To become a nursing home administrator you usually need a bachelor's degree, supervised training as an administrator-in-training, and a state licence, which every US state requires. In Florida, for example, you need a degree plus an internship or a 1,000-hour or 2,000-hour administrator-in-training program, depending on your major, and you must pass the state licensing exam.
Nursing home administrators run the whole facility: admissions, staffing, budgets, building maintenance and the care residents receive. It's a senior management job with a lot of responsibility, and the licence is what makes it different from most healthcare management roles.
I've used four official sources, all read as of October 2026: the US Bureau of Labor Statistics (BLS) profile for medical and health services managers, the federal rules in 42 CFR part 431 subpart N, Florida Statutes section 468.1695, and the UK National Careers Service profile for care home managers.
Why the licence is universal
BLS says all states require licensure for nursing home administrators, and federal law is the reason. Under 42 CFR part 431 subpart N, a state's Medicaid plan must include a program for licensing nursing home administrators, and only nursing homes supervised by a licensed administrator may operate in that state.
The federal rules leave the detail to each state, but they set the standard. Administrators must be of good character, otherwise suitable, and qualified by training or experience in institutional administration. If a post becomes vacant unexpectedly, a state may issue one provisional licence for no more than 6 months.
Pay and jobs in the US
| Measure | BLS figure (medical and health services managers) |
|---|---|
| Median pay (May 2025) | $123,860 a year |
| Median in nursing and residential care facilities | $100,520 |
| Lowest 10% earned less than | $73,390 |
| Highest 10% earned more than | $224,340 |
| Jobs in 2025 | 640,400 |
| Projected growth, 2025 to 2035 | 24%, much faster than average |
| Openings each year | About 62,300 |
BLS doesn't publish a separate figure for nursing home administrators, so these numbers cover all medical and health services managers, as of October 2026. The nursing and residential care median is the closest guide to what administrators earn.
Florida's routes to a licence
Florida is a useful example because section 468.1695 spells out the routes clearly. You must apply to take the licensing exam, pass background screening and pay an exam fee set by the board, which can't be more than $250 as of October 2026. Then you need one of these combinations:
| Your background | Training you also need |
|---|---|
| Bachelor's degree majoring in health care administration, health services administration or an equivalent, or 60 semester hours in the subjects the board sets | A college-affiliated or university-affiliated internship, or a 1,000-hour administrator-in-training program |
| Any bachelor's degree | A 2,000-hour administrator-in-training program |
| Any bachelor's degree plus 1 year of management experience in a skilled nursing facility | No extra training program |
| Any bachelor's degree plus 1 year of management experience in a hospital, hospice, assisted living facility with at least 60 licensed beds, or geriatric residential treatment program | A 1,000-hour administrator-in-training program |
The exam is given at least two times a year and covers health and safety standards, federal, state and local laws, general administration, the psychology of patient care, principles of medical care, personal and social care, and long-term care services.
Becoming a nursing home administrator, step by step
- Earn a bachelor's degree. BLS says medical and health services managers typically need one, and a health care administration major can shorten your training.
- Get healthcare experience. BLS notes that nursing home administrators may have years of experience as a registered nurse, and many managers start in administrative or clinical roles.
- Complete an administrator-in-training program or internship. Your state sets the hours.
- Pass your state's exam. Florida's board may use a national exam in place of part or all of its own.
- Keep your licence in good standing. States must investigate complaints and can suspend or revoke a licence.
A common route in from nursing
Many administrators come from the nursing side. If you're already a nurse, your clinical experience counts for a lot when you move into management, and my guide on how to become a nurse covers that first step. Social work is another route, because some positions also ask for a social worker licence; see how to become a social worker.
The UK equivalent: care home manager
In England the job title is care home manager, and the route is different. The National Careers Service says you could study health and social care management, nursing or social work, or take an Adult Care Level 5 Higher Apprenticeship, which takes around 2 years.
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Many people work up from senior care worker or nurse. You'd normally start the Level 5 Diploma in Leadership for Health and Social Care and Children and Young People's Services within 3 months of starting the job and complete it within 2 to 3 years. To manage an adult care home you'll need to register with the Care Quality Commission (CQC), and Ofsted registration applies to children's homes.
What the work is like
Evening or weekend work may be needed, because nursing homes run around the clock, and you may be on call for emergencies. Most managers work full time, and some work more than 40 hours a week. You'll balance resident care, staff, budgets and inspections, often on the same day.
My verdict
This is a demanding role, but BLS expects 24% growth across healthcare management, and every nursing home must have a licensed administrator. Get a bachelor's degree, build experience in a care setting, complete your state's administrator-in-training hours and pass the exam. A health care administration major can save you a thousand hours of training in states like Florida.
Related: writing for us on psychology.
Frequently asked questions
Do all states require a nursing home administrator license?
Yes. BLS says all states require licensure for nursing home administrators, and federal rules in 42 CFR part 431 subpart N require each state's Medicaid plan to include a licensing program.
How long is an administrator-in-training program?
It depends on the state and your background. In Florida it's 1,000 hours if you majored in health care administration or have qualifying management experience outside a skilled nursing facility, and 2,000 hours with another degree.
How much do nursing home administrators make?
BLS doesn't publish a separate figure, but medical and health services managers in nursing and residential care facilities had a median of $100,520 in May 2025, as of October 2026.
What is a nursing home administrator called in the UK?
In England the role is usually called care home manager. You'll need to register with the Care Quality Commission to manage an adult care home.
