3 Steps to Becoming a Nursing Home Administrator


    GUIDE
    February 17, 2021
    3 Steps to Becoming a Nursing Home Administrator
    Kathleen Gaines
    By: Kathleen Gaines MSN, RN, BA, CBC

    By: Kathleen Gaines MSN, RN, CBC

    Nursing home administrators (NHA) 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!

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    Part One What is a Nursing Home Administrator?

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

    Much of their daily operations are centered around 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.

    Part Two What Does a Nursing Home Administrator 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. 

    Nursing Home Administrator 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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    Part Three Nursing Home Administrator Salary

    According to Salary.com, nursing home administrators earn an average annual salary of $117,994. The annual salary range typically falls between $104,943 and $131,328. 

    Payscale.com reports an average annual salary of $91,511 or $38.00 per hour. 

    Nursing Home Administrator Salary by Experience

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

    1. Less than one year of experience earn an average annual salary of $74,198
    2. 1-4 years of experience earn an average annual salary of $84,998 
    3. 5-9 years of experience earns an average annual salary of $96,713
    4. 10-19 years of experience earns an average annual salary of $100,549
    5. 20 years and higher years of experience earns an average annual salary of $105,471

    Highest Paying Cities for Nursing Home Administrators

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

    1. New York, New York - $137,191
    2. Los Angeles, California - $136,974
    3. Detroit, Michigan - $111,176
    4. Philadelphia, Pennsylvania - $95,000
    5. Denver, Colorado - $94,929

    Part Four 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 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 Bachelors in Healthcare Administration

    An RN license isn't required, but a degree in healthcare administration is for nursing home administrators. 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 the administrative tasks like budget planning and proposals, federal regulations, and human resource skills like interviewing prospective employees and managing safe staffing ratios. 

    Step 4: Become Licensed 

    Each state is specific in licensure requirements for becoming a licensed nursing home administrator. This is a requirement for individuals in this position and something that is non-negotiable for reputable facilities as federal and state funding is tied to these requirements.  

    National licensing is overseen by the National Association of Long-Term Care Administrator Boards (NAB). There are also several different licenses students can complete:

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

    It’s important to note that not all states recognize all of these certifications. For that reason, it is essential that candidates carefully check the NAB website for state licensing. 

    The requirements for sitting for licensure exams vary widely based on the state but all require at minimum a bachelor’s degree in a healthcare-related field. Other common requirements for licensure include:

    • Being a minimum age of 18 to 21
    • Passing a background check
    • Having anywhere from 200 to 2,040 training hours (depending on state requirements)

    Part Five Where Do Nursing Home Administrators Work?

    Nursing home administrators 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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    Part Six What is the Career Outlook for a Nursing Home Administrator?

    The Centers for Disease Control and Prevention (CDC) estimates 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 32% from 2019-2029. 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 4% for all occupations, the career outlook looks very strong for nursing home administrators!

    Part Seven What are the Continuing Education Requirements for Nursing Home Administrators?

    Nursing home administrators will be expected to maintain an active nursing home administrator license and some states require continuing education hours. 

    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 it meets 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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    Part Eight 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

    Part Nine 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 and/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.

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    Part Ten Related Healthcare Administration Articles

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

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