What is a nursing home administrator license, and how do you get one?
Every state licenses nursing home administrators, because federal rules require nursing facilities participating in Medicare and Medicaid to be administered by a licensed administrator. Licensure normally requires a bachelor's degree — often with specified health administration or business coursework — completion of an Administrator-in-Training internship under a licensed preceptor, and passing the National Association of Long Term Care Administrator Boards examination plus a state component. Medical and health services managers earn a $123,860 median.
- Complete a bachelor's degree with the coursework your state requires.
- Secure an Administrator-in-Training internship with a licensed preceptor.
- Complete the internship hours.
- Pass the NAB examination and the state component.
- Apply for licensure and renew with continuing education.
How to get a nursing home administrator license
- 1
Complete the required education
Earn a bachelor's degree, checking your state board's coursework requirements in health administration, gerontology, finance and management before choosing a programme — some states specify credit hours in named subjects.
- 2
Arrange an Administrator-in-Training internship
Secure a placement with a licensed administrator willing to act as preceptor and register the internship with the board. This is the step most likely to delay candidates, so start looking well before you finish your degree.
- 3
Complete the internship hours
Rotate through the operational domains of the facility — clinical services and resident care, human resources and staffing, finance and budgeting, physical environment, and regulatory compliance and the survey process — documenting hours as the board requires.
- 4
Pass the NAB examination and the state component
Sit the national examination covering the domains of long-term care administration, and the state examination on its own statutes, regulations and survey process. Both are required before the licence is issued.
- 5
Apply for licensure and keep it current
Submit your application with degree, internship verification, examination results and background check. Then renew on the board's cycle with continuing education, and consider the health services executive qualification if you will work across long-term care settings.
Nursing Home Administrator license requirements
Requirements come from each state board within a framework driven by federal nursing facility rules. You need:
Education
A bachelor's degree in most states, frequently with specified coursework in health administration, gerontology, finance or management; some states accept alternative combinations of education and long-term care experience.
Administrator-in-Training internship
A supervised internship under a licensed administrator serving as preceptor, with the hours set by each state and covering the domains of practice from resident care to finance and regulatory compliance.
NAB examination
The national examination from the National Association of Long Term Care Administrator Boards, covering the domains of long-term care administration, plus a state examination on that state's regulations.
Background check and application
Application to the state board of nursing home administrators or licensing agency with a criminal background check and fee.
How much a nursing home administrator license costs
The internship rather than the fees is the economic barrier. Budget for:
The degree dominates, and the internship is commonly unpaid or low-paid, which is the real economic barrier for candidates. NAB publishes examination fees directly and each state board sets its own application and renewal fees.
The nursing home administrator license exam
The NAB examination covers the domains of long-term care administration: care and services for residents, human resources, finance, physical environment and atmosphere, and leadership and management. It is scored against a scaled standard and taken once eligibility — degree and internship — is established. Alongside it, each state administers a component on its own long-term care statutes, regulations and survey process, which is where the operational detail of running a facility in that state is actually tested. Because the federal survey and certification framework is common but state enforcement and licensure rules differ, both parts genuinely matter.
How long it takes to get licensed
Four to five years including the degree, with the Administrator-in-Training internship the step that most often sets the pace because placements must be arranged with a licensed preceptor.
Nursing Home Administrator license types: the full ladder
The ladder here runs from department leadership through the internship into licensure and multi-facility roles.
Department head
Leading nursing, dietary, activities or environmental services within a facility — the usual route into administration but not itself licensed.
Administrator-in-Training
A registered status while completing the supervised internship under a licensed preceptor, rotating through the domains of facility management.
Licensed nursing home administrator
The licence required to serve as administrator of a nursing facility, with statutory accountability for the facility's compliance and operation.
Assisted living or residential care administrator
A separate credential in many states for assisted living and residential care settings, with its own requirements and generally lighter than the nursing home licence.
Health services executive
A NAB credential recognising qualification across multiple lines of long-term care service, useful for administrators working across settings.
Regional and multi-facility leadership
Roles overseeing several facilities, generally requiring licensure plus a track record of successful survey outcomes and financial performance.
Nursing home administrator vs Assisted living administrator: nursing home administrator license
Nursing Home Administrator license reciprocity between states
Licensure by endorsement is common for nursing home administrators, because the NAB national examination provides a shared basis: a licensed administrator in good standing can generally obtain licensure in another state on that examination plus the destination state's own component and application. What does not transfer is the state examination itself, since long-term care regulation and the survey process are state-specific, and some boards impose additional experience requirements. Assisted living administrator credentials rarely transfer at all. Confirm with the destination board before accepting a role.
Nursing Home Administratorsalary & job outlook
Medical and health services managers, the category nursing home administrators are counted in, earn a median of about $123,860 per year ($59.55/hour), with multi-facility and regional roles above that. Employment is projected to grow 23.2%, among the fastest of any management occupation, with roughly 62,100 openings a year across the category. See the full nursing home administrator salary guide for pay by state, city and experience level.
Nursing Home Administrator license requirements by state
Every state licenses nursing home administrators, so what differs is the education and internship requirements, the state examination and whether assisted living is separately licensed.
All states license nursing home administrators, driven by federal requirements for certified nursing facilities. States differ on the degree and coursework required, the length and structure of the Administrator-in-Training internship, the state examination, and whether assisted living or residential care administration carries a separate licence. Confirm with the state board before arranging an internship.
Browse all state guides
Nursing Home Administrator license FAQs
BLS Occupational Outlook Handbook (Medical and Health Services Managers) · National Association of Long Term Care Administrator Boards (NAB) · CMS, nursing home survey and certification · U.S. Bureau of Labor Statistics, OEWS May 2025 (11-9111). Requirements and fees are set per state and change, confirm with your state board before applying.
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