Nursing Home Administrators: Education and Careers

As of January 2023, the US Department of Health and Human Services says there are more than 1.4 million Americans living in the country’s 15,000+ nursing homes. Every one of those seniors needs and deserves attentive care. They need dieticians, doctors, nurses, and safe, homey communities to live in. But bringing it all together takes meticulous planning and unyielding organization. Nursing home administrators (NHAs) make that happen.

If you’d like to help America’s seniors enjoy their golden years in comfort and safety, here’s what a career in nursing home administration may look like and how you can get there.

What Is a Nursing Home Administrator?

Nursing home administrators oversee all operations at nursing home communities including both clinical and administrative tasks. These tasks include dealing with budgetary issues, marketing, patient care, and staff management. Some administrators may help oversee multiple areas while others focus on one specialty.

Other names, roles, and specialties in nursing home administration include:

• Long-term Care Administrator (LTC)
• Residential Care and Assisted Living Administrator (RCAL)
• Home and Community-based Services Director (HCBS)
• Administrative Coordinator
• Wellness Director
• Medical Records Director
• Director of Nursing Services

Some roles (especially roles managing clinical services or nursing staff) may require extra schooling, certifications, or experience. Similarly, financial administration roles in senior care often require a knowledge of insurance, Medicaid, Medicare, and social security laws.

What Do Nursing Home Administrators Do?

In broad terms, NHAs handle big-picture affairs within their organizations. This includes both clinical and administrative management. While nurses, dieticians, and other caregivers work with individual residents, it’s often the administration team’s duty to provide their front-line colleagues with the means to administer quality care.

Common duties for nursing home administrators include:

• Allocating funds to different areas as needed (activities, maintenance, housing, medical supply, etc.).
• Securing funding from government and private sources.
• Overseeing administrators in charge of different departments.
• Ensuring communication, coordination, and cooperation between the different departments in their organization.
• Outlining and enforcing federally- or state-mandated safety laws.
• Devising marketing strategies.
• Drafting hiring policies that draw the diverse set of senior care professionals their organization needs.
• Resolving and responding to problems faced by staff, residents, and residents’ families.
• Conducting performance reviews.

While many of these duties are conducted in the background, nursing home managers and administrators usually interact with clients, medical professionals, and all stakeholders in the organization.

Nursing Home Administrator Work Settings

America’s senior care sector is made up of different types of communities, each catering to a different segment of the aging population. A nursing home administrator’s duties are often defined by the type of community they work for.

Some of the most common types of nursing homes and senior living communities include:

• Adult Day Cares. These non-residential communities are tailored to aging adults who require supervised care during the day. Adult day cares are often great resources for caregivers who need to work throughout the day.
• Skilled Nursing Facilities. Seniors who need round-the-clock care, specialty medical equipment, or otherwise high levels of medical care often live in skilled nursing facilities. Generally, skilled nursing facility residents have very limited levels of independence and/or mobility.
• Assisted Living Communities. Assisted living community residents typically have some level of independence, but need help with activities of daily living (ADLs) like dressing, eating, or grooming.
• Memory Care Communities. Seniors with Alzheimer’s, dementia, or other memory issues often need help with ADLs as well as medication reminders, therapeutic treatment, and secured living quarters.
• Continuing Care Retirement Communities. These communities often contain several levels of care from independent living to skilled nursing. This way, seniors can age in familiar surroundings as their medical needs change.
• VA Community Living Centers. The US Department of Veterans Affairs (VA) has communities across the country where aging veterans can receive either long-term or short-term nursing care at a variety of levels.

Salary and Job Growth for Nursing Home Administrators

Nursing home administration can be a multi-faceted and sometimes taxing industry. Fortunately, senior care administrators seem to earn salaries that reflect all of the hard work they accomplish.

The Bureau of Labor Statistics (BLS) reports that managers and administrators in the nursing care sector have an annual mean salary of $96,520. But that’s not the only good news. The BLS also predicts that employment for all medical and health services managers will increase by a breakneck 28% through 2031. On average, that works out to over 56,000 job openings every year.

This market growth is supported by stats from the US Census Bureau. They estimate that by 2030, 21% of Americans will be older than 65. By 2034, they project that older Americans will outnumber children for the first time in history.

How to Become a Nursing Home Administrator: Educational Paths

NHAs are required to obtain licenses to practice in every state. The first step in obtaining a state NHA license is usually getting the right kind of degree. In most states, this will either be an associate or bachelor’s degree. However, a handful of states require a Master’s degree in healthcare administration.

You can check out the licensing information below for specifics on each state.

Earn an Associate Degree

Many states require licensed NHAs to have associate degrees in a health administration-related field. However, some employers may want job candidates with more advanced degrees.

There aren’t many associate-level nursing home administration degree programs, so it may be wise to choose an associate degree in a related area like:

• Health Information Technician
• Medical Billing and Coding
• Medical Administration Assistant
• Health Sciences
• Medical Assisting

To be accepted into an associate program, you will need a high school diploma or GED and possibly take a placement exam. Associate programs typically take two years to complete.

Earn a Bachelor’s Degree

In the majority of states, bachelor’s degrees are required to become a licensed nursing home administrator. But like associate degrees, there aren’t many bachelor’s-level NHA programs. Instead, students may want to explore nursing, healthcare administration, or health services administration programs with concentrations on geriatric care.

To be accepted into a bachelor’s program, you will need a high school diploma, typically with a GPA of 2.0 or higher, or a GED. You may also need to submit letters of recommendation and a personal essay. Bachelor’s programs usually take four years (or 120 credit hours) to complete.

You can expect to take classes such as healthcare economics, healthcare marketing, healthcare quality management, and healthcare research. You may also be required to complete a capstone project.

Earn a Master’s Degree

Some states require you to have a master’s degree in healthcare administration to earn your license. Even if your state doesn’t require it, earning one can mean you need fewer training hours or you may be more competitive for certain jobs.

As with associate or bachelor’s degrees, master’s degrees specifically in nursing home administration are rare. Instead, you can earn your master’s in long-term care or healthcare administration. Other master’s degrees that may be useful or required are a Master of Science in gerontology or a Master of Business of Administration (MBA) in healthcare administration.

Master’s degrees typically take two years to complete. You may also be expected to complete a capstone project or thesis.

Earn a Doctorate in Healthcare Administration (DHA)

Earning a Doctorate in Healthcare Administration may make you a more attractive candidate for jobs or boost your earning potential. You could also become a professor, teaching future generations to succeed in the nursing home administration field.

Doctoral degrees typically take four to six years to complete, and a dissertation will be required.

Earning Your Nursing Home Administrator License

After earning the appropriate degree, it’s time to pursue licensure through your state’s regulatory board. Though each state’s eligibility requirements are a little bit different, they mostly follow similar guidelines.

Common NHA licensure requirements include:

• Being a minimum age of 18 to 21.
• Passing a criminal background check.
• Completing anywhere from a couple hundred to around 2,000 training hours. Generally referred to as Administrator-in-Training (AIT) programs, many schools have integrated these supervised internship opportunities into their curriculum. In some states, applicants with higher-level degrees are required to complete less training hours.
• Passing the National Association of Long Term Care Administrator Boards (NAB) exam. According to the NAB, all 50 states and Washington, DC, require NHAs to pass the NAB exam before licensure.
• Passing a state-specific exam in addition to the NAB exam. Not all states have their own separate exams, but some do. In some cases, the exam is developed in cooperation with other NAB members.

The regulatory boards of all 50 states and Washington, DC, are members of the NAB. So despite some variances in policies, they all work together to establish professional standards in the long-term care administration industry.

What’s on the NAB Exam?

Though NHAs apply for the NAB exam through their state regulatory boards, the exam itself is administered on the national level. This means that the content is generally the same for everyone taking it across the nation. The exam includes 60 scored questions and 15 unscored pilot questions, all of which are multiple choice. The time limit for the exam is 90 minutes.

According to the NAB Exam Candidate Handbook, the NHA exam covers three domains as of November 2022:

• Care, Services, and Supports: medical practices, nutrition guidelines and other care-based topics
• Operations: financial, risk, and human resource management.
• Environment and Quality: safety guidelines and laws, facility management, and regulatory compliance.

As of 2017, all new long-term care administrators must also take the NAB’s Core of Knowledge exam. This is a 125-question test (100 scored and 25 unscored multiple-choice questions) that covers the foundational concepts of long-term care administration. Along with the three domains covered in the NHA exam, the Core exam also covers the domain of leadership and strategy. The time limit for this exam is two and a half hours.

Earning Continuing Education Credits

Once nursing home administrators have earned their licenses, they must typically earn continuing education (CE) credits to renew them. Like training hours, CE requirements vary by state.

CE classes and opportunities are reviewed and approved by the National Continuing Education Review Service (NCERS), a branch of the NAB. The NAB CE Database lists a number of in-person and virtual courses about topics like abuse and neglect, customer service, and memory care.

LNHA Requirements by State

The following information was gathered from National Association of Long Term Care Administrator Boards, Provider Management LLC, and state licensing boards.

 

Resources for Nursing Home Administrators

The following resources may help NHA students and practitioners learn more about NHA careers and stay abreast of trends in the field.

• National Association of Long Term Care Administrator Boards: This organization creates standards and best practices for health services executives. Their site contains information about licensing, exams, a database of approved CE providers, and training information.
• American College of Healthcare Executives: This is an international society for people who work in healthcare administration. They offer education and events, publications, research, career resources, and more.
• Medical Group Management Association: MGMA provides resources such as educational certifications, networking events, materials to help make long term care facilities succeed, and data tools to help healthcare professionals make informed decisions.
• American Association of Healthcare Administrative Management: The AAHAM “provides information, education, and advocacy in the areas of reimbursement, admitting and registration, data management, medical records, patient relations, and so much more.” They offer advanced certifications and special events as well.
• American College of Health Care Administrators: This nonprofit maintains a calendar of events by location, offers education opportunities, awards scholarships, and publishes a blog.
• LeadingAge: LeadingAge is a nonprofit that promotes education and advocacy for the aged—their mission is “to provide a voice for the aging.” They accomplish their mission by offering events, a “newsroom” that provides up-to-date resources for nursing home administrators, podcasts, and other resources that can help NHAs make their facility thrive.

2021 US Bureau of Labor Statistics salary and employment figures for nursing care facility staff reflect national data, not school-specific information. Conditions in your area may vary. Data accessed January 2023.

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