Nursing Home Executive Director – A Day in the Life

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A nursing home executive director, a.k.a. a nursing home administrator is responsible for managing all operations in a long-term care facility.

They have to delicately balance business insight and empathetic leadership.

A nursing home executive director is in charge of the financial health of the facility, staff management, interaction with patients and their families as well as maintaining compliance with local and federal regulations.

The small- to medium-scale of a long-term care facility and the sensitive scope of practice, including end-of-life care, require these professionals to be compassionate and excellent in face-to-face communication with the facility community.

Talented nursing home executive directors face increasing demand.

As of 2014, there were approximately 1.4 million residents of nursing homes in the US.

However, by 2050, the number of elderly American citizens is expected to double.

According to the BLS, healthcare managers’ employment is projected to increase three times as fast as the average for all occupations in the US by 2026.

While the employment rates and salary levels are expected to grow, this profession is not for the solely profit-focused.

Nursing home executive directors run the facilities where they provide care for people who are at a fragile stage of their lives.

All organizational and business know-how of these directors should be tempered with a compassionate human touch.

Work Environment

Nursing home executive directors usually work out of an office and most of their work focuses on people.

Face-to-face communication is vital in developing shared goals and trust.

Nursing homes are usually smaller than hospitals, so executive directors can take a hands-on approach to leadership through developing stronger relations with patients and staff.

The work environment goes beyond the walls of a medical facility.

Sometimes it requires interaction with donors, professional organizations, government establishments, and the wider public.

The downside to all this interaction and movement is that the job doesn’t include the off-hours.

Nursing home facilities operate 24/7, and residents always need effective and safe care.

Like directors in many other healthcare sectors, nursing home administrators should be on-call.

Nursing home administrators provide end-of-life care and deal with family grief as well as severe disorders such as Alzheimer’s or dementia.

So, burnout and compassion fatigue are quite common side effects of this job.

The best administrators know that the work is both mental and physical, and they can navigate dichotomy within themselves as well as their patients, families, and staff.

Typical Daily Responsibilities

The day-to-day responsibilities of a nursing home executive director vary depending on the scope, size, location, and the population of the facility.

Even though, no two days are the same since administrators should juggle the overall health of the business of the facility, customers, staff, clinic, and compliance.

All of these have their policies, needs, and moving parts.

The daily tasks of a nursing home administrator typically include:

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

Nursing home administrators can have a particular area of expertise such as healthcare informatics, healthcare financial management, personnel management, gerontology, or healthcare law.

However, in modern nursing homes, administrators are expected to be familiar with all these aspects and the agility to manage each of them to fit the wider organization.

Required Skills and Knowledge

Nursing home executive directors should be well-versed both in business-minded and clinical skills.

While they don’t spend as much time at the bedside of a patient, they are responsible for the type of care that the facility provides to its residents.

This position is a leadership role that requires communication, multitasking, time management, and empathy.

These priorities are precisely balanced by the federally provisioned practice called the Quality Assurance and Performance Improvement (QAPI).

The five-piece framework provided by the Centers for Medicare and Medicaid Services (CMS) advises nursing home administrators to take a data-driven and systematic approach to improve quality and safety while including staff in creative and practical problem-solving.

Typically, QAPI proficiency is one of the job requirements for nursing home administrators.

As for education requirements, administrators must hold a bachelor’s degree.

The majors can include healthcare administration, management, public health, or business administration.

They are also recommended to attend a program accredited by the Commission on Accreditation for Healthcare Management Education (CAHME).

A master’s degree in health administration (MHA) and a master’s in business administration (MBA) with a specialty in healthcare administration are the most popular types of graduate-level education.

These degrees are generally preferred and are mandatory at larger facilities.

Additional courses in relevant topics, such as pain management, gerontology, elder abuse, aging, can make a candidate better prepared to serve their target residents.

Ultimately, there are more than just one pathway to a position of a nursing home administrator.

Some administrators start their careers as clinical nurses and then move to management and administration at a nursing home.

Others start in healthcare administration right away and learn clinical awareness later.

Regardless, work experience is vital.

Future nursing home executive directors should gain as much experience as possible through interning, volunteering, consulting, or working part-time at elder care facilities.

Nursing Home Executive Director Certification

Nursing home administrators are required to be licensed by all states.

The exact requirements such as clinical hours, degree level, and continuing education vary by state.

However, all candidates for licensure have to pass examinations held by the National Association of Long Term Care Administrator Boards (NAB).

The exams include 100 questions on the fundamentals and 50 on the line of service.

Re-licensing requirements on clinical hours and continuing education also vary by state.


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