How to Hire Nursing home administrators: An Employer's Guide

Hiring a nursing home administrator means filling the seat federal rules put at the head of the facility. With it comes the accountability you assign to that person: the staffing plan and its budget, the compliance calendar, the survey file, the relationship with families, and the culture your nurses and aides work in. The director of nursing runs clinical practice; the administrator runs the operation the clinical practice depends on.

The rule itself is federal. Nursing homes must be administered by an administrator licensed by the state where licensing is required (42 CFR 483.70), and every state Medicaid plan must provide a program for licensing nursing home administrators (42 CFR 431.702). An open seat, or a license that lapses after the hire, is an operational risk to raise with your governing body before it becomes one.

Keep the seat distinct from your director of nursing. The federal nursing home rules require a facility to use an RN at least 8 consecutive hours a day, 7 days a week, and designate a full-time RN director of nursing, with waivers possible (42 CFR 483.35(b)). Your administrator and your DON are two different hires with two different credentials — one state license and one nursing license — and postings that blur them draw the wrong shortlists.

The staffing plan the administrator owns rests on a sufficiency standard, not a ratio. Federal rules require sufficient nursing staff on a 24-hour basis based on the facility assessment rather than a fixed numeric ratio (42 CFR 483.35(a)). The 2024 federal rule that would have added numeric minimums — 24/7 RN onsite and 3.48 total nurse staffing hours per resident day — was blocked by statute until September 30, 2034, and CMS repealed those provisions effective February 2, 2026. Hire an administrator who can run a staffing plan against the facility assessment and document sufficiency, not just count heads.

The seat also owns the survey calendar. The state survey agency must conduct a standard survey of each nursing facility no later than 15 months after the previous one, with a statewide average interval of 12 months or less (42 CFR 488.308). An administrator candidate should be able to talk through a survey cycle and a plan of correction without notes.

The worker-side view — pay expectations candidates arrive with, the routes into the license, and how the career ladder runs — lives in the nursing home administrator career guide. This page stays on the employer's side.

Start from the license, because federal rules start there. A nursing home must be administered by an administrator licensed by the state where licensing is required (42 CFR 483.70), and federal Medicaid rules require every state Medicaid plan to maintain a program for licensing nursing home administrators (42 CFR 431.702).

Verify the license rather than accepting a copy from the candidate's file. Ask for the license number and issuing state, then confirm status and standing with the board or program that issues it. If your strongest candidate is licensed in another state, the path to qualification in yours is your board's to define — confirm it before you extend an offer.

Do not let the license line do the DON's work. Administrator licensure runs through a separate state program: the licensing program for nursing home administrators that federal Medicaid rules require each state plan to maintain (42 CFR 431.702). The DON seat is a separate requirement — a full-time registered nurse designation under the federal rule, with waivers possible (42 CFR 483.35(b)). If a candidate offers to cover both seats, walk through what your survey history and staffing structure say about that plan before you accept it.

Beyond the license, experience requirements are yours to set. The useful move is to define them in terms of the seat's work: a staffing plan run against a facility assessment, a standard survey and any plan of correction carried, a budget defended to an ownership group, and a payroll the facility could sustain. State what you will train versus what you require on day one.

What each state's board requires — education routes, the examination, administrator-in-training paths and renewal — is credential detail, and it changes. The state-by-state license requirements page tracks it, and the NAB exam page covers the examination piece; confirm the current rules with your state board before you write the posting's qualification line.

Rules change, and they are state-specific. Verify administrator licensure with your state licensing board or program, and nursing staffing requirements with CMS's conditions of participation and your state survey agency, before you finalize the qualification lines in your posting.

Frame the market first. BLS Employment Projections put medical and health services managers — the broad category that covers nursing home administrators — at 24.2% growth from 2025 to 2035, with an average of 62,300 projected openings a year. Those openings are category-wide, not administrator vacancies: the SOC row covers health-care managers across settings, so read the figure as market scale for the occupation, not a count of openings at your seat.

Look internal first. An assistant administrator, a business office leader or a DON with governance ambitions may already be building toward the seat. The assistant administrator career guide and the administrator-in-training program page describe the routes candidates work through — the same paths your own staff would follow if you fund them.

Externally, post where licensed operators look for work, work your referrals — governing-body members, regional leadership, the state health care association circle — and show up where long-term care leadership gathers. Search firms are a legitimate channel for a seat this senior; our research found no published fee benchmark, so treat any figure you are quoted as one firm's price, not a market rate.

Two sourcing rules apply. It is illegal under EEOC-enforced laws to publish a job ad that shows a preference for or discourages applicants based on race, color, religion, sex, national origin, age (40 or older), disability or genetic information. And the EEOC's own example of recruiting that can discriminate is word-of-mouth: relying on word-of-mouth recruiting by a mostly Hispanic work force may violate the law if the result is that almost all new hires are Hispanic. Spread sourcing across channels rather than through a single network.

Name the realities in the posting itself: the setting and bed count, the survey history the candidate inherits, the budget and staffing structure, on-call or travel expectations if the seat covers multiple buildings, and the reporting line to ownership. Candidates for this seat will ask about all of it; an ad that answers up front gets better shortlists.

The channel mechanics — budget across boards, referral structure, and how a leadership funnel differs from an aide funnel — belong to the recruitment strategy guide. To sanity-check your posting against what candidates see, browse the nursing home administrator jobs board before you publish.

Screen in a fixed order, license first. Confirm the license is active and in good standing with the issuing state board or program, then pull references from people who saw the candidate operate — a governing-body member or owner they reported to, a regional leader, or the DON they partnered with. Ask each reference about survey outcomes and how the candidate handled them.

Say you order a consumer report on an applicant — a criminal background report, a credit report or a license-verification service report. The Fair Credit Reporting Act requires a clear written disclosure in a stand-alone document and the applicant's written authorization before you obtain it (15 U.S.C. 1681b(b)(2)).

Exclusion screening matters more the higher the seat sits. No Medicare, Medicaid or other federal health care program payment covers items or services furnished by an excluded individual. A provider that employs or contracts with a person it knows or should know is excluded can face civil monetary penalties, an assessment of up to three times the amount claimed, and exclusion itself. Federal law does not require providers to check the OIG's List of Excluded Individuals (LEIE) — OIG says so itself — but OIG recommends screening before hiring and periodically thereafter, and the list updates monthly.

One more layer sits on top. State Medicaid agencies must check the LEIE and the EPLS for providers and their owners, agents and managing employees no less frequently than monthly (42 CFR 455.436) — a category your administrator can fall under, depending on how your state applies it. Ask your state Medicaid agency how the rule reaches the seat before you rely on your own screening alone.

Sequence the health steps lawfully. Under the ADA, a covered employer may require a medical examination only after a job offer and before duties begin, and only if every entering employee in the job category gets one (42 U.S.C. 12112(d)(3)).

Add a work-sample screen alongside the compliance screens. A budget scenario, a survey-preparation walkthrough or a staffing-plan review shows you how the candidate actually prioritizes — the judgment a license and a resume never fully show.

The step-by-step — what to order, in what order, with which disclosures — is the background checks guide's territory. Confirm your screening sequence with your state agencies, the EEOC or HHS-OIG, or health-care counsel.

Anchor the offer to the closest published figure, and label it honestly: our sources carry no administrator-specific wage series. In the Occupational Employment and Wage Statistics for May 2025, medical and health services managers (SOC 11-9111), the broad category that covers nursing home administrators and other health-care managers, earned a national median of $123,860 a year ($59.55 an hour), with 597,080 employed. That is a category median, not an administrator wage.

The industry rows sharpen it for your setting. The same release puts the broad category at a median of $105,550 a year in skilled nursing facilities and $101,830 a year in home health care services. Each row is the broad category in that setting — the closest published anchor your setting has, and not interchangeable with the national figure.

National percentiles and the full pay tables sit on the nursing home administrator salary data page — link your hiring managers to it rather than rebuilding the table by hand. Then check the live postings in your market, because what you need to offer to compete is set locally.

If you classify the seat as exempt from overtime under the FLSA's professional exemption, the salary or fee basis must be at least $684 a week (29 CFR 541.600(a), as amended May 15, 2026). Meeting that floor is one required test, not exemption on its own — the duties tests still apply. State salary thresholds can be higher, so confirm classification with the DOL's rules or employment counsel before you set the structure.

On bonuses and incentives, our research found no published benchmark for administrator sign-on bonuses, retention bonuses or incentive structures tied to survey or census outcomes. Build any of those from your own budget and the postings you compete with, and put the terms in the offer letter rather than in the ad.

One posting rule to check before you publish: Washington requires employers with 15 or more employees to disclose the wage scale or salary range and a general description of benefits in each job posting. Other states have their own pay-transparency laws, so confirm your state's requirements with your state labor agency.

Interview against the seat's real decisions, not its job description. Build scenario questions around four situations the seat can face in an ordinary quarter. Ask about a survey deficiency and the correction plan that follows it, a staffing shortfall on a weekend, a budget or census miss explained to ownership, and a family complaint that has escalated to the state. Listen for chain of command, documentation habits, and whether the answers run through the DON or around them.

Keep the questions lawful. The EEOC's guidance is to limit pre-employment information requests to what is essential for determining whether a person is qualified, and to generally avoid questions that would indicate the applicant's race, sex, national origin, disability status, age, religion, color or ancestry. Reasonable accommodation applies to applicants with a disability, unless providing it would cause significant difficulty or expense — build the interview so a qualified candidate can request an adjustment.

If you use a test or exercise — a budget case, a mock plan of correction, a staffing model — it must be necessary and related to the job, and it may not exclude people based on protected characteristics.

Sequence after the yes. The ADA allows a required medical examination only after an offer and before duties begin, and only if every entering employee in the job category gets one. That is also the point where license verification, exclusion screening and background reports should be wrapping up ahead of a start date. The offer then turns into paperwork with a fixed deadline: Form I-9 Section 2, the employer's review and verification of documents, must be completed within three business days of the hire.

Write the offer around what candidates for this seat actually weigh:

• The salary and its pay basis, including any exemption classification.
• Any incentive structure and how it is measured.
• The survey calendar they inherit.
• The staffing and budget authority they get.
• The reporting line to ownership or the board.
• The length and shape of orientation.

Name the licensure requirement in the same words the posting used, so the offer, the posting and the credential file all match.

Onboarding for an operator is a handover, not an orientation video. Complete the credential file before day one, with the license verification and its expiration date in it. Walk the staffing plan and the facility assessment it rests on. Hand over the survey calendar, with the standard survey falling no later than 15 months after the last one.

Set the staffing conversation to the rules in force. Federal rules require sufficient nursing staff on a 24-hour basis based on the facility assessment rather than a fixed numeric ratio (42 CFR 483.35(a)). The 2024 rule that would have added numeric minimums was blocked by statute until September 30, 2034 and repealed effective February 2, 2026. Planning to a repealed number misshapes the budget; defending sufficiency from the facility assessment gives you a plan that holds up on paper.

Protect the administrator-DON partnership from day one. The federal rules require a facility to designate a full-time RN director of nursing, with waivers possible. Your two leadership hires share a building and a survey — set up the meeting rhythm, the escalation path and who owns which deficiency in writing, before the first one arrives.

Keep the credential calendar after the hire, too. Track the license renewal date and any continuing-education deadlines your state board sets, and calendar them with the same discipline as your survey dates — a lapsed license is the kind of compliance problem that is preventable on paper.

The levers that keep an operator are ones you control: authority that matches responsibility, a staffing and budget structure they did not have to rebuild from scratch, coverage expectations that survive a bad week, and a development path toward multi-site or regional responsibility. Judge the result in your own records — separations, exit reasons, weeks from posting to start — rather than against industry folklore.

The scheduling, wage-hour and workforce topics around this hire sit in the employer hiring guide, alongside the rest of the cross-role guides.

Employer information, not licensing, legal, medical, benefits or tax advice. Administrator licensure is verified with your state licensing board or program, and nursing staffing and survey requirements come from CMS and your state survey agency. Screening and pay-posting rules come from HHS-OIG, the EEOC, the DOL and your state labor agency. Confirm the current requirements with the bodies named above, and with a CPA or health-care counsel for classification and pay-structure questions, before you hire.