Nursing Home Executive Director - A Day in the Life

A nursing home executive director, sometimes called a “nursing home administrator,” is responsible for maintaining all operations of a long-term care facility. This requires a delicate balance of business acumen and empathetic leadership. Nursing home executive directors are charged with ensuring the financial health of a facility, managing the staff, interacting with patients and their families, and maintaining compliance with federal and local regulations. The small- to medium-scale of a long-term care facility, combined with a sensitive scope of practice that includes end-of-life care, means that these professionals must be compassionate and excel in face-to-face interaction with the facility and the wider community.

The demand for talented nursing home executive directors is increasing. There were roughly 1.4 million nursing home residents in the U.S. in 2014, but the number of elderly Americans is expected to double by 2050. According to the Bureau of Labor Statistics (BLS), the need for healthcare managers is projected to grow three times faster than the average for all occupations between 2016 and 2026.

While nursing home executive directors can expect solid job opportunities and salary prospects, this is not a job for the solely profit-focused. These professionals run long-term care facilities where they will care for people at a fragile stage in their lives. All of one’s business and organizational know-how must be tempered with a definitively human touch.

Read on to learn about the work environment, daily responsibilities, skill requirements, and certifications needed for a nursing home executive director.

Work Environment

Nursing home executive directors typically work out of an office, but most of their job centers around people. Face to face communication is critical to developing trust and shared goals. Since nursing homes are often smaller than hospitals, an executive director can take a hands-on approach to leadership by building stronger relationships with the staff and patients. The work environment stretches outside of a medical facility’s walls, too—sometimes requiring interaction with donors, government institutions, professional organizations, and the wider public.

The downside to all that movement and interaction is that this is a job that does not have off-hours. Nursing home facilities run 24 hours a day, seven days a week, and residents need safe and effective care at all times. Many other healthcare sectors require directors to be on-call, and nursing home administration is no different.

Nursing home executive directors deal with end-of-life care, family grief, and severe disorders such as dementia and Alzheimer’s. This means that compassion fatigue and burnout can be common side effects of the position. The best nursing home executive directors know that the work is both physical and mental and they are capable of navigating that dichotomy not only within themselves but also with their staff, patients, and families.

Typical Daily Responsibilities

The daily responsibilities of a nursing home’s executive director will vary depending upon the size, scope, location, and specific population of their facility. Even within that individualized context, no two days will necessarily be the same, as executive directors must juggle the overall health of a facility’s business, staff, clinic, customers, and compliance—each with its own set of moving parts, policies, and needs.

Nursing home administrators typically perform the following daily tasks:

  • Hiring and supervising facility staff
  • Implementing and overseeing quality assurance protocols
  • Coordinating between caregiving and organizational departments
  • Ensuring compliance with all federal, state, and local regulations
  • Designing a facility budget and securing additional funding through grants and donations
  • Attending board meetings to outline the financial health and trajectory of the facility
  • Acting as a liaison between families, patients, and staff
  • Representing the facility in professional and community activities

Nursing home executives can also specialize in a particular area such as healthcare financial management, healthcare informatics, gerontology, personnel management, or healthcare law. But in modern nursing home facilities, executive directors are increasingly expected to have familiarity with all of these aspects, as well as the agility to manage each of them as they fit into the wider organization.

Required Skills and Knowledge

Nursing home administrators need a solid foundation in both clinical and business-minded skills. While they may not spend much time at a patient’s bedside, nursing home administrators are largely responsible for the type of care their facility’s residents receive. This is a leadership position that requires time management, communication, multitasking, and empathy.

The precise balance of those priorities has been distilled into a federally provisioned practice called the Quality Assurance and Performance Improvement (QAPI). Through a five-piece framework provided by the Centers for Medicare and Medicaid Services (CMS), nursing home administrators are advised to take a systematic and data-driven approach to improving safety and quality in their facilities, while also including staff in practical and creative problem-solving. Prospective nursing home administrators should not be surprised to find “QAPI proficiency” on the listed requirements of job postings.

As far as educational requirements, a bachelor’s degree is mandatory for this position. Some common undergraduate majors include management, healthcare administration, business administration, or public health, and it is recommended that prospective nursing home administrators attend a program that is accredited by the Commission on Accreditation for Healthcare Management Education (CAHME).

The most popular types of graduate-level education include a master’s in healthcare administration (MHA) and a master’s in business administration (MBA) specializing in healthcare administration. These degrees are increasingly preferred, and at larger facilities, are mandatory. Extra courses in relevant topic areas such as gerontology, pain management, aging, and elder abuse can prepare a candidate to serve their target population.

That said, there is more than one pathway to becoming a nursing home administrator. Some nursing home administrators begin their career as clinical nurses and then transition into administration and management at a nursing home facility. Others focus on healthcare administration from the beginning and pick up clinical awareness later on. In any case, work experience is crucial. Prospective nursing home administrators should gain as much as they can along the way through volunteering, interning, consulting, and part-time employment at elder care facilities.

Nursing Home Executive Director Certification

All states require that nursing home administrators be licensed. While precise requirements regarding degree level, clinical hours, and continuing education vary from state to state, all candidates for licensure must pass exams administered by the National Association of Long Term Care Administrator Boards (NAB). The exams consist of 100 questions on core knowledge and 50 on the line of service. Re-licensure requirements regarding continuing education and clinical hours will, again, vary from state to state.

Broader certification as a Certified Nursing Home Administrator (CNHA) is available through the American College of Health Care Administrators (ACHCA). CNHA certification can fast-track re-licensure in several states, increase employment opportunities, and boost the recognition of the profession as a whole.

The ACHCA has been certifying nursing home administrators since 1978, and they have repeatedly updated their certification test to include emerging trends in the profession. All test takers must have two years of licensure (as required by state) and 40 hours of completed continuing education. The exam itself consists of 110 questions on general knowledge and 40 questions on specialty topics. Recertification is required every five years, at which time nursing home administrators must accrue 150 hours of continuing education, which conveniently overlaps with state licensure and re-licensure requirements.

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