What Does a Nursing Home Administrator Do?

More than a million Americans currently live in nursing homes, a number that is expected to grow as the Baby Boomer generation ages. That should mean greater opportunities for nursing home administrators, the professionals who oversee these facilities to ensure that residents receive high-quality, compassionate care. It’s not a job everyone is cut out to do. Keeping a nursing home or long-term care facility up and running is mentally and emotionally challenging work. Turning an assisted living facility into a place residents happily call home is even more difficult.

Burnout is common among nursing home administrators, or NHAs, with an annual turnover rate of 40 percent. Between the red tape, financial roadblocks, an ever-changing landscape of regulations, and the fact that assisted living facilities are open 24/7, nursing home administration can feel like a Sisyphean job.

It is not, however, an impossible one. Successful licensed nursing home administrators are passionate enough about delivering the best possible quality of care to tackle a tremendous range of tasks, both big and small, day in and day out. For those who can handle the workload, the financial rewards can be substantial.

In this article about what does a nursing home administrator do, we’ll cover:

• What kinds of people become nursing home administrators?
• What is a nursing home administrator responsible for?
• What might a nursing home administrator do in a workday?
• What qualifications are required to become a nursing home administrator?
• What is the typical advancement path for nursing home administrators?
• How much money does a nursing home administrator earn?
• What can you expect from a nursing home administrator job?

What kinds of people become nursing home administrators?

Given the outsize turnover and burnout rates, you might wonder what kind of person thrives in this career. The quick answer: people who love what they do and love it enough to deal with the stress. Nursing home administration is a juggling act, according to Elliott D. Cahan, author of A Place Like Home: Candid Reflections of a Nursing Home Administrator. In an interview with I Advance Senior Care, he describes the job this way: “All the disparate parties involved in resident care—residents, families, staff, regulators, owners—come at it from different angles, but ultimately, it’s the administrator who is holding the bag for providing the care… It’s like a stack of cards, and you’re never quite sure which card is holding up the stack… It’s a precarious business.”

NHAs have to be flexible enough to make changes as circumstances change; strong enough to persevere when the needs of residents, families, and staff are in conflict with budgetary realities and complicated regulations; and humble enough to step in and pick up the slack when they see something that isn’t getting done. Nursing home administrators are paid very well for what they do (more on this later), but they don’t work in the kinds of ivory towers CEOs occupy. When you become a nursing home administrator, you are responsible for your facility’s success. You can’t fulfill that obligation day in and day out from behind a desk.

What is a nursing home administrator responsible for?

The question ‘what does a nursing home administrator do?’ is easy to answer but hard to quantify (though we’ll try in the next section). They literally coordinate everything. NHAs have a hand in nearly all the administrative and clinical activities that directly and indirectly contribute to resident quality of care. They:

• Manage facility operations
• Handle the finances
• Monitor medical care in the facility
• Develop quality improvement strategies.

In other words, as a nursing home administrator, you are responsible for just about everything, including the things that go wrong. If a resident is injured, you’re responsible. If unsafe conditions are discovered in your facility, you’re responsible. If financial fraud is discovered, you’re responsible.

In this role, you’ll handle a lot of administrative and managerial tasks, but you’ll also spend plenty of time just trying to make people happy. When there’s tension between financial leadership and clinical leadership, you’ll handle it. When a resident or a resident’s family is unhappy, you’ll handle it. When the board is dissatisfied with costs, you’ll handle it. And when the staff doesn’t feel appreciated, you’ll handle it.

If the phrases “you’re responsible” and “you’ll handle it” give you the heebie-jeebies, this is not the job for you.

What might a nursing home administrator do in a workday?

The day-to-day responsibilities of a licensed nursing home administrator can vary depending on the needs of a facility, but all NHAs do things like:

• Manage the day-to-day operations of the facility
• Create or approve staff member schedules
• Oversee the work of facility staff members
• Manage mid-level administrative personnel
• Hire and fire employees at every level
• Set financial and performance goals for the facility
• Oversee billing and set fees
• Meet with prospective residents and their families
• Process resident admissions
• Mingle with residents to assess their satisfaction
• Present status updates to the board
• Meet with representatives from insurance companies and care agencies
• Create, review, and sign off on budgets
• Schedule equipment maintenance and upgrades
• Review records to ensure they comply with federal and state regulations
• Ensure the facility is in compliance with local, state, and federal regulations
• Approve resident-care protocols
• Make sure individual care plans are being followed
• Schedule and provide regular safety and compliance training
• Settle staff and resident disputes
• Find new vendors and order supplies
• Research the most up-to-date best practices in long-term care and assisted living
• Schedule social or physical activities for residents

This is a demanding job. You need to be an expert in both business and healthcare. You’ll be regularly called upon to make do when resources are scarce. You’ll have owners, a board of directors, or a board of commissioners watching your every move. Nursing homes never close, so you may have to work on evenings, weekends, and holidays. And when there’s a need, you may have to step in to fill just about any role that doesn’t involve direct patient care.

What qualifications are required to become a nursing home administrator?

Fifty percent of nursing home administrators have bachelor’s degrees—usually in subjects like long-term care administration, healthcare administration, healthcare management, hospital administration, and nursing. Very few colleges and universities offer nursing home administration bachelor’s degree programs (Kent State University at Kent is one), though some, like Saint Joseph’s College of Maine, offer nursing home administration specialization tracks for undergrads.

Healthcare administration programs don’t spend a lot of time on clinical topics. Instead, they study:

• Medical administration
• Operations management
• Financial management
• Human resources management
• Marketing and public relations
• Leadership in healthcare administration
• Ethics in healthcare administration
• Business law in healthcare

If you’re sure you want to become a nursing home administrator, minoring in gerontology may help you better understand what nursing home administrators do and why. You’ll gain valuable clinical insights that can be helpful when you’re trying to balance patient requirements against administrative constraints.

You can pursue a nursing home administrator license after earning a bachelor’s degree. All 50 states require that nursing home administrators be licensed, but the exact licensure requirements for nursing home facility administrators vary from state to state. To get a license, you’ll need to pass the National Association of Long-Term Care Administrator Boards (NAB) exam and complete at least 400 to 1,000 administrator-in-training hours.

You can also pursue voluntary certifications for NHAs that might make it easier to find a job or help you negotiate for a higher salary when you get offers. Some healthcare administration certifications you should look into are:

• The Certified Medical Manager (CMM) designation
• The Certified Healthcare Financial Professional (CFHP) designation
• The Certified Healthcare Access Manager (CHAM) designation
• The Certified Professional in Healthcare Quality (CPHQ) designation
• The Certified in Healthcare Compliance (CHC) designation

While only 38 percent of nursing home administrators have master’s degrees, you should at least look into earning a Master of Healthcare Administration (MHA), Master of Long-term Care Administration, or a related degree; more education can increase your job prospects and earnings. There are very few master’s degree programs dedicated exclusively to nursing home administration, but most health administration and long-term care administration master’s programs offer students the opportunity to study subject matter related to nursing home care, gerontology, and nursing home management. Some colleges and universities, like Utica College, offer nursing home administration as a concentration or specialization track.

What is the typical advancement path for nursing home administrators?

Most nursing home administrators spend years working in managerial and lower-level to mid-level administrative jobs in nursing homes or assisted-living facilities before advancing into this role. Before that, they may work in healthcare administration in smaller medical practices or hospitals, or even in the marketing department or in medical billing. According to CareerBuilder, 36 percent of nursing home facility administrators have amassed 21 or more years of work experience in healthcare administration. Patience is a virtue when your goal is to become a nursing home administrator.

How much money does a nursing home administrator earn?

The data on nursing home administrator income is inconsistent. According to Salary.com, the average nursing home administrator salary in the United States is $115,508. Indeed reports that the average salary for a nursing home administrator is $92,284 plus $5,750 in overtime pay. PayScale’s figure is closer to $90,000, and the US Bureau of Labor Statistics reports that median pay for administrators in nursing and residential care facilities is about $84,000.

Depending on where you live, $84,000 can fund a pretty lavish lifestyle or a solidly middle class one. Getting closer to Salary.com’s average will be a matter of bringing more skills and experience to the table. If you can show you have effective budget and operations management experience, you’ll probably make more. If you’ve previously worked as a medical office administrator or in another healthcare administration role, you’ll make more. And if you have a master’s degree, you’ll definitely make more when you’re hired and over the course of your career than you will with a bachelor’s degree.

What can you expect from a nursing home administrator job?

You can expect good pay from day one and generous raises. Nursing home facilities want to keep successful administrators on board, and one way they do that is by offering generous salaries. Paul Gavejian, managing director of Total Compensation Solutions, told McKnight’s Long Term Care News that, “it’s pretty difficult to recruit new people at the executive level. There’s the suggestion if you give decent increases, you’re not necessarily going to see them jumping ship.”

Job stability is another reason to consider a career in healthcare administration. People in the US are aging—one in five Americans will be 65 or older by 2040—and a lot of them will eventually need nursing home or assisted living care. As a result, job opportunities in healthcare administration and management are expected to grow much faster than average.

Unfortunately, you can also be reasonably sure that your job will be stressful. You’ll spend your days trying to provide the best possible quality of care for your residents, even though roadblocks like budgetary constraints and federal and state rules can make it tough to make even minor improvements to your facility. It’s important to realize, however, that burnout is not inevitable. Small changes do matter. Nursing home administrators who are dedicated enough to fight for their residents at every turn eventually do make life better for them. In other words, the most crucial thing nursing home administrators do is simply keep going.

Questions or feedback? Email editor@noodle.com