Becoming a licensed nursing home administrator requires a bachelor’s degree, a supervised training period, and passing a national exam, with the entire process typically taking five to six years including your undergraduate education. Every U.S. state requires licensure before you can run a nursing home, and while the broad steps are consistent nationwide, specific hour requirements and supplemental exams vary by state.
Education Requirements
You need at minimum a bachelor’s degree from an accredited college or university. The most common majors are health administration, healthcare management, long-term care administration, public health, and business administration. Some programs offer a specific concentration in long-term care or gerontology, which can give you a head start on the knowledge you’ll need for the licensing exam and your supervised training.
A master’s degree isn’t required in most states, but it can make you more competitive for positions at larger facilities and may shorten your supervised training period in some states. Master of Health Administration (MHA) and MBA programs with healthcare concentrations are the most popular graduate paths. If your undergraduate degree is in an unrelated field, a graduate program in health administration can bridge the gap.
The Administrator-in-Training Program
Before you can sit for the licensing exam, most states require you to complete an Administrator-in-Training (AIT) program. This is a structured internship where you work inside a licensed nursing home under the supervision of a practicing administrator. The required hours vary significantly by state. Texas, for example, requires a minimum of 1,000 hours. Other states set their minimums higher or lower, so check with your state licensing board early in the process.
The national framework for AIT programs, developed by the National Association of Long Term Care Administrator Boards (NAB), is organized into four modules. You start with program design and orientation, then move into learning domains that cover the core knowledge and skills of facility management. The program includes a self-assessment and professional development plan specific to nursing home administration, along with reference materials covering medical terminology, common diagnoses, and abbreviations you’ll encounter daily. Throughout the program, you’ll rotate through departments, observe regulatory processes, and gradually take on management responsibilities under your preceptor’s guidance.
Finding an AIT placement typically requires you to contact nursing homes directly or work through your state licensing board, which may maintain a list of approved preceptors. Some university programs have partnerships with facilities that streamline placement.
The National Licensing Exam
The licensing exam is administered by NAB and consists of two parts: the CORE exam, which covers knowledge common to all long-term care settings, and the NHA (Nursing Home Administrator) line-of-service exam, which is specific to skilled nursing facilities. You apply for both as a combo application, which costs $480 as of February 2026.
The exams are scored on a scale from 50 to 150, and you need a scaled score of 113 to pass each one. This isn’t a simple percentage. The score is adjusted to account for slight differences in difficulty between test versions, so 113 represents a consistent competency standard regardless of which form of the exam you receive.
The content is organized around nine domains of practice, which NAB updated in 2026 for exams beginning July 2027:
- Quality of Care and Quality of Life, covering resident services and well-being
- Financial Management, including budgeting, billing, and reimbursement
- Risk Management, covering safety, liability, and emergency preparedness
- Human Resources, from hiring and retention to labor law
- Care Setting, focused on the physical environment and operations
- Regulatory Compliance, covering federal and state survey processes
- Leadership and Organizational Strategy, addressing governance, ethics, and long-range planning
Each domain now includes specific task statements describing the duties and responsibilities you’re expected to perform competently. Study materials aligned to these domains are available through NAB and various test prep companies.
State-Specific Requirements
Your state licensing board sets additional requirements on top of the national exam. Many states require a separate state jurisprudence exam that tests your knowledge of that state’s specific laws and regulations governing nursing homes. Texas, for instance, requires both the national NAB exams and a state exam. Some states also set their own minimum age (often 21), require specific coursework in areas like state Medicaid regulations, or mandate a certain number of clinical experience hours beyond the AIT.
Because requirements differ so much, your first step after deciding to pursue this career should be contacting your state’s long-term care administrator licensing board. They’ll give you the exact checklist for your jurisdiction, including approved AIT preceptors, state exam details, and any additional documentation like character references or background checks that your state requires.
Keeping Your License Active
Licensure isn’t a one-time achievement. You’ll need to complete continuing education (CE) credits on a regular cycle to renew your license. The number of required hours varies by state. New York, for example, requires 48 CE credits per renewal period. These credits cover updates to federal regulations, advances in care practices, leadership development, and other topics relevant to facility management.
CE courses are available through professional associations, universities, and approved online providers. Many administrators use annual conferences and workshops to knock out a large portion of their credits while networking with peers. Letting your CE requirements lapse can result in license suspension, so building a tracking system early in your career is worth the effort.
Career Outlook and Salary
The job market for this role is strong and getting stronger. The Bureau of Labor Statistics projects 23 percent employment growth for medical and health services managers from 2024 to 2034, which is much faster than average across all occupations. An aging population is the primary driver, as demand for skilled nursing and long-term care facilities continues to climb.
The median annual salary for medical and health services managers, the broader category that includes nursing home administrators, was $117,960 in May 2024. Your actual salary will depend on facility size, geographic location, and whether the home is part of a larger healthcare system. Administrators at multi-facility organizations or in high-cost-of-living areas typically earn more. Experience in the AIT program and early career roles like assistant administrator or department director within a nursing home positions you well for upward movement.
Total Cost and Timeline
Beyond tuition for your bachelor’s degree, the direct costs of licensure are relatively modest. The NAB combo exam application is $480. State application fees vary but generally range from $100 to $300. Some states charge additional fees for background checks, fingerprinting, or state exam registration. If you need to withdraw a NAB exam application, a 40 percent processing fee is withheld from your refund, so be sure you’re applying for the correct exams before submitting.
The typical timeline looks like this: four years for a bachelor’s degree, then roughly six months to a year for an AIT program depending on your state’s hour requirements and whether you complete it full-time. Add a few months for exam preparation, scheduling, and state application processing. Most people can be fully licensed within five to six years of starting their undergraduate education, or within one to two years if they already hold a relevant bachelor’s degree.