The long-term care field is beset by numerous challenges.

There is never enough money to go around. Regulations are often overwhelming. And finding and keeping the best possible workers is a perennial issue.

To be sure, these are all difficult issues. But they are not the sector’s biggest problem. The answer to what is should be obvious, but it rarely gets discussed: universal mistrust.

Start with operators. Most clearly don’t trust regulators or lawmakers. The reason is fairly simple. Only a masochist would put faith in people who seem to take a sick pleasure in making life miserable. When a surveyor visits, the best that can be hoped for is that nothing bad will happen. Otherwise, it’s all downhill.

And if we are going to go by the available evidence, facilities don’t seem to place much trust in residents or their families. That’s not to say operators are not compassionate or do not try to provide the best care possible. But the reality is that each resident/family represents a potential lawsuit.

A cynical assessment? Perhaps. But I’m not the one fighting hammer-and-tong to keep arbitration agreements in place. By the way, I am not saying the field is wrong in its efforts to head off lawsuits. It’s a sound legal strategy. But what does this approach tell you about the level of trust operators have toward their customers?

And it’s not like this is a one-way street. Why are regulators constantly adding new rules to the mix? Well, it’s not because they believe operators are doing a swell job. Same goes for lawmakers. Google “long-term care legislation” and see what I mean.

So how did we get to this tense impasse? I don’t think there is one answer.

To be sure, the way many operators have conducted themselves over the years has hardly helped. There’s a reason why nursing homes have not historically enjoyed a stellar reputation. Yes, things have improved tremendously in recent years. But to believe that every facility is now is a paragon of virtue is to be incredibly naïve.

There are also plenty of families that have behaved less than scrupulously. Chances are you know some of them all too well: the non-visitors suddenly filing lawsuits alleging substandard care, or those who flat out did not pay for services, and so on.

Collectively, this universal mistrust has created a less-than-ideal atmosphere. More troubling still is the sticking power this challenge is likely to have.

The usual laundry list of problems facing this sector basically comes down to money. Add more money, and they can be resolved. That may be easier said than done, to be sure. But at least we know how to attack the problem.

But how do you get different parties who have little or no faith in each other to suddenly come around? That sort of lost capital is far more difficult to replace.