Medical Director who is typically less physically present in the home, especially when the NP has expertise in geriatric medicine. NPs support education and coaching of the clinical team as well as providing direct care. They can also assist with medication management, reduction in polypharmacy, and have been associated with the reduction in need to transfer residents to hospital, reducing hospital costs and improving the resident experience”^[4]