Leadership. Unfortunately, the management here does not lead. Supervisors and senior management come from friendship rings. They are in desperate need of true leaders, not management, with business knowledge.
Process management. This reflects back to the lack of leadership knowledge. We need a better process for almost everything. You have the wild west in LTC. One manager/sup wants it done one way, the next does it another way. This leads to confusion and headaches.
No help to build your career. Again, going back to leadership. If you are not looking or already good friends with management forget about a career path. There is little to no career coaching or advancement.
Pay structure. Pay is low. Others along with myself truly feel underpaid.