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How to Become a Licensed Nursing Home Administrator (LNHA) in California

Licensed nursing home administrators (LNHA’s) are responsible for the administration of nursing homes in accordance with applicable federal, state, and local laws and regulations. In addition to ensuring compliance with relevant laws and regulations, LNHA’s responsibilities include managing staff, patients, admissions, budgets, records, and equipment.

LNHA’s thus play an important role because if they perform poorly the health and safety of nursing home residents could be jeopardized. The position can be stressful and very challenging, so state governments—which are responsible for licensing LNHA’s—need to make sure that they only license individuals who can handle the job. However, being a LNHA can be a rewarding job and the salary is typically in the six figures because the job is so demanding, so the process of obtaining a license is somewhat challenging. However, LNHA’s are still in high demand.

In fact, demand for LNHA’s is so high that the US government recently reported that job openings for medical and health service managers—a category which includes LNHA’s—will increase 32 percent nation-wide during this decade. This is due to the fact that the number of seniors in need of long-term care will increase dramatically this decade as more members of the baby boomer generation start to need long-term care.

In order to become a LNHA in California there are three threshold requirements: 1) you must be at least 18; 2) you must pass a moral character and criminal background check; and 3) you must be either a U.S. citizen or a legal resident with the right to work in California. If you meet these threshold requirements, then the next step is to satisfy the educational and/or practical training requirements which California mandates for those who wish to become a LNHA in the state. Finally, after meeting the threshold requirements and the educational and/or practical training requirements you must pass two LNHA exams, a national exam and a California state-level exam

In order to boost your job prospects the recommended path to becoming a LNHA is to first attend a college that has either a nursing home administration major or offers a degree in a closely related field. Courses that aspiring LNHA’s should take during college include long-term care administration, public health administration, health services administration, and business administration.

After graduating from college it’s best to consider obtaining a master’s degree in health administration, gerontology, long-term care, or nursing home administration. This enables future LNHA’s to deepen their understanding of the field and take classes in specific areas that interest them. Although having a bachelor’s or master’s degree isn’t required in order to become a LNHA in California these degrees are both very beneficial when it comes to applying for jobs because they make you stand out from the crowd.

Regardless of which educational pathway you choose there is a practical training requirement that must be satisfied in order to be eligible to sit for the LNHA exams. If you choose to pursue a master's degree your practical training requirement will be included in your degree program and consists of an internship or residency program lasting at least 480 hours during which you gain experience in a skilled nursing facility or an intermediate care facility.

If you don’t think a master’s degree is right for you then you will need to fulfill the practical training requirement by completing an Administrator-In-Training (AIT) program approved by the California Department of Public Health’s Nursing Home Administrator Program (NHAP). An AIT program is an internship in which the AIT works under the supervision of a preceptor, which is a licensed administrator who has met certain qualifications specified by the state government.

The purpose of the AIT program is to promote the professional development of AIT’s in the field of long-term care administration, and many colleges which have health care administration majors offer AIT programs as part of their curriculum, which is why attending a college that includes an AIT program is a good choice for people who are serious about becoming a LNHA.

There are several ways to qualify for the AIT program, including the following:

  1. Have a doctorate degree in medicine and a current valid license as a physician and surgeon;

  2. Have a baccalaureate degree;

  3. Have ten years of full-time work experience and a current valid license as a registered nurse. At least the most recent five years of the 10 years of work experience shall be in a supervisory or director of nursing position.

  4. Have ten years of full-time work experience in any department of a skilled nursing facility, an intermediate care facility, or an intermediate care facility/developmentally disabled with at least 60 semester units (or 90 quarter units) of college or university courses. At least the most recent five years of the 10 years of work experience shall be in a position as a department manager.

  5. Have ten years of full-time hospital administration experience in an acute care hospital with at least 60 semester units (or 90 quarter units) of college or university courses. At least the most recent five years of the 10 years of work experience shall be in a supervisory position.

If you qualify under one of the above criteria, then you can submit your proposed AIT program to the NHAP exam board for approval. This submission must include your preceptor’s qualifications, an outline of the 1000 hours of training, an application form, and the necessary fees.

Once you’ve satisfied California’s LNHA education and/or training requirements the next step is to take the two LNHA exams. You can take the national and state-level exams in any order. The national exam is computer-based and is organized by the National Association of Long-Term Care Administrator Boards (NAB). To sit for the national LNHA exam you must submit an application which includes proof that you’ve met the educational and/or practical training requirements and pay an application fee.

Even though the national exam application is submitted to the NAB it’s actually the California NHAP which determines whether you’re eligible to sit for the national exam. To be specific, when you apply to the NAB for the national exam the NAB will send notice of your application to the California NHAP, and the California NHAP will decide whether you’re eligible to sit for the national exam by virtue of having satisfied California’s LNHA educational and/or practical training requirements. California’s NHAP will then send notice of their decision to you and the NAB within four months. If you’re eligible for the national exam, the NAB will send you an e-mail which includes an Authorization-to-Test letter, after which you must schedule and take the exam within 60 days of receiving the letter. More information about the national LNHA exam can be found on the exam section of the NAB website (see this link).

The California LNHA exam consists of 100 multiple choice questions and covers the Omnibus Budget Reconciliation Act; the California Code of Regulations (Title 22, Division 5); other aspects of nursing home administration; and certain issues that are specific to the state of California.

Although your education and practical training will help you prepare for the two LNHA exams it’s best to thoroughly prepare for them by using study materials and taking practice tests.

Finally, if you already have a nursing home administrator license from another state that means you’ve already fulfilled the practical training requirement and taken the national LNHA exam, so you only need to satisfy two requirements. First, you need to take the California LNHA exam. Second, you must have satisfied the education requirements that existed in California at the time you were originally licensed in the other state.

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