How to Become a Nursing Home Administrator (NHA)

Nursing home administrators (NHAs) oversee the daily operations of long-term care facilities, also known as nursing homes. Handling both clinical and administrative tasks in assisted living facilities as well as residential care facilities. 

In this guide, we’ll explain what a nursing home administrator does, how to become one, how much they make, and more!

What is a Nursing Home Administrator (NHA)?

Nursing home administrators run the day-to-day operations of long-term care facilities, adult care centers, and retirement communities. They are responsible for both administrative and clinical duties. 

Much of their daily operations are centered around the state and federal regulatory guidelines to ensure that all compliances are met. This allows the facility to get much-needed state and federal funding as well as all private and federal insurance money. 

RN to Nursing Home Administrator

Many NHAs are either nurses or medical doctors, as this makes running the clinical aspect of running an LTC more feasible. Nursing home administrators are not required to have a registered nursing license, but many do. However, they must have a degree in healthcare administration in order to be eligible to be an NHA and obtain certification.

>> Related: What is an MDS Nurse?

What Does a Nursing Home Administrator (NHA) Do?

Unlike hospital settings, nursing home administrators are in charge of all clinical and administrative aspects of a care facility. 

They often do not have other senior management available to delegate the different tasks to. Some larger facilities may have nurse managers or financial directors. But that's not always the case. 

NHA Duties

Nursing home administrators perform a variety of specific tasks, including,

1. Obtaining medical equipment
2. Advertising for new residents
3. Managing personnel operations
4. Creating standards for patient care that comply with state and federal standards of care and law
5. Monitoring expenses, finances, and accounting
6. Being the “face” of the facility
7. Reporting to the board of directors regarding operations of the facility
8. Acting as a primary advocate for residents
9. Coordinating their patient’s schedules and activities

How Many Hours Do Nursing Home Administrators Work?

Since nursing homes are 24/7 operations, nursing home administrators work untraditional hours that vary depending on their meetings and the flow of the workplace. 

NHAs can expect to be on-call nights, weekends, and holidays, and most work over 40 hours per week consistently. 

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Nursing Home Administrator Salary

According to ZipRecruiter, the average nursing home administrator's salary is $121,986 annually as of December 2024. The annual salary range typically falls between $47,000 to $181,500.

NHA Salary by Experience

Nursing home administrators can earn a higher annual salary with more years of experience, according to Payscale.

1. Entry level earns an average annual salary of $77,250
2. Early-career earns an average annual salary of $89,420
3. Mid-career earns an average annual salary of $101,157
4. Experienced earns an average annual salary of $103,861
5. Late career  earns an average annual salary of $112,504

Highest Paying Cities for Nursing Home Administrators

Currently, nursing home administrators earn the highest salaries in the following cities, according to ZipRecruiter.

1. New York City, NY - $130,036 avg. annual salary
2. Green River, WY - $125,510
3. San Mateo, CA - $125,334
4. Daly City, CA - $123,309
5. Boston, MA - $123,160

How to Become a Nursing Home Administrator

The journey to becoming a nursing home administrator often starts with a degree in nursing, healthcare administration, or a similar field of study. 

Step 1: Attend Nursing School (Optional)

Some nursing home administrators, NHAs, begin their careers as nurses. In this case, you’ll need to earn either an Associate’s Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN) from an accredited nursing program, then pass the NCLEX-RN and gain experience.

The type of bedside experience doesn’t matter as much for an administrator-in-training (AIT) as it does for other nursing specialties. Ideally, those interested in becoming a nursing home administrator would benefit from a specialization in gerontology or a long-term care facility. This enables nurses to become well-versed with the patient population. 

Step 2: Earn a Bachelor's Degree in Healthcare Administration

An RN license isn't required for nursing home administrators, but a degree in healthcare administration is a must. RNs will need to take this step and earn a bachelor’s degree in healthcare administration after they've completed their nursing studies. Non-nurses can go straight to this step. 

Step 3: Earn a Master’s Degree in Healthcare Administration

A master’s degree, such as a Master in Health Administration (MHA), is often required for this position because individuals will learn administrative tasks like budget planning and proposals, federal regulations, and human resource skills like interviewing prospective employees and managing safe staffing ratios. 

Step 4: Take the Exam and Become Licensed 

Each state has specific requirements for becoming a licensed NHA, also known as an LNHA. This requirement is non-negotiable for individuals in this position and is tied to federal and state funding for reputable facilities.  Here are the available licenses you could obtain along the NHA path:

• Residential Care and Assisted Living (RCAL)
• Nursing Home Assistance (NHA)
• Home and Community-Based Services (HCBS)

National licensing is overseen by the National Association of Long-Term Care Administrator Boards (NAB). To obtain national licensure, you'll need to take the national exam required by all states. Fees for the exam range from $185-$400, depending on which exams you take:

• Core Exam + NHA Line of Service Exam: $440
• Core Exam + RCAL or HCBS Exam: $415
• Core Exam ONLY: $310
• One Line of Service (NHA, RCAL, or HCBS) Exam ONLY: $185

Some states also require a state exam, so be sure to check with the state you're looking to get licensed to ensure you take all the necessary exams. It’s important to note that not all states recognize all three certifications. For that reason, it is essential that candidates carefully check the NAB website for state licensing. 

Where Do Nursing Home Administrators, NHAs, Work?

NHAs typically work in long-term care facilities. But they can work in other settings that are not commonly considered. These include:

1. Adult daycares
2. Memory care facilities
3. Skilled nursing facilities
4. Senior homes
5. Department of Veteran Affairs (VA) nursing homes
6. Continuing care retirement communities  

Regardless of the setting, nursing home administrators enjoy similar benefits. While actual benefits may vary depending on the institution, most include the following:

1. Health, dental, and life insurance
2. Certification reimbursement      
3. Retirement options
4. Holiday pay and paid time off
5. Family, maternity, and bereavement leave
6. Relocation assistance
7. Childcare             
8. Continuing education reimbursement

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What is the Career Outlook for an NHA, or Nursing Home Administrator?

The Centers for Disease Control and Prevention (CDC) estimates that 1.3 million residents occupy approximately 15,600 nursing homes across the country. Each of these facilities has a nursing home administrator, making this job very in demand. However, this statistic doesn’t account for adult daycare centers as well as retirement communities. 

According to the United States Census Bureau, about 10,000 baby boomers turn 65 years old each day and have been since 2010. By 2030, all 73 million baby boomers will be older than 65. These individuals are living longer, albeit some are sicker and require additional healthcare.

Nursing homes, adult daycares, and retirement communities will be needed for a large portion of these individuals, and nursing home administrators will desperately be needed to run them. 

According to the U.S. Bureau of Labor Statistics (BLS), the job outlook for medical and health services managers is 29% from 2023-2033. While the BLS does not differentiate between nursing home administrators and other medical managers, this figure is representative of the ongoing need in this field. 

Compared to the average growth rate of 3% for all occupations, the career outlook looks very strong for nursing home administrators!

What are the Continuing Education Requirements for NHAs?

Nursing home administrators will be expected to maintain an active nursing home administrator license, and some states require continuing education hours. Earning your license makes you a LNHA.

The National Continuing Education Review Service (NCERS) -- NAB's continuing education review service -- reviews and approves thousands of continuing education programs offered by hundreds of providers across the country. Information can be found here. 

The website has updated continuing education offerings relevant to nursing home administration, including:

1. Elder abuse
2. ADL management
3. Alzheimer’s disease
4. Brain potential
5. Financial responsibility

If a nursing home administrator also has an active Registered Nurse (RN) license, Continuing Education Units (CEUs) will need to be completed according to state guidance. Generally, in order for an individual to renew their RN license, they will need to fill out an application, complete a specific number of CEU hours, and pay a nominal fee. 

Each state has specific requirements, and it is important to check with the board of nursing prior to applying for license renewal. CEUs related to a nursing home administrator license may also be used for an RN license if they meet the requirements and eligibility. 

If the RN license is part of a compact nursing license, the CEU requirement will be for the state of permanent residence. Some states require CEUs related to child abuse, narcotics, and/or pain management. 

A detailed look at Continuing Nurse Education hours can be found here.

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Resources for Nursing Home Administrators

1. American Assisted Living Nurses Association
2. National Association of Long-Term Care Administrator Boards
3. American College of Healthcare Executives
4. American College of Healthcare Administrators
5. American Association of Healthcare Administrator Management
6. American Geriatrics Society
7. American Nurses Association
8. American Society of Aging
9. Eldercare Workforce Alliance
10. Hartford Institute for Geriatric Nursing
11. National Gerontological Nursing Association
12. The Gerontological Society of America

Nursing Home Administrator FAQs

• What does it take to become a nursing home administrator?

  • To become a nursing home administrator, individuals must first earn a bachelor’s degree in nursing, healthcare administration, or a related field. A master’s degree will be expected in order to learn the administrative duties expected of an NHA. States require that all nursing home administrators pass a national licensure exam and maintain certification while employed. 

• What is the role of a nursing home administrator?

  • The nursing home administrator is responsible for the day-to-day operations at a long-term care facility, retirement community, adult daycare, or assisted living facility. This can include meeting with staff, budget planning, navigating state and federal funding, as well as securing needed medical equipment and supplies. 

• Is a nursing home administrator a good job?

  • A nursing home administrator is a demanding job but one that is highly lucrative and in demand. Individuals can expect to have a lot of responsibility and work long hours but are rewarded nicely. It can be stressful because of the expectations and long hours.  

• What is it like being a nursing home administrator?

  • Nursing home administrators spend a good portion of their day in meetings related to staffing, budget, enrollment and recruitment, policy and procedures, and regulations. Time is also spent touching base with clinical and non-clinical staff, working with outside healthcare systems to ensure proper care of the residents when needed, communicating with family members, and reporting to a board of directors or senior-level management.

Related Healthcare Administration Articles

Explore these other articles and guides for more info on starting your healthcare administration career:

• How to Get Into Healthcare Administration
• Bachelor's in Healthcare Administration Degree Guide
• Master's in Healthcare Administration (MHA) Degree Guide
• Top 10 Online Healthcare Administration Programs
• 10 Highest Paying Healthcare Administration Jobs