I picked up a few shifts at a small care home while I figured out my next career move.

Within a week, I was the manager and director of care.

I had no idea what I was doing. I had no leadership education, no management background, no network to call. Just eleven residents who needed good care, a skeleton staff, and a steep learning curve I didn’t see coming.

What I figured out — eventually, the hard way — is that there’s a difference between leading and managing. That they’re not the same thing. That most of us default to one without realizing it. And that the default, running without awareness, costs the team — and us — more than we know.

It took me several years and a formal course before I even had language for it. By then I’d already made most of the mistakes. I’m grateful to be able to say, looking back, that I also did many things right. Most of it by running on instinct, trying to be a good and wise human.

I’ve written about what I learned — and what I’d want every LTC leader to understand before those mistakes happen. It’s the first in a series on leading and managing: what the difference actually is, why it matters, and how to start choosing deliberately instead of defaulting.

Here’s what I learned.

Something happens when a Long-Term Care leader isn't clear on the difference between leading and managing. The work gets harder than it has to be. The team feels it — even if they can't name it. And the leader ends up exhausted, cycling through the same problems without understanding why nothing sticks.

It's not a skills gap, usually. It's a clarity gap.

Knowing when to lead and when to manage — and understanding what each one actually requires — is foundational to everything else. Conflict response. Staff retention. Culture. Quality of care. All of it runs through this distinction.

So let's be direct about what each one is, and what each one asks of you.

What Managing Actually Is

Management is the work of ensuring the operation holds. Schedules. Compliance. Resources. Risk. The standards are met, the documentation is done, the processes are running. In Long-Term Care, that includes staffing levels, care schedules, regulatory adherence — the infrastructure that keeps residents safe and the home functioning.

It tends to be measurable. It often happens behind a desk. It asks for precision, consistency, and follow-through.

None of that is small. A home where management is weak is a home where residents are at risk. Managers who can hold the operational line under pressure are doing essential work.

But management alone doesn't build a team. It doesn't create the kind of culture where staff feel they belong to something, where they stay, where they bring their best thinking to difficult problems.

That's where leadership comes in.

What Leading Actually Is

Leadership is the work of people. Vision. Direction. Culture. It involves your team in decisions, creates space for honest conversation, and builds a shared sense of what this place is for and why the work matters.

In a Long-Term Care setting, leadership is often what determines whether a staff member who's burning out quietly keeps showing up — or starts looking for the exit. It shapes whether a team functions as a group of people doing assigned tasks, or as people who actually care about the same outcomes.

Leadership mostly happens outside your office. In the hallway. At the nursing station. In the five-minute conversation after handover.

And it requires something different than management precision. It requires attention. Presence. The willingness to understand what your people are carrying.

The Overlap — and the Difference

These two approaches aren't opposites. They're not competing. High-performing Long-Term Care homes need both — and leaders who can move between them fluidly, depending on what the situation requires.

Think of it this way. Knowing when to use a fork and when to use a spoon — and when to use both — isn't complicated. But if you only ever reach for one, you end up making a mess of something that didn't need to be messy.

The same leader, in the same afternoon, might need to hold a firm accountability conversation (managing) and then sit with a staff member who is exhausted and close to breaking (leading). Reaching for the wrong tool in either moment costs something.

A few broad contrasts worth holding onto:

Managing is primarily concerned with tasks, processes, compliance, and outcomes. It asks: are we doing things right?

Leading is primarily concerned with people, direction, culture, and meaning. It asks: are we doing the right things, and do our people understand why?

Managing directs and controls resources to deliver results.

Leading empowers and inspires people to work toward something worth working toward.

Both matter. The question isn't which one you prefer. The question is whether you're choosing deliberately.

What Happens When You Don't Choose

When a leader defaults unconsciously to one approach — without awareness of the other — the team feels the gap.

A leader who only manages may resolve problems efficiently. But the team starts to feel like units to be deployed rather than people to be trusted. Morale thins. Turnover rises. The good people start looking for somewhere they feel seen.

A leader who only leads may be deeply liked. But accountability slips. Standards drift. And at some point, the operational gaps start affecting residents — which is the thing that cannot be allowed.

The confusion doesn't have to be dramatic to be costly. It can show up quietly, over time, as staff who shrug and say "I'll just do my job" — and mean it as a withdrawal, not a commitment.

This Is a Starting Point

In future posts, I'll look at how intentionally combining both approaches transforms how you handle conflict, manage risk, support staff retention, and build a culture that actually holds. These aren't abstract ideas. They show up in the specific moments that define your leadership.

But it starts here. With clarity about what each approach is, what it asks of you, and what happens when you're not paying attention to which one the moment requires.

One question worth sitting with:

Think of a situation that didn't go the way you hoped. Looking back — were you leading, managing, or trying to do both without knowing it? What would you do differently?

Share your thoughts below. I'd like to hear what you're seeing.

Sources Cited:

Dana, B., & Olson, D. (2007). Effective Leadership in Long Term Care: The Need and the Opportunity. American College of Health Care Administrators Position Paper – Effective Leadership in Long Term Care . Retrieved on March 28, 2023 at  https://achca.memberclicks.net/assets/docs/ACHCA_Leadership_Need_and_Opportunity_Paper_Dana-Olson.pdf