Questions About Nursing Home Administration

What do nursing home administrators do?

What do nursing home administrators do?

Although specific duties vary from facility to facility, every administrator of every Minnesota nursing home is required by Minnesota Department of Health rules to be the person in immediate charge of the operation and administration of the nursing home s/he serves. Administrators develop long-term strategic plans and day-to-day operational policies and procedures for the operation, management and maintenance of the nursing home. They enforce rules and regulations to ensure quality care and safety of residents and to protect their personal and property rights. They maintain an effective human resources program to train and manage all staff of the facility through subordinate supervisors such as the Director of Nurses, Business Manager, Dietary, Housekeeping, Maintenance and other department heads. They develop and oversee the facility budget and accounting system, market the facility to prospective residents and their families, and maintain effective public relations with the community at large and the health care community in particular.
Who must be licensed as a nursing home administrator?

Who must be licensed as a nursing home administrator?

Anyone who is employed as the administrator of a facility licensed by the Minnesota Department of Health as a nursing home. This includes persons who administer nursing home beds in units attached to hospitals whether or not those persons also serve as hospital administrators.

Many persons who are not the administrators in charge of nursing homes (and therefore are not legally required to be licensed) also choose to obtain and retain a license as a nursing home administrator. These persons typically work at other jobs in long-term care—as assistant administrators, as managers in corporate headquarters of organizations that operate nursing homes, as managers of senior housing and assisted living facilities or home health services. In Minnesota, Assisted Living requires individuals working as an Assisted Living Director to be licensed.
Where do administrators work and under what conditions?

Where do administrators work and under what conditions?

Administrators work just about anywhere; in large metropolitan or suburban facilities of over 500 residents and hundreds of staff, in small urban or rural facilities of less than 25 residents and approximately the same number of staff, in stand-alone nursing homes or in wings attached to hospitals, on campuses of senior-serving complexes where the nursing home is one of many housing and health alternatives available, for management companies or individual owners with for-profit or not-for-profit charters, for city, county and state-government owned and operated facilities. Regardless of the size or location of the facility administered, each administrator operates under state and generally, also, federal laws and rules in an industry which is heavily regulated to ensure good care to residents through effective management practices.
How much are administrators paid?

How much are administrators paid?

Information about pay rates for administrators (categorized under medical and health service managers) may be obtained from the Bureau of Labor Statistics. Keep in mind that this data reflects rates paid to all administrators, some of whom have many years of experience. Starting salaries will likely be lower. Rates tend to vary between metro and rural facilities and with the size of the facility as well.
What’s the job market like?

What’s the job market like?

According to the Bureau of Labor Statistics, employment is projected to grow. As the large baby-boom population ages and people remain active later in life, the healthcare industry will see an increase in the demand for medical services. There will likely be increased demand for nursing care facility administrators as baby-boomers age. A newly licensed administrator, who is willing to locate in rural areas will likely have success in their first position.
What kind of preparation do I need to become an administrator?

What kind of preparation do I need to become an administrator?

Current Minnesota Rules require a bachelor’s degree from an accredited college or university. Though there is no requirement that the degree have been earned in any particular field, most frequently persons pursuing licensure have earned degrees in health care areas, social services or business administration. Some persons opt to complete a 4-year bachelor’s degree curriculum designed specifically to prepare them for a career in nursing home administration. Others make a “mid-career shift” to nursing home administration, most often from a career in health care or business administration. Those making a career shift typically concentrate strictly on fulfilling the course requirements.

Some facilities, particularly smaller ones in non-metro areas, are willing to hire new licensees, without previous administrative experience, “fresh out of school.” So are some of the larger management companies that often put their new hires through a company-sponsored administrator-in-training program before placing them in charge of a facility. Some companies or individual facilities hire newly licensed administrators as assistant administrators so they can obtain some experience before taking on the administrator responsibilities. Some of the larger, metro-based facilities expect their administrators to hold or obtain master’s degrees and to have many years of experience.

The Application Process

How can I speed up the application process?

The mission of the Board of Executives for Long Term Services and Supports is to promote the public’s interest in quality care, effective services and supports for consumers of nursing homes and assisted living communities by ensuring that licensed executives are qualified to perform their administrative duties. We do this by ensuring all applicants and licensees are meeting the minimum standard set in Minnesota Laws and Rules.

The short answer is, there are no shortcuts.

The best information that can be given to an applicant who wishes to have a speedy application process is to be prepared. Gather all the documents listed in the Application Instructions sent to you by email, review the applicant handbook, read and understand the communications you receive from the office and the Minnesota State Rules as they apply to the practice of quality care. The effort you put in on the front end of the process will assist in understanding licensure as a whole and ultimately promote a higher standard for the practice and an increased quality of life for Minnesota's elder population.
What fees can I expect?
BELTSS and all other health-related licensing boards receive no general tax funding. Rather, they are completely user funded. Thus the board must charge fees for all services it performs. The some fees involved in the licensure process are as follows:
- $150 to open a file with the board and begin the licensure process
- $100 optional fee for review of education and/or experience to determine how many of the requirements for licensure you may already have completed. You may choose to request this service to help you decide whether or not you want to begin the licensure process. This fee is charged only if you seek the determination from the board prior to opening a file. If you seek the determination and then follow through with an official application to begin the licensure process, the $100 fee is applied to the $150 filing fee, provided you apply to open a file with the board within one year of paying the $50 review fee.
- $100 to take the State exam
- $250 licensure fee to obtain a license once all requirements are complete if initial license is conferred between July 1 and December 31; $100 licensure fee if the license is conferred between January 1 and June 30.
All fees paid to the board are non-refundable.

Another cost associated with meeting licensure requirements is tuition to enroll in courses to satisfy the board’s requirements. The per-credit cost of courses varies from school to school. Consult the program director or course catalog for the schools at which you are considering taking courses.
How do I submit items for my application?
Many items received for an application have to come directly from the creator of the document, this is referred to as primary source verification. Items that need to be submitted via primary source verification include:
- License verification from other jurisdictions
- Transcripts (Complete - all grades and degrees listed on the document)
- Employment verification
- Position descriptions
- Exam scores
Primary source verification can be sent electronically or by mail. Items must come directly from the originator of the document and must be able to be validated by the office as an original and complete document. Paper transcripts issued to the student by the college registrar's office and received by the office in a sealed envelope will be accepted.
Must I provide a transcript?

Yes. Board staff can work from student copies of transcripts to identify which requirements you have completed, and which you have left to finish. Eventually, however, you will need to provide official transcripts, sent directly from your school to the board office, to verify award of your bachelor’s degree and grades for every course you submit to satisfy the licensure requirements.
Which exams do I have to complete?

Minnesota requires all applicants for licensure to pass a 1 hour 20 minute, 34-item, multiple choice open book State exam, This exam tests the candidate's ability to research and interpret Minnesota Statutes and Rules pertaining to operation of a Minnesota nursing home.

Minnesota, like all 50 states and DC, requires applicants to successfully complete the examination developed by the National Association of Boards of Examiners for Long Term Care Administrators - the NAB exam. It is a 150-item multiple choice test covering the Domains of Practice.

You must have an active application for licensure on file with the state licensing board to be eligible to take either exam. For more information about the exams, visit the Exam Information page under the Applicants tab above.
What is a Practicum?

What is a Practicum?

A practicum is an internship taken for academic credit through an accredited college or university but performed at a nursing facility under the direction (preceptorship) of a licensed nursing home administrator. It may be paid or unpaid, depending on the arrangements you are able to make with the facility or the management company responsible for the facility. The majority of practicums (99%) are unpaid, but there is no prohibition on paid practicums.

When and where can I do my practicum?

Most often the practicum is the capstone experience before licensure, taken after the other courses and just before taking the exams. While the board has no rules prescribing that it must be taken in this sequence, some schools require that all or part of the other required courses be completed before a practicum is arranged. Talk with your academic program director.

Your academic program director will also work with you to arrange for an administrator and a facility for your practicum. In some cases you will be required to interview with one or more administrators to identify a good fit. If you have some ideas about a facility and administrator who would be willing to serve as your preceptor and practicum site, discuss this with your program director. Your program director will approve and arrange for training for the prospective preceptor to be sure that s/he follows a plan acceptable to the sponsoring academic institution.

If you are already employed at a facility there is no prohibition in board rules on doing your practicum at that facility provided you are relieved of your previous duties while engaged in the practicum. Some sponsoring academic programs advise strongly against and may even prohibit doing a practicum in a facility where you are employed. Even if you can shift your mindset, other staff may frequently have difficulty seeing you in the intern or “preparing administrator” role, and may call on you to perform your previous duties. Doing your practicum in another facility also gives you an opportunity to learn how others do things and may expose you to a totally different environment from that you’ve known. The board encourages applicants to use the practicum as the best possible learning experience to broaden your perspective on the full gamut of nursing facility settings.

What are the requirements for a practicum?

It must be a “for credit” academic course (not an AIT directed solely by a facility or management company), taken under the direction of a licensed administrator who has been licensed and practicing as an administrator for a minimum of two years and who is not related to you. It must take place in a nursing home, not an assisted living facility or corporate offices. You must devote at least 20 hours per week to the practicum. Most often students work full time—40 hours per week—on the practicum. For persons without previous nursing home related experience, the practicum must be a minimum of 1000 hours. Every practicum must include a series of activities specified in board rules.
If I have experience in a nursing home, must I still do a practicum?

If I have experience in a nursing home, must I still do a practicum?

The answer here is, “it depends”—on the type and amount of experience you have had. If you have been an administrator in another state for a year or more or if you have been an assistant administrator in a nursing home for one year, you may present evidence to have the practicum waived entirely. If you have had other types of employment in a nursing home or hospital or other high level administrative experience you may be eligible to have the number of hours of required practicum reduced to 750, 500, or even 200 hours.
What is an Acting Administrator Permit?

What is an Acting Administrator Permit?

It is authorization from the board to serve a specified nursing facility as its acting administrator for a maximum of six months from the termination of the facility’s previously licensed administrator. It is issued to give the facility time to conduct a search and make a permanent appointment of a fully licensed administrator. An acting permit requires a request from the management of the facility involved and a separate application verifying that the person selected to serve as acting administrator has either previous experience in the management of a nursing home or has completed at least half of the requirements for full licensure. Any person who is appointed on an acting permit must also pass the state exam. The fee for an acting administrator permit is $250 and cannot be applied to the permanent license.
Do I Qualify for an Acting Permit?

If I get a job offer and am not quite through with all my requirements, can I take the job on a temporary basis with the expectation of continuing once I have my license?

Yes, provided you obtain an acting administrator permit from the board. Before doing so, however, you will want to be sure that you can complete all remaining requirements within six months from the termination of the facility's previous licensed administrator since permits cannot be extended beyond that six month period. You will want to explore this option carefully and consult with board staff before accepting a position on a temporary basis.

For more information about the Acting Administrator Permit, visit the Acting Permits
When I'm almost done with my requirements, can I get an acting permit to use in searching for a job?

When I'm almost done with my requirements, can I get an acting permit to use in searching for a job?

No, an acting permit is issued only in conjunction with a specific vacancy at a specific nursing facility and applies strictly to work at that facility. What you can do instead is send the board office an authorization to disclose information about your pending licensure status to requesting employers. The board can then verify on request that you have completed x and y and have only z left to finish to obtain your license.

Licensure Responsibilities

First and foremost, learn About Your License. Review the pages under the Licensees tab on the Board website. This tab reviews:

Once I get licensed, how do I find a job?

Once I get licensed, how do I find a job?

Keep your eyes and ears open and network. Be sure that everyone you know in the long-term care industry knows that you will soon obtain your license and be looking for a job as an administrator. Check the employment ads in your local and statewide newspapers—both in the administrative and health care sections. Become a student member of either or both of the associations that serve long term care facilities and their staff.

Care Providers of Minnesota Inc. (CPM) offers free membership in their association to students who are enrolled in recognized academic programs upon application signed by an instructor in the program. That entitles you to receive their weekly newsletter which lists openings advertised by their member long term care facilities. Once you graduate you can continue as a personal member for a cost of $200 per year, which entitles you to continue to receive the weekly newsletter and to provide CPM your resume for referral to their facilities on request. Call (952) 854-2844 for further information. Web site: http://careproviders.org

LeadingAge Minnesota offers a student membership program free of charge to persons who are current, full-time students in a senior housing or Long Term Care licensure program at an accredited post-secondary institution. To be eligible you must be either a junior or senior in such a program or a student intern at an MHHA-member facility (not available to licensure candidates who are also full-time employees of a long-term care or housing facility). Benefits include a complimentary subscription to the weekly association newsletter, Monday Mailing, which contains information on job openings; a free directory of member facilities; reduced tuition for educational programs sponsored by the association; a resume referral service; invitation to attend district meetings; and, following the end of the student membership benefit period (six months after graduation date), the opportunity to subscribe to Monday Mailing at the individual job-seekers rate ($30 per three months). For further information contact Aging Services of Minnesota at (651) 645-4545. Web site: www.agingservicesmn.org/

BELTSS itself maintains a file with contact information of licensees who are looking for employment (either on a permanent or interim basis) that staff refers to facilities and management companies on request. Management companies for large groups of nursing and senior housing facilities are often looking for staff to join their organizations. Develop an appropriate cover letter expressing your interest in their organization and send them a copy of your resume. Also check out the trade publications in the long term care field. They usually have sections listing employment opportunities in each issue.
How do I make a good decision about my first administrator job?

How do I make a good decision about my first administrator job?

Ask around, do some research. But, whatever decision you make, be sure to check the survey history of the facility. Survey information is required to be available at the facility. Ask to see it. It is also available on line at the Minnesota Department of Health, Licensing and Certification Program. Note the number and kind of deficiencies cited during the last surveys. Do problems seem to be increasing or decreasing? Are they so numerous that the facility may just be too big a challenge for any new administrator—even you?

While getting a job is important, getting the right job is even more important. Keep your eyes open and don’t let the need to get started somewhere blind you to problems that might make your first administrator job an experience you will need to work extra hard in the long run to overcome. Know your own strengths and weaknesses. Learn the facility’s strengths and weaknesses. Decide whether you have a potentially good or bad match.
Are there different paths to become licensed?

There are four different approaches to licensure:

A. Examination Track: For the new college graduate who complete all courses, the practicum, state and national exams.

B. Experience Track: This track takes into account previous health care/elder care experience, previous college course completion, with additional course work to fill educational gaps on an individualized basis, with state and national exams.

C. Endorsement Track: Recognizes administrators entering Minnesota from states with similar requirements.

D. ACHCA Certification Track: National Certification from the American College of Health Care Administrators.
What are the eligibility requirements to become a licensed nursing home administrator in Minnesota?

Our standard advice is to review the information under the Applicants tab at the BENHA website at www.benha.state.mn.us and suggest you download or print both the application form and course review requests, as both documents guide you in determining what items require completion. All application forms give direction to complete the five minimum license requirements:

1. Bachelors degree.
2. Eight specific long term care course requirements. If you believe you've covered the course topics listed for each course in a previously completed academic course, you may seek waiver status for the course by using the Course Review Request forms and following the listed procedures.
3. 400 hour practicum for applications received prior to September 1, 2017. For an initial application. received and September 1, 2017 and after, a 1000 hour practicum must be completed. Waivers are available for those with previous health care experience.

You must have a current and completed application for licensure on file with BENHA before you will be approved by board staff to sit for the
4. state examination and
5. national exam.
What is expected of me as a Licensee?

What is expected of me as a Licensee?

BELTSS requires annual licensure renewal. All licenses are issued through June 30 of each year and must be renewed by July 1. In May of each year, the board will send you notification for renewal by email. Each year, you are required to inform the board of the continuing education credits you have completed during the preceding year (the CE “year” runs from May 1 – April 30). Each licensee is required to complete 20 credits every year. The number of credits required in your first year of licensure is prorated, depending upon how long you are licensed during that year. The board reviews and approves continuing education workshops for sponsoring organizations and posts notice of approved workshops and seminars.

Once licensed, you will have a number of professional obligations, like keeping the board informed of your mailing address and phone number, practicing in accord with statutes and board standards, renewing on time, etc. Please visit the "Licensee Responsibilities" section of the board website for further details.

Best of luck as you pursue that goal. Call the board office whenever you have questions. Staff will be happy to help.
I’m a new college graduate from an accredited NAB or state approved program. How do I apply?

Option A is typically for new graduates recently awarded a bachelors degree which meet the course requirements from a NAB or Minnesota board accredited college. Those accredited and approved colleges are listed in the Option A form, with the approved course(s) listed for each requirement. Graduates from the list of approved college LTC Administration programs meet the academic and practicum requirement.

Steps for a successful application:
1. Complete Online Application A
2. Request an official transcript upon degree completion. If you are applying prior to the end of your academic experience, the board will accept a student transcript or unofficial confirmation from the program advisor to be followed up with an official transcript.
3. Upon receipt of the application, information to apply to sit for the state and national examinations will be provided to you.
I didn’t graduate from an approved program but earned a BA/BS and a few courses may meet the requirements. How do I apply?

Option B is typically for an individual with a baccalaureate degree in an ancillary field who require only a portion of the Minnesota required courses or seeks a reduction in practicum hours. Courses not currently approved must be reviewed and approved by the board through the Course Review process as found in Option B.

Steps towards a successful Application:
1. Complete Option B online application
2. Submit official transcript showing at minimum a Bachelors Degree.
3. Submit evidence/requests for eight academic courses completed using the forms in Option B.
4. Submit evidence of required practicum using forms found in Option B.
5. Upon receipt of the application, information to apply to sit for the state and national examinations will be provided to you.
I have a college degree, have taken college courses very similar to those required, and don’t want to repeat any I’ve already taken. How do I waive those similar courses?

The website provides you the Course Review Request forms for candidates to petition the board and seek waiver of similar courses required for all candidates. The instructions provide the individual course requirement and need to be filled out completely. You may call the office for a preliminary review of previously Board-approved individual courses.
I have worked in health care for many years. Do I need to complete the entire practicum?
How long is the application for licensure valid?

The application is valid for 18 months. You must complete all requirements or a new application will be required after 18 months.

Upon receipt of your application to open a file with the board, BENHA staff will review your application and any accompanying documentation. They will assign you an identification number and will notify you of your ID number and of the date of your application receipt. Your application is valid for 18 months. You must reapply if you have not obtained licensure within that time. The staff will also let you know by e-mail or written document which of the requirements your documentation satisfies and which requirements you have left to complete. Each time critical information is received from you, from the school(s) where you're completing courses, or from NAB about test scores, etc., updates will be posted to your online account and you will be notified by email when items are received and entered into your file. When you have met all the requirements and qualify to be fully licensed, BENHA will email you an initial license application form to complete and return, along with the fee, to apply for your license as an administrator.
What do I need to submit to get my license endorsed from another state?

Option C lists out the requirements on the application and includes the following:

1. Complete Option C application
a. Facility name, location, services offered, with dates of employment which must be two years in the past five years in one jurisdiction.
b. Documentation from each facility showing clear evidence of administrative dates and role.
c. Copies of the two most recent CMS 2567s or surveys of the facilities outlined in Option C
d. License verification from each state applicant has held licensure sent directly to the board office.
e. License verification, including NAB scores from original state of licensure (or from PES).
2. Upon receipt of the application, information to apply to sit for the state examination will be provided to you.
What is the ACHCA Certification track to licensure?

The American College of Health Care Administrators offers a certification program that BENHA has accepted as meeting the state of Minnesota entry level requirements. If a candidate provides ACHCA verification, the academic and practicum experience is waived.

Steps to complete for a successful application:
1. Complete Option D online application
2. Request ACHCA verification be sent directly to the board office.
3. Upon receipt of the application, information to apply to sit for the state examination will be provided to you.
I’m a new graduate from an approved BENHA/NAB college. How do I proceed?
I’ve completed continuing education on the same subject as the course requirement; does that count towards the course completion?

No. Per rule, each course must be completed for academic credit at an accredited post secondary college and must be documented on an official transcript. Continuing Education will, however, benefit you when completing the required courses, and life experience is always beneficial.
What colleges are approved by BENHA/NAB?
Do I need an official transcript?

We can accept an unofficial email from an approved college advisor until your grades are posted if a job is pending. An official transcript must be sent directly to the BENHA office unopened. Please ask your advisor to update our office upon course completion, if you desire an expedited process due to pending employment. No license will be issued prior to the commencement date.
What must be submitted when applying for licensure?

There are four tracks to licensure and each one has a slightly different approach to the final board record. All board files contain an official transcript (s), work history or resume, state and national examination official results. The board staff will individualize the essential documents you need with the initial review of the application. A licensure data sheet is emailed upon submission of any item found acceptable.
What are the application fees?
Can I get licensed before I finish my college degree?

No. You may complete all the requirements and be license eligible prior to the completion of your college degree, but the board will require official notification from the college that you have been awarded a BA/BS before issuing your first license. With that notification, the board staff can process the license within 24 hours. Initial licensees will request an official transcript from their college, which must arrive prior to the first renewal of your license.
Do I apply with all of the supporting evidence needed for licensure or should I apply and then send in the requirements in piecemeal as I complete them?

Either way. Most candidates find it easiest to make application and then respond to the undocumented items listed on the Licensure Data Sheet. Board staff will email an update with your formal application and email each time another item is completed so candidates can see when official documents are approved and view their current status.