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Steps to Become a Nursing Home Administrator

If you’re a leader and passionate about people, this career could be right for you.

administrator walking with medical staff in hallway
Home » Specialties » Nursing Home Administration

Nursing Home Administrator At a Glance

  • What you’ll do: You’ll lead a facility for older adults, overseeing their care and communicating with their families, and managing staff and day-today operations.
  • Where you’ll work: Nursing homes, assisted living facilities, and memory care homes
  • Degree you’ll need: Bachelor’s degree, and possibly a master’s to remain competitive
  • Median annual salary: $104,280

Nursing home administration is at the intersection of healthcare and business. Nursing home administrators are charged with leading staff while overseeing the care of residents and the operations of a long-term care facility.  

A nursing home administrator’s day-to-day responsibilities can include managing budgets, meeting with potential and current residents and their families, creating schedules, working with staff specialists, such as gerontologists, OTs, and respiratory therapists, and maintaining a healthy working and living environment for employees and patients.

Marc Halpert, chief operating officer of Monarch Healthcare Management, which operates assisted living centers, long-term care facilities, and memory care homes in Minnesota, says the best nursing home administrators show a passion for their work.

“The need for outgoing and energetic administrators is there,” Halpert says.

How to Become a Nursing Home Administrator

Follow these steps to launch your career.

  1. Decide if being a nursing home administrator is right for you.

    Are you a people person? Are you passionate about advocating for the vulnerable? If so, this job could be a good fit for you.

  2. Determine what education you’ll need.

    Several states require only a high school diploma or an associate degree for this role, but most require a bachelor’s degree. And to rise to the top of your field, you’ll likely need a master’s.

  3. Graduate from an accredited program.

    On average, it takes four years to complete a bachelor’s degree if you attend school full time and longer if you attend part time. An associate degree takes two years to complete.

  4. Gain experience in the field.

    Most states require nursing home administrators to complete a training program or an internship. Some schools include this in their programs.

  5. Get licensed.

    All states require nursing home administrators to be licensed. There are three national licenses to choose from, and your pick might depend on where you work.

  6. Consider earning a certification.

    Nursing home administrators aren’t required to have these credentials, but they can demonstrate your expertise and give you an edge as you advance in your career.

What Do Nursing Home Administrators Do?

Nursing home administrators are a type of healthcare administrator. They are typically the top executive of a nursing home, also known as a long-term care or skilled nursing facility. These homes offer 24-hour care, therapeutic or rehabilitation services, and everyday activities for residents. Nursing home administrators may also work in memory care facilities, which focus on patients with dementia, or assisted living facilities, which offer more independent living options.

While a nursing home administrator doesn’t need a clinical background, they are tasked with ensuring that resident care is of the highest quality.

Nursing home administrators are not medical office managers, who oversee the administrative staff in doctors’ offices and clinics. Rather, they oversee operations and act as the “face” of the facility. While a clinical background isn’t required, an administrator is tasked with ensuring that resident care is of the highest quality.
Due to the nature of the work, a nursing home administrator’s job isn’t a Monday-through-Friday, 9-to-5 position. Weekends, evenings, and even holidays are likely required at times.

Primary responsibilities include:

  • Hiring and managing clinical staff and administrative employees, such as health information managers
  • Managing day-to-day operations while also working toward long-term facility goals
  • Ensuring the facility is in compliance with local, state, and federal regulations
  • Overseeing billing activities and medical records while maintaining the facility’s budget
  • Serving as a liaison among staff, patients, families, governing board, and the public

Halpert says the rewards of being a nursing home administrator are many, including “(seeing) a smile on a resident’s face when discharging home after successful rehab, or a family member that visits and is so thankful for you for taking care of their loved one.”

Skills of a Successful Home Administrator

Are you both analytical and personable? Focused on people and details? Confident enough to lead a team of employees whose responsibilities range from healthcare to housekeeping?

To thrive as a nursing home administrator, a person should be:

Detail-oriented:

Nursing home operations require strict record-keeping and adherence to state and federal regulations and laws.

A capable communicator:

You’ll not only have to provide direction to the home’s team and staff gerontologists and caretakers, but also interact with patients and their families.

Forward thinking:

Technology is constantly changing, so nursing home administrators must stay up to date on advances in healthcare and data analytics.

Self-confident and self-reliant:

You’ll need to motivate, counsel, and provide direction for a team of employees with diverse skills and responsibilities.

Caring and compassionate:

Do you feel a calling to care for others—especially the elderly and those who are most vulnerable?

“Being a patient, happy, energetic individual allows one to deal with the stress and circumstances that come up and handle them properly,” Halpert says. “It is important to develop relationships with your staff where they can rely on you and work as a team to ensure a smooth-running operation at all times.”

Education to Become a Nursing Home Administrator

Education requirements can vary by state.

Only a high school diploma is required to be a nursing home administrator in:

  • Utah
  • Montana
  • Missouri
  • Colorado
  • Georgia
  • Pennsylvania

In another eight states, an associate degree is required:

  • Tennessee
  • South Dakota
  • South Carolina
  • North Carolina
  • Nebraska
  • Mississippi
  • Arkansas
  • Alabama

In the remaining states, you’ll need at least a bachelor’s degree to become a nursing home administrator, and many states also require completion of an “administrator-in-training” program or other field experience.

To remain competitive in their field and broaden their knowledge, some nursing home administrators pursue master’s degrees.

In his market, Halpert says, “a bachelor’s degree and nursing home administration experience are prerequisites” to become a nursing home administrator.

Most Common Education Requirements

A nursing degree isn’t required to be a nursing home administrator. The most common requirements include:

  • A bachelor’s degree in healthcare administration
  • An internship or administrator-in-training program
  • Passage of one of three licensing exams offered by the National Association of LongTerm Care Administration Board’s exam
  • State requirements such as continuing education, annual or biennial license renewal, and a background check

Bachelor’s Degrees

If you want to succeed and progress in your career, Halpert says, you’ll have the best luck with a four-year degree. Some examples of popular bachelor’s degrees for nursing home administrator careers include:

  • Long-term Care Administration
  • Healthcare Management
  • Health Service Administration
  • Business Administration
  • Health Sciences

For a bachelor’s in healthcare administration, expect coursework that covers:

  • Healthcare economics
  • Healthcare ethics and law
  • Healthcare finance and accounting
  • Public policy and healthcare
  • Public health
  • Human resources management
  • Marketing and communications in healthcare

In addition, depending on the state, an internship or “administrator-in-training” program of up to 1,000 hours will likely be required. Typically, it takes four years or 120 credits to earn a bachelor’s degree.

Master’s Degrees

While a master’s isn’t required to become a nursing home administrator, you may need one to remain competitive as you progress in your career. Common degrees in this field include:

  • Master of Health Administration
  • Master of Business Administration in Executive Health
  • Master of Business Administration with an emphasis on healthcare administration

In a master’s program, you’ll likely take some mix of courses like these:

  • Healthcare finance
  • Accounting
  • Population health
  • Statistics
  • Leadership
  • Organizational behavior
  • Healthcare policy

The time to complete this level of study is typically two years. Admission requirements for a master’s program vary by school but generally include:

  • Bachelor’s degree
  • Minimum GPA, usually 3.0 or higher
  • Personal statement
  • Official education transcripts
  • Letters of recommendation

Training Programs

Most states will require you to participate in an administrator-in-training program, which is essentially an internship. Depending on your education level, you’ll need to complete up to 1,000 hours as part of your state’s requirements.

In an administrator-in-training program, a student works under the guidance of a licensed administrator. Many healthcare administration programs have incorporated these into their curricula. Interns usually are required to complete rotations in some or all of the following areas:

  • Administration
  • Human resources
  • Nursing
  • Financial management
  • Dietetics
  • Rehabilitation
  • Medical records
  • Resident activities
  • Social services/admissions
  • Housekeeping/laundry
  • Environmental management/maintenance

Licensing

All nursing home administrators must be licensed, but each state has its own requirements. The National Association of Long Term Care Administrator Boards (NAB) is governed by state boards and offers three licenses for nursing home administrators, plus continuing education courses.

The exams for all three licenses have 55 questions and must be completed in an hour.

Nursing Home Administrator (NHA) license:

All states offer this license. The exam measures entry-level knowledge specific to nursing home administrators.

The Residential Care and Assisted Living (RC/AL) license:

The exam measures the entry-level knowledge specific to residential care/assisted living administrators.

The Home and Community Based Services (HCBS) license:

The test encompasses independent living, adult day, home health, and community-based services, and palliative and hospice care. Currently, very few states offer licensure in HCBS.

Professional Certifications

Nursing home administrators aren’t required to earn professional certifications, but they’re another way to demonstrate your expertise. They can also help you remain competitive and stand out among your colleagues. Some common certifications include:

What to Look for in a School

Halpert says that when looking at educational opportunities, look for universities “that have good placement options and connections to nursing homes.” 

These connections can help you land a spot in a training program, network, and ultimately find a job when you graduate.

Accreditation

Attending an accredited school and program is important for a number of reasons:

  • You can’t apply for federal financial aid or loans if your school isn’t accredited.
  • You can’t transfer credits from an unaccredited program to an accredited program, should you decide to pursue more education at a different institution.
  • You could be at a disadvantage in the job market if your education isn’t from an accredited school or program.

Accrediting agencies include:

  • The NAB, which accredits schools with undergraduate and graduate-level programs. The association says graduates of NAB-accredited schools score higher than the national average on the Nursing Home Administrator (NHA) licensing exam.
  • The Commission on Accreditation of Healthcare Management Education (CAHME) accredits programs for master’s degrees in healthcare management.
  • The Council on Higher Education Accreditation (CHEA) accredits undergraduate and graduate programs.

Online Programs

Many bachelor’s and master’s programs are offered online, and this can be a huge advantage for working students who must attend classes around a work schedule and possibly family responsibilities.

If you’re interested in an online program, check to see if classes are recorded so you can watch or listen to them on your schedule. Also, find out if there are online forums for students and whether your professors keep online office hours.

Many bachelor’s and master’s programs are offered online, and this can be a huge advantage for working students who must attend classes around a work schedule and possibly family responsibilities.

Some programs might be hybrids, meaning they include online and classroom coursework. Whatever the case, you should expect the same level of coursework online and to complete your training program in person.

Where You’ll Work

While most nursing home administrators oversee long-term care facilities, there are other workplaces for these professionals:

Rehab centers:

While some long-term care centers offer rehabilitation, others specialize in rehab services for older adults who need help recovering from surgery, a fall, or a stroke or heart attack.

Assisted living:

Many assisted living centers are for older adults who are still active but need help with some aspects of daily life.

Memory care:

These homes are for people who have dementia or Alzheimer’s disease and may need more specialized care.

Salary and Career Outlook

According to the U.S. Bureau of Labor Statistics, the job growth rate for health service managers—a broad category that includes nursing home administrators—is projected to be 32%. This is much higher than the 4% average projected growth rate for all occupations from 2019 to 2029.

Part of the reason for this dramatic growth is that baby boomers are aging and living longer. This means that many in this generation will require extended healthcare services for diseases and chronic conditions and to manage their lives.

The median annual wage for all workers in this category is $104,280, but it can vary widely. The lowest 10% of workers earn $59,980 a year, while the highest 10% earn more than $195,630.

Many factors can play a role in your salary, including your education and experience. So can location. Here’s a look at how salaries for health service managers stack up by state.

Medical and Health Services Managers

National data

Median Salary: $104,280

Bottom 10%: $59,980

Top 10%: $195,630

Projected job growth: 32.5%

State data

State Median Salary Bottom 10% Top 10%
Alabama $82,610 $55,080 $143,710
Alaska $108,740 $64,110 $202,370
Arizona $105,970 $60,190 N/A
Arkansas $78,810 $52,620 $133,930
California $130,640 $63,600 N/A
Colorado $109,100 $65,940 $189,230
Connecticut $110,260 $73,650 N/A
Delaware $111,930 $74,070 N/A
District of Columbia $140,600 $89,220 N/A
Florida $95,810 $52,700 $181,280
Georgia $92,780 $43,590 $172,200
Hawaii $124,850 $78,360 N/A
Idaho $91,280 $48,580 $156,730
Illinois $106,880 $64,780 N/A
Indiana $92,220 $54,500 $160,150
Iowa $80,980 $56,490 $135,430
Kansas $89,090 $54,810 $151,930
Kentucky $84,390 $51,030 $148,740
Louisiana $94,800 $60,570 $162,350
Maine $92,630 $63,480 $140,250
Maryland $118,520 $77,960 $201,640
Massachusetts $118,750 $68,590 N/A
Michigan $95,640 $56,090 $169,770
Minnesota $101,560 $67,740 $163,530
Mississippi $87,960 $49,880 $158,980
Missouri $99,840 $61,260 $170,380
Montana $90,370 $61,720 $142,690
Nebraska $107,440 $66,530 N/A
Nevada $111,690 $66,610 $178,420
New Hampshire $103,310 $66,570 $195,700
New Jersey $116,630 $85,690 $183,010
New Mexico $108,870 $71,980 N/A
New York $134,310 $81,370 N/A
North Carolina $103,940 $69,710 $189,450
North Dakota $110,940 $68,950 N/A
Ohio $94,350 $57,310 $168,590
Oklahoma $83,040 $52,890 $151,080
Oregon $116,060 $68,850 N/A
Pennsylvania $96,110 $57,440 $165,300
Rhode Island $116,020 $72,630 N/A
South Carolina $94,600 $56,620 $165,370
South Dakota $101,320 $69,840 $149,330
Tennessee $93,270 $51,950 $165,360
Texas $100,320 $56,150 $171,790
Utah $90,950 $49,870 $183,610
Vermont $96,680 $60,750 $172,390
Virginia $109,790 $64,550 $176,240
Washington $119,380 $70,840 N/A
West Virginia $97,420 $58,020 $166,400
Wisconsin $106,020 $72,230 $177,960
Wyoming $95,980 $65,230 $150,360

Source: U.S. Bureau of Labor Statistics (BLS) 2020 median salary; projected job growth through 2030. Actual salaries vary depending on location, level of education, years of experience, work environment, and other factors. Salaries may differ even more for those who are self-employed or work part time.

Professional Resources

Networking is always valuable for any career. For nursing home administrators, these groups offer various combinations of webinars, podcasts, conferences, publications, job boards, certification, and continuing education.

  • American College of Healthcare Executives (ACHE)
  • Medical Group Management Association (MGMA)
  • American Association of Healthcare Administrative Management (AAHAM)
  • Professional Association of Health Care Management (PAHCOM)
teresa kenney

Written and reported by:
Teresa Kenney
Contributing writer

mark halpert

With professional insight from:
Marc Halpert, Chief Operating Officer
Monarch Healthcare Management