Nursing homes are big business. According to the Centers for Disease Control (CDC), approximately 1.3 million Americans reside in the nation’s 15,000 nursing homes. Unsurprisingly, the likelihood of residing in a nursing home increases with age. The National Institute on Aging and the National Institute of Health report that:
Someone needs to make sure that these facilities are well-managed and safe, and that they provide optimal quality of life for residents. That someone is a nursing home administrator. Nursing home administrators coordinate all of the administrative and clinical activities that directly contribute to patient or resident quality of care. As a nursing home administrator, your responsibilities may include everything from monitoring medical practices to overseeing facility operations to ensuring that your facility complies with all local and federal regulations. In fact, you may be called upon to step into just about any role that doesn’t involve direct patient care.
You need to be comfortable with responsibility to succeed in this role. Christin Delahay (LNHA, CDP) explained to McKnight’s Long Term Care News blog that she transitioned from nursing aide to nursing home administrator because she wanted to make the rules.
“I tried hard to share my approach with my peers, to teach others how to provide exceptional care with compassion. There was only one problem: ‘That’s not your job. You’re an aide, you don’t make the rules’… I decided that if I wanted to make a real difference, to really be able to show people what great care looks like, to change the face of an industry plagued by negativity, I would have to become an administrator.”
When you become a nursing home administrator, you’ll be responsible for your facility’s success. You’ll pursue the best hires, the best equipment, and the best practices your budget can accommodate. You’ll keep patients, their families, and staff apprised of changes, so you’ll also need excellent communication skills.
In this article, we’ll cover:
It might be easier—and take less time—to list all the things nursing home administrators don’t do. On a typical day, a nursing home administrator may:
They may also be responsible for hiring and supervising a large staff of nurses, aides, medical specialists, and administrative personnel—which is a big job all by itself.
It’s a demanding job that can be stressful as well, especially if you are working with insufficient resources. Nursing home administrators need to be experts in both business and healthcare. They also need to be referees, because it’s their job to deal with conflicts among staff and between patients or residents. Nursing homes never close, so you may be required to work on evenings, weekends, and holidays.
Nursing home administrators work in nursing homes, retirement communities, assisted living facilities, and related facilities. The nursing home administrator may report to a facility’s owners, a system vice-president, a board of directors, or a board of commissioners.
Meanwhile, the following staff report to nursing home administrators:
Health administration undergraduates sometimes start out in admissions, marketing, risk management, managed-care analysis, or other non-clinical staff positions and work their way into higher-level administrative roles. While it’s possible to work in healthcare administration without an MHA, it can take a lot longer to climb the managerial ladder without a master’s degree. (
According to the most recent data from the Bureau of Labor Statistics, as of May 2018, the median wage for health service managers was $99,730 per year, with the highest 10 percent in the field earning over $182,600 in base pay. Employment opportunities for health services managers is expected to grow by 20 percent by 2026. This growth is much faster than growth for other occupations. ( )
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To become a nursing home administrator you will need at minimum a bachelor’s degree. Appropriate majors for aspiring nursing home administrators include nursing, long-term care administration, and health administration. Some schools offer nursing home administration majors (e.g., Kent State University at Kent offers an NHA major) or nursing home administration specialization tracks as part of a long-term care administration major.
You can also study:
In health administration programs like those at George Washington University, the University of Alabama at Birmingham, and Jefferson (Philadelphia University + Thomas Jefferson University), students study administrative topics such as:
You can choose a different path, however, and begin your career in health administration by becoming a registered nurse. You’ll gain valuable clinical experience that will be helpful when you have to handle patient requirements, put together budgets for patient care, and manage daily operations.
After earning a bachelor’s degree, you should seriously consider pursuing a Master of Healthcare Administration (MHA), Master of Long-term Care Administration, or a related degree. You should also consider the Master of Science in Gerontology with a concentration in nursing home administration, especially if you are looking for a program that dives more deeply into clinical topics. There are very few master’s degree programs dedicated exclusively to nursing home administration, but in most healthcare and long-term care administration master’s programs students have the opportunity to take courses in nursing management, gerontology, and other subject matter specific to nursing home administration. Some schools, like Utica College, offer nursing home administration concentrations.
Look for programs that are accredited by the National Association of Long-Term Care Administrator Boards. Look to see whether the program will help you study for the nursing home administrator’s licensure examination (Bowling Green State University – Main Campus is one that does).
As you pursue your master’s degree, you’ll take classes like:
Most master’s degree programs, including the MHA, take two years to complete when you’re studying on-campus and going to school full-time. There are also accelerated one-year online programs like the MHA offered by Stony Brook University or the MHA offered by Indiana University – Bloomington.
Getting your education is only the first step toward becoming a nursing home administrator. Every state requires nursing home administrators to hold a license; the exact requirements vary from state to state.
National licensing is overseen by the National Association of Long-Term Care Administrator Boards (NAB), and all 50 states use the NAB exam. The exam consists of 150 questions covering the following five topics:
There is an official NAB Study Guide for sale as well as free study materials online and in forums.
Most states require that licensed nursing home administrators complete at least 400 to 1,000 administrator-in-training hours and that they complete continuing education courses throughout their careers. How many hours of continuing education are required varies from state to state. In California, it is 40 hours, and 10 of those hours must be focused on patient care or aging. In New York, it is 48 hours.
The NAB also offers additional licenses in residential care/assisted living and home and community-based services that can distinguish you when you’re looking for jobs in this field. To find out precisely what licenses and certifications you’ll need to become a nursing home administrator, check with your state’s Board of Examiners.
Nursing home administrator is a role most people ascend to after years of working in nursing homes or assisted living facilities. First, they rise to mid-level administrative or management positions while studying healthcare regulations and emerging best practices. By the time they become administrators, they should know the business of care and the specifics of care inside and out. Their previous experience in other administrative jobs helps in this regard.
That said, nursing home administrators come from all different business functions. Some begin their careers in the marketing department, HR, or in medical billing.
Nursing home administrator is not the end of the line in terms of career advancement. From this position, you can advance into a supervisory role in a large assisted living system, choose a specialty area and work at a specialized facility, or work as a consultant for numerous health systems.
The proportion of elderly citizens in the United States is growing, and as a result career prospects for nursing home administrators are solid. By 2040, one in five Americans will be 65 or older. Many of these people will eventually need nursing home care.
According to the Bureau of Labor Statistics, healthcare administration jobs, such as nursing home administrators, are projected to grow by 18 percent by 2028. The average nursing home administrator salary is about $96,658.
Nursing home administration is a challenging field with a reported annual turnover rate of 40 percent. Studies suggest the causes include red tape, roadblocks, an ever-changing field of regulations, emotional exhaustion, and cynicism, all confronted while trying to provide patients and residents the best possible quality of care.
Disenchantment takes its toll on those who are unprepared for the depth and breadth of challenges they’ll face in this role. If you do decide to become a nursing home administrator, you may feel like you run up against wall after wall whenever you try to improve your patients’ quality of life.
What keeps successful nursing home administrators going may be the knowledge that they are making a difference in people’s lives. Even if it takes a while to make improvements and even when those improvements aren’t perfect, they can mean the world to the patients and residents who live in your facility full time. One Quora respondent answered like this when asked what it’s like to be an administrator at a large skilled nursing home facility:
“This is what my present Executive Director would say: The residents who live here deserve the very best, and we provide them with everything possible. There are challenges, sure—every business has challenges—but every single staff person here is dedicated not simply to this company, but to these residents.”
The key to thriving in this role isn’t just to have the appropriate degree or licenses but to have a lot of patience and persistence. With those, you’ll be able to give the people in your care what they need to love where they live.
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