Dedication, a strong sense of purpose, and a willingness to move beyond your comfort zone are all necessary traits for becoming a long-term care administrator. As you will see, there’s more to becoming a licensed nursing home administrator (LNHA) than just fulfilling degree requirements and passing a standardized test. In this article, we provide guidelines for becoming a nursing home administrator and share practical steps for achieving great success in long-term care by developing a healthy culture in LTC facilities.
We also provide an inside look into the journey of becoming a nursing home administrator by looking at the case of Joe Mason, the compassionate and decisive 28-year-old nursing home administrator of the Prairie Manor Care Center of Blooming Prairie, Minnesota. He joined our Peter Murphy Lewis to talk about the process of becoming a nursing home administrator on the LTC Heroes podcast.
What it means to have a long-term care administrator job
So what does a nursing home administrator do? Being a long-term care administrator is about being able to handle a great variety of everyday tasks and manage people and their needs.
The primary duties of a nursing home administrator are:
- Planning, coordinating, and supervising health care delivery
- Monitor and oversee every aspect of their facilities to ensure they are in compliance with the most up-to-date federal regulations as well as state and local regulations, all of which are becoming increasingly stringent
- Acting as primary liaisons for residents, families, nurses, health care staff, and the general public
- Researching new ways to keep patients and residents happy, healthy, and safe
Day-to-day tasks as a nursing home administrator include:
- Directing 24/7 care
- Scheduling social or physical activities for residents in accordance with their abilities
- Overseeing billing through long term care financial systems
- Attending board meetings to discuss expenditures, budget, and operational policies
- Creating work schedules
- Maintaining patient records using a long term care software system or EHR
- Supervising admission
- Deciding when to send residents to other facilities, like hospitals and rehabilitation centers
- Hiring, training, and firing health care professionals
- Purchasing medical equipment
- Keeping up with the technology relevant to managing a facility, like the latest long term care software for electronic health records systems
- Scheduling equipment maintenance and upgrades
- Ordering supplies
The average annual salary for a nursing home administrator right now is $118,908, with a range that typically falls between $105,757 and $132,347.
Meanwhile, the U.S. Bureau of Labor of Statistics reports that the average salary in 2020 was $104,280 and the median hourly wage for medical and health services managers was $50.13.
Another major task for nursing home administrators is utilizing a proper marketing strategy for improving occupancy rates, which Mason reports was difficult even before the COVID-19 pandemic. “The numbers are trending downward,” he says. “There is more home health, people are living longer, and a lot of assisted living has popped up. So nursing homes are no longer retirement homes,” he explained.
The minimum requirements for aspiring LTC administrators are to obtain a bachelor’s degree from an accredited college and pass the National Association of Long Term Care Administrator Boards. While national exam fees total about $425, the cost of state exams varies from state to state as does the minimum number of hours necessary to meet Administer in Training (AIT) requirements. For instance, in Texas, the application fee is $100, the licensure fee is $100, and the state exam fee is $190. Texas requires 1,000 hours of Administer in Training (AIT). While the AIT hours are the same in California, the licensure fee ($491) and state exam fee ($391) are significantly higher. Missouri, meanwhile, has a minimum requirement of 500 AIT hours and a maximum of 2,000 hours with its own specific guidelines for courses and training.
The application for the NAB exam is online, and the format is computer-based.
States have different requirements for the NAB, but getting 75% of answers correct is typically enough to pass. For more specific information, visit the NAB website.
The subject matters covered on the exam are:
- Resident-centered care and quality of life
- Human resources
- Leadership and management
The best way to prepare for the NAB is to take practice exams and utilize study guides.
While Mason earned his prestigious job before graduating college, the typical path to becoming a nursing home administrator involves:
- Graduating high school – preferably with an emphasis on chemistry, biology, math, finance, and writing – or passing the GED (four years)
- Obtaining a bachelor’s degree in nursing administration or a closely related field, like business administration, health care administration, or public health administration (four years)
- Earning a master’s degree in health care administration (MHA) or something related, like gerontology (two years)
- Getting licensure from the NAB (less than a year)
Clinical Backgrounds For Long Term Care Administrators
Employers usually prefer to hire nursing home administrators with a clinical background. At the same time, they want people with experience. That is why many master’s programs in health care administration include a supervised experience component for licensees.
It is, of course, still possible to enter the field with a non-clinical background. One way to gain the relevant experience would be to initially pursue an assistant manager position. This can mean working for a smaller health care business, becoming an intern, or even volunteering. Reach out to a nursing home administrator and ask them about the path they took to get a better idea of what might work for you.
What if you have a degree in something unrelated, like psychology? Don’t worry. You can still get on the path to becoming a nursing home administrator by starting as a registered nurse. That will give you both the clinical experience you need as well as the know-how for putting together budgets and managing daily operations.
Curious about what opportunities are out there? iHire Healthcare Administration provides a job board that pulls from over 30,000 sites to help you find the nursing home administrator job that fits your particular location and situation.
While the required credentials and training hours might seem like a lot, the good news is that, according to the U.S. Bureau of Labor Statistics (BLS), the job outlook for medical and health services managers is excellent.
Employment is expected to grow 32% from 2019 to 2029, about eight times the growth for other occupations.
There were 422,300 jobs for medical and health services managers in 2019 alone.
After receiving your license, you will need to renew it every two years by completing units of Continuing Education (CE) approved by the NAB. In California, for instance, that requires passing 40 units.
Of course, if one really investigates how to become a long-term care administrator, one will soon find that there are other conditions that must be fulfilled on a personal level. One must develop a deep sense of compassion and make oneself constantly available to both staff members and residents.
For Mason, the path to becoming an LTC administrator began far before he even took the NAB. As a child, he watched his mother in her work at a nursing home, where he enjoyed the company of a couple that regularly treated him to a dish of candy and a man who laughed so hard he would fall back onto his bed.
By the age of nineteen, Mason decided that he wanted to be a part of their beautiful world and hear more of their magnificent stories. “I thought, these people are amazing,” he said. “They need leaders to help run these facilities to give them great care.” It is that compassion that helped shape his career decision and – when combined with years of experience – drive his success in his field.
What does humane long-term care look like?
Culture change in residential care facilities is a must, says Mason. And for that to happen successfully, three things must be emphasized:
- Autonomy for residents
- Contentment of employees
- The consistent presence of administrators
When Lewis asked him how his administrative style has changed over the years, Mason highlighted the increasing relevance of culture. He observed a trend toward resident-centered care and “a stronger culture to make it a home-like environment for them.” Real examples he provided are: doing away with bibs in the dining room and allowing residents to choose the paint color of their rooms.
Mason argues that residents must be allowed their autonomy even when it opposes every bone in an administrator’s body. He recalls that, as a student, he subscribed to a formulaic approach to care, playing everything by the book. Then, a teacher told him that, “A resident has the right to fall.” That resonated with him and has helped shape his career. “I’ll never forget it. It was so hard to swallow,” he admitted.
Before that wake-up call, Mason had viewed LTC as a business. “It will come back to hurt us,” he had responded to his teacher. Eventually, though, he came to realize that such freedom was key to making a nursing home feel like, well, home.
Making an LTC facility feel like home for both staff and residents
The aforementioned forms of autonomy are not sufficient for making an LTC facility feel like home, or, a warm environment in which one is surrounded by loved ones. The next step, according to Mason, is to build a culture of family. He notes a great disparity between residents and their caretakers, as the former view facilities as their homes, while the latter view them as simply places of work. “With staff, culture is entirely different,” he remarked. “For them, it’s a job, not where they live. And a lot of them are simply after a paycheck,” he stated.
Mason’s approach to instilling in employees the appropriate culture is to ensure that they are content at their workplace and consistently demonstrating his appreciation for their efforts. He mentioned allowing them to have an employee council and buying them treats.
A nursing home administrator must be present
A nursing home administrator doesn’t just oversee all of the processes, in person and through nursing home software, at his or her facility. It’s also necessary to build relationships between employees and residents. Mason notes that, even if a nursing home administrator takes the steps above to build culture, there will still be scenarios where the culture is not quite right, when “tension can be cut with a knife,” and things are just falling apart. Mason admitted that, at such times, he is tempted to remain in his office and lock the door. But he recognizes that is precisely the opposite of what is needed. “It’s dealing with those people that will make you a good leader,” he opined.
“I came up with a method to get myself out there,” he said. This method was to force himself to engage with both residents and staff. If he was required to leave his office, he would make sure to stay out of it a bit longer. “When I would go to use the restroom or get a drink, I would then force myself to walk down a hall afterward or talk to somebody before I went back to my office,” Mason stated. This was greatly appreciated and helped him develop communication and strengthen relationships at Prairie Manor.
Overcoming personal obstacles
Being a nursing home administrator means being a leader. But that doesn’t mean you can’t be human and grow into the position. What is so remarkable about his outgoing approach is that Mason is an introvert. Early in his career, it prevented him from being transparent. He tried to make terminations as quick as possible. He even struggled to get in touch with strangers for a signature or other request. “I remember sitting in the office as a brand new administrator literally scared to make a phone call,” he said.
Mason, though, would build up his confidence over time by facing his fears, in part thanks to the mentorship of Chad Stroschein, the CEO of Caring Professionals. “He forced me to have those tough conversations and be more transparent,” Mason said.
Today, Mason is a confident and decisive leader who is upfront about what needs to be done. “I am fine with giving a black and white, direct answer because I am always able to back it up,” he said. He reveals that he does not let his youth or introverted personality get in the way of being strong-willed because “people want a confident leader, and they want answers.”
Of course, that hard-earned confidence does not mean that Mason is now free of self-doubt entirely. “I think, even when I am fifty years old, I will see my name on that administrator’s door and ask whether I belong,” he said. “That feeling will never go away,” Mason predicted. But he views that as a positive attribute. When Lewis asked if insecurities keep him on his toes, Mason confirmed that they do, responding, “If you have no insecurities, you become complacent. You become arrogant.”
Youth as an advantage in long term care
Do you think being a long-term care administrator means you need thirty years of experience in health care? Well, that’s simply not the case. The minimum age is as low as 18 in states like California and Missouri and still only 21 in Georgia. Some states, like Arizona and Texas, have no minimum age requirement at all.
Still, you might be surprised to learn that Mason’s young age has not been an obstacle on his path to becoming a nursing home administrator. Instead, any concerns over his fresh-faced looks are quickly overcome. “Once people get to know me and hear about my five years of experience as an administrator, it proves to them that I’m able to handle myself in this environment,” he said. If anything, [a lack of] age has worked to Mason’s advantage; his youth has given him an edge in LTC technology and helped him connect with younger certified nurse assistants on shared interests.
His combination of experiences, disposition, and determination to evolve has made Mason a complete and compassionate administrator. And you can become one, too, if you similarly embrace your role as a caretaker, which, as Mason revealed, means much more than simply writing policies and determining procedures (both of which he loves, by the way). “I now see myself as a kind of counselor or therapist,” he said. “That’s something a lot of people in upper management don’t realize– we have to act as therapists and listen to what is going on in people’s personal lives.”
Mason is an excellent case study of the process by which one grows into the position of LTC administrator. For more on the journey to becoming a nursing home administrator, you can listen to the entire interview here.