Health Administration Careers in Nursing Homes, Assisted Living Facilities and Hospices

Long-term care administrators have a strong influence on the quality of healthcare services available to America’s aging population and others in need of long term care, providing quality leadership in nursing homes, assisted living facilities, and similar environments where skilled nursing is required. These senior-level managers establish healthcare standards, make strategic policy decisions, and implement personnel management procedures so as to support their overall vision for quality long-term care.

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According to the Centers for Disease Control and Prevention (CDC), more than 8 million people received care through long-term care facilities in the United States in 2012. Long-term care services comprise a significant component of personal healthcare spending in the United States. According to the SCAN Foundation, total spending for long-term care in the United States in 2010 was nearly $208 billion, or 8 percent of all personal healthcare spending.

As the baby boomer population enters retirement, long-term care services and their associated costs must rise to meet the demand. As a result, long-term care administrators who can ensure quality patient care and efficient healthcare operations will be more important than ever.

Health Administration Careers in Nursing Homes and Assisted Living Facilities

Long-term care administrators (also referred to as nursing home and assisted living administrators, depending on the facility) manage the operations and staff of long-term care facilities.

The main job responsibility of long-term care administrators is to provide residents with a high quality of life—including superb medical and personal care—while ensuring the efficient operation of a single facility or multi-facility system.

Because long-term care facilities are businesses, long-term care administration professionals must oversee both the business management side and the healthcare side of the facilities they manage.

Long-term care administration professionals must be proficient in a wide array of areas, including:

  • Facilities operations
  • Financial planning
  • Personnel management

Long-term care administrators serve as the head of operations, or the chief executive officer, of a facility. Long-term care facilities are quite diverse, with some housing older adults who require minimum assistance with their daily lives and others housing very ill patients who require specialized, complex nursing care services. Some long-term care facilities house specific populations, such as Alzheimer’s and dementia patients, while others provide a continuum of care to accommodate their patients as they age.

Ultimately, the job duties of long-term care administrators depend on the type of facility, the size of the facility, or the number of facilities within one campus or under one umbrella organization. However, their general focus includes:

  • Setting and enforcing policies
  • Staff hiring, training, and retention
  • Patient/resident care
  • Day-to-day operations
  • The promotion of the institution to the public
  • Budgeting
  • Disease control/prevention and pharmaceutical control
  • Federal/state/local regulations and legislation
  • Employee/patient/family grievances

Health administrators of long-term care facilities must supervise a staff that may include food service, nursing, cleaning, maintenance, finances, admissions, and social services departments, among others.

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On any given day, long-term care administration professionals must juggle everyday activities, emergencies, and situations requiring their immediate attention. The daily responsibilities of these healthcare professionals involve:

  • Communicating with diverse populations
  • Establishing and maintaining relationships with staff, patients, and patient family members
  • Assessing the needs of the patient and staff populations
  • Employing outstanding counseling and crisis intervention techniques
  • Analyzing financial needs and predicting future financial needs
  • Protecting patient rights
  • Analyzing, creating, and updating policies and procedures as needed


Long-Term Care Administrator Degree Requirements and Certification Options

Similar to many other careers in health administration, today’s long-term care administrator jobs often require professionals with advanced degrees in health administration or similar fields. Although some entry-level jobs do not require education beyond a bachelor’s degree, the standard for long-term administration jobs has become the master’s degree in health administration or long-term care administration.

Health Administration Master’s Degrees

A master’s degree in health administration prepares students to achieve leadership positions in a wide array of settings, including governmental, nonprofit, and private organizations. These programs receive accreditation through the Commission on Accreditation of Healthcare Management Education (CAHME).

Graduates of a master’s degree in health administration often seek executive-level positions in hospitals, health systems, managed care organizations, nursing homes, assisted living facilities, and physician offices, just to name a few. Many also seek jobs in policy, academia, and research.

These graduate programs include in-depth study in the following areas:

  • Organizational development for healthcare
  • Leadership in healthcare
  • Healthcare financial management
  • Health law
  • Human resources for health care managers
  • Health policy
  • Health care marketing
  • Ethics and law

Students interested in working in long-term care administration often take a number of elective courses to satisfy their state license requirements. These courses often include gerontology, nursing home administration, and personnel management, among others.

A capstone experience rounds out most programs, thereby allowing students to apply their knowledge and skills to a project focused on a contemporary issue in healthcare.

Students of health administration master’s degree programs often choose to take pre-licensure or administrator-in-training (AIT) courses after completing their program as a way to meet state licensing requirements. These courses/programs are offered through community colleges and four-year colleges and universities.

Long-Term Care Administration Master’s Degrees

Long-term care administration master’s degrees (also offered at the bachelor’s degree level) provide students with an interdisciplinary course of study in the healthcare needs of the elderly. They receive accreditation through the National Association of Long-Term Care Administrator Board (NAB).

Graduates of these master’s programs are prepared to achieve senior-level positions in nursing homes, assisted living facilities, hospice centers, continuing care retirement communities, home care agencies, and other private and public organizations that serve the elderly. Core coursework includes study in long-term care, health administration, and gerontology.

The curriculum of these programs includes:

  • Healthcare organization
  • Ethics of healthcare
  • Delivery of services to the elderly
  • Long-term care delivery

Most of these programs culminate in a practicum experience that satisfies the administrator-in-training (AIT) requirement for state licensure.

Professional Certification Options

Professional certification in long-term care administration is a voluntary process often pursued to meet professional and/or personal goals.

The American College of Health Care Administrators offers certification for both nursing home administrators and assisted living administrators:

  • Certified Nursing Home Administrator (CNHA): Candidates must possess a bachelor’s degree, a current state nursing home administrator license, and at least two years of experience as a nursing home administrator
  • Certified Assisted Living Administrator (CALA): Candidates must meet specific experience and education requirements to qualify to take the CALA exam


State Licensing as a Long-Term Care/Nursing Home Administrator

All U.S. states, as well as the District of Columbia, require long-term care/nursing home administrators to possess a state license, which generally involves completing an accredited, state-approved training program (usually a bachelor’s degree), completing an internship (called an AIT practicum), and passing a state/national licensing examination.

Most states use the National Association of Long-Term Care Administrator Boards (NAB) Nursing Home Administrator Exam (NHA) for licensure. Some states also use a state examination.

For example, Texas requires candidates to possess a bachelor’s degree, complete a 400-hour AIT practicum, and pass the NHA examination. The District of Columbia, on the other hand, requires candidates to possess a bachelor’s degree, complete 1,000 hours of AIT courses, and pass both the NHA and state exam. All states require long-term care administrators to complete continuing education to keep their state license current.

Note: Most states do not license residential care/assisted living administrators. A few states that require licensure, including South Carolina and Virginia, require candidates for licensure to possess an associate’s degree. Hawaii is the only state to require a bachelor’s degree for residential care/assisting living administration licensure.

Long-Term Care Administrator Salary Expectations

According to the Bureau of Labor Statistics (BLS), long-term care administrators earned an average salary of $118,800 as of May 2020. Early career professionals earned about $78,820, mid-level pros with graduate-level education and at least a handful of years of experience earned about $104,280, and senior-level administrators earned about $195,630.

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Those working in skilled nursing facilities earned an average salary of $100,160 during this time.

May 2020 Bureau of Labor Statistics salary and job market trends for medical and health services managers represent national data, not school-specific information. Conditions in your area may vary. Salary statistics representing entry-level/early career = 25th percentile; mid-level= 50th percentile; senior-level/highly experienced = 90th percentile. Data accessed August 2021.

Resources for Long-Term Care Administrators

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