The Path to Becoming a Nursing Home Administrator
To become a nursing home administrator, you need a bachelor's degree, a state license, and work experience in healthcare or long-term care. Most states require you to pass the Nursing Home Administrator (NHA) licensing exam, which tests your knowledge of regulations, resident care, and facility management. The exact requirements vary by state — some require a specific degree in health administration, while others accept any bachelor's degree plus relevant work experience.
The timeline from starting education to holding a license typically takes four to six years. You will spend four years on a bachelor's degree, then one to two years gaining the required work experience before you can sit for the licensing exam. After passing the exam, your state will issue your license, usually within a few weeks.
Key Takeaways
- All states require a bachelor's degree and a passing score on the Nursing Home Administrator licensing exam, but the degree field and work experience requirements differ by state.
- Most states require one to two years of work experience in a nursing home, hospital, or related healthcare setting before you can take the licensing exam.
- The NHA exam covers federal and state regulations, resident rights, financial management, and staffing — not clinical nursing skills.
- After you pass the exam and receive your state license, you will need to renew it every two to four years, depending on your state, and complete continuing education hours.
Education Requirements: What Degree You Need
A bachelor's degree is required in all 50 states, but the field of study varies. Some states specify that the degree must be in health administration, long-term care administration, business administration, or a related field. Other states are more flexible and accept any bachelor's degree as long as you have the required work experience in healthcare.
Common degree paths include a Bachelor of Science in Health Administration, Healthcare Management, or Business Administration with a healthcare focus. Some universities offer a specialized track in Long-Term Care Administration within a broader health administration program. If you already have a bachelor's degree in another field, you can still pursue this career — you will just need to document your healthcare work experience more carefully when you explore for the licensing exam.
A few states allow you to substitute additional work experience for a degree requirement, but this is rare. Check your state's specific rules through your state's Department of Health or the state board that oversees nursing home licensing.
Work Experience: Where and How Long
Most states require one to two years of full-time work experience in a nursing home, assisted living facility, hospital, or other long-term care setting before you can take the NHA licensing exam. Some states count part-time work at a reduced rate — for example, two years of part-time work might count as one year of full-time experience. A few states require as much as three years of experience.
The work does not have to be in an administrative role. You can gain the required experience as a nursing assistant, licensed practical nurse, registered nurse, dietary supervisor, maintenance director, or business office manager. The key is that the experience must be in a licensed facility and must be documented by your employer. When you explore for the exam, you will need to submit verification letters from each employer showing your job title, dates of employment, and hours worked.
Some people work their way up from a direct care role to a supervisory position and then pursue the administrator license. Others complete their degree and work experience at the same time, taking on a management role in a nursing home while finishing their bachelor's degree.
The Nursing Home Administrator Licensing Exam
The NHA licensing exam is a standardized test administered by the National Association of Long Term Care Administrator Boards (NAB). The exam covers federal and state regulations, resident rights, infection control, financial management, human resources, and quality assurance. It does not test clinical nursing skills — it focuses on the business and regulatory side of running a facility.
The exam is typically offered multiple times per year at testing centers in your state. You register through your state's licensing board, which will tell you the testing dates, locations, and the fee (usually between $200 and $400). You will have a set amount of time — usually three to four hours — to complete the exam. Most states require a score of 75 percent or higher to pass.
Many people take a review course before the exam. These courses are offered by universities, professional organizations, and online providers and typically cost $300 to $800. They cover the exam content and include practice questions. Some employers offer to pay for the review course if you commit to working for them after you pass the exam.
State Licensing and Renewal
After you pass the NHA exam, your state will issue your license. The license is valid for two to four years, depending on your state. To renew your license, you must complete continuing education hours — usually between 12 and 40 hours per renewal period — and pay a renewal fee.
Continuing education must cover topics relevant to nursing home administration, such as changes in federal regulations, resident care standards, or management practices. You can earn these hours through workshops, online courses, conferences, or university classes. Many states accept courses offered by the American College of Health Administrators or the National Center for Assisted Living.
If you move to a different state, you will need to get licensed in that state. Some states have reciprocity agreements that allow you to transfer your license with minimal additional requirements, while others require you to take their state exam or complete additional coursework. Check with the new state's licensing board before you move.
Job Outlook and Where Administrators Work
Nursing home administrators oversee the day-to-day operations of long-term care facilities. They manage staff, handle budgets, may support the facility meets state and federal regulations, and work with families and residents. Most administrators work in nursing homes, but some work in assisted living facilities, continuing care retirement communities, or other long-term care settings.
The job requires strong communication skills, the ability to manage multiple priorities, and knowledge of healthcare regulations. You will spend time in meetings with staff, families, and state inspectors. You will also handle complaints, review financial reports, and make decisions about staffing and resident care policies.
The salary and job availability vary by location and facility size. Larger facilities in urban areas typically pay more than smaller rural facilities. Some administrators move between facilities to advance their careers, while others stay in one community for many years.
Steps to get your free guide Now
If you are interested in this career, start by researching your state's specific requirements. Contact your state's Department of Health or the board that licenses nursing home administrators — they will send you a handbook that lists the exact degree requirements, work experience rules, and exam details.
Next, decide whether you need to complete a bachelor's degree or whether you already meet the education requirement. If you need a degree, look for programs in health administration or healthcare management at universities in your area or online. Many programs can be completed in four years while you work part-time.
If you already have a bachelor's degree, start looking for a position in a nursing home or long-term care facility. Even an entry-level role will count toward your work experience requirement. Talk to the administrator or human resources director about your goal — many facilities will help you prepare for the licensing exam and may even pay for your review course.
Frequently Asked Questions
Do I need a nursing degree to become a nursing home administrator?
No. You need a bachelor's degree, but it does not have to be in nursing. Most states accept a degree in health administration, business, or any related field. You do not need to be a nurse or have clinical healthcare experience, though some administrators do have a nursing background.
Can I take the NHA exam without work experience?
No. All states require one to two years of full-time work experience in a healthcare setting before you can sit for the exam. This experience must be documented by your employer and verified when you explore to take the test.
How much does it cost to become a nursing home administrator?
The total cost depends on whether you already have a bachelor's degree. A four-year degree costs $20,000 to $100,000 or more depending on the school. The NHA exam review course costs $300 to $800, and the exam fee is $200 to $400. Some employers cover these costs if you work for them.
How long does it take to get licensed after I pass the exam?
Most states issue your license within two to four weeks after you pass the exam. You will need to submit your exam results, pay the licensing fee, and complete any final paperwork. Your state's licensing board will tell you the exact timeline and what documents you need to submit.
What happens if I fail the NHA exam?
You can retake the exam. Most states allow you to register for the next available test date, usually within a few months. Many people take a review course again or study different materials before their second attempt. There is no limit to how many times you can take the exam in most states.