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Becoming a Nursing Home Administrator


Updated July 01, 2014

Doctor talking to hospital administrator
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The nursing home administrator is a leader in the organization who not only directs its operations but in a large part is responsible for setting the tone of the culture. Now more than ever, true leaders are needed in this area of healthcare. Find out the career ladder for success in this position.

Reporting Responsibilities:

The Administrator can report to various sources. If an entity of a County, the relationship could be to a board of commissioners. A not-for-profit may have a board of directors. A private stand alone facility may have owners who the administrator reports to and for facilities that are part of a system, the administrator could report to a system vice president.

Reporting to the administrator, depending on the size of the organization, could be the following directors:

  • Quality Assurance
  • Staff Development
  • Environmental Services
  • Food Services
  • Nursing
  • Social Services
  • Activities
  • Finance
  • Human Resources
  • Marketing
  • Sales
  • an Executive Secretary

Scope of Responsibilities:

The Nursing Home Administrator directs the provision of skilled, intermediate and rehabilitation care on a 24-hour basis and ensures a smooth, high quality and professionally acceptable operation. The incumbent must ensure the care and services provided meet the satisfaction of the residents, their families and physicians, and all state, federal, and local regulations and laws.

The Administrator develops and implements nursing home policies and procedures to comply with Federal, State and Local requirements and to fulfill licensure certification standards.

The incumbent hires, monitors and directs the activities of several direct reports to this position in the implementation of these policies and procedures. This position continuously analyzes departmental operations, evaluates the environment and equipment necessary for effective functioning and implements any necessary procedural change.

The administrator must ensure conformance with the Nursing Home annual budget and strive to maintain a high occupancy rate with payer sources.

The administrator participates on multi-disciplinary advisory committees; confers with the Medical Director and other consultants as necessary and serves on various community boards to assure continued care for residents.

The administrator serves as the primary liaison for the nursing home with residents, their families and the general public. The incumbent is referred admission decisions of a complex nature, problems with resident's occupancy, waiting list inquiries.

The administrator is referred problems not resolvable at the departmental level, including employee grievances, problems with unionization, and more. This position also makes decisions pertaining to physical plant problems, including equipment replacement, repairs and redecorating.

The administrator is responsible for a fire and safety program to prevent fire and injury to residents, staff, and visitors and to maintain a safe and hazard free environment in the nursing home. Program directives must comply with state public health regulations and state fire marshal directives.

The Administrator strives to retain a reputation for quality care while remaining locally competitive and continuously monitors the changes in the various regulations and standards for the industry.

The Administrator acts as liaison to nursing home auxiliary to maximize their efforts in volunteer hours and donated monetary projects that benefit the home.

The administrator plans and oversees capital improvements. The incumbent compiles budget projections, revenues and expenses to support justification to the Board. The administrator meets with community groups and hospital administrators to develop admission criteria, special unit policies and procedures, evaluate equipment necessary for effective functioning; and plans for new or expanded programs that meet community needs for geriatric services.

The Administrator has ultimate responsibility for operations with regard to staffing, payroll and benefits administration, in-service education, budget review and analysis and operational and capital expenditures. The incumbent researches and makes recommendations to the Board for personnel policy changes, salary increases, staffing increases, annual budget amendments, resident rate increases, outside contractual services, major capital improvements and grants.


Minimum requirements necessary to effectively carry out position responsibilities requires the incumbent to be licensed as a Nursing Home Administrator in the State and have extensive experience in administration of a long-term care facility; considerable knowledge of Federal and State licensure requirements for nursing home operations, and respect for the principles of resident rights, confidentiality, EEO and ADA. See more below.

Personal Choice:

Some nursing home administrators prefer to work in extremely large nursing home organizations, which may have several different separate facilities. Others prefer to work in a small residential care facilities with as few as six to ten patients, and an opportunity to know each one personally. Only you can decide what environment is right.

Salary Guide:

A nursing home administrator salary averages about $70,000 per year, but can range as high as $90,000 to $100,000 annually. The median expected salary for a typical Nursing Home Administrator in the United States is $89,932. Income varies, depending on:

  • credentials
  • location
  • type of facility
  • years of experience

Education and Training:

Most nursing home administrators are required to have a bachelor’s or master’s degree from an accredited college or university. An associate degree combined with substantial experience may be accepted by smaller facilities.

To prepare for a nursing home administrator employment, studies include a variety of subjects including:

  • accounting
  • health care
  • human resources
  • legal issues
  • management

All 50 states require a nursing home administrator license. Only the Board of Examiners can grant licensure. Requirements vary from state to state. In Minnesota, for example, candidates must have a minimum of a baccalaureate degree with required courses, a practicum and specific scores on both the state and national exams.

A practicum consists participating and learning in a licensed nursing home while closely supervised by a fully licensed nursing home administrator.

When applying for a nursing home administrator position, previous experience in health care, human resources, management and medical technology are looked upon favorably. Examples of relevant work experience include:

  • management position in a health-related environment
  • nursing home employment, such as accounting or customer service positions
  • sales and marketing jobs in a residential care facility
  • volunteer work in a nursing home

Career Advancement:

Advancement opportunities for nursing home administrators include:

  • consulting
  • more senior positions, such as supervisor of other nursing home administrators in a large system
  • specialization in areas of interest, such as Alzheimer's patients or hospice
  • variety of increased responsibilities, such as counseling different clients

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