How To Find a Nursing Home Administrator in 2026

Hiring a nursing home administrator comes down to three core parts — determining whether you need an interim administrator to protect operations, clearly describing and posting the position requirements and compensation, and interviewing for both a cultural and skills match for your company. 

According to 2024 research in Risk Management and Healthcare Policy, nursing home administrator (NHA) turnover has hovered near 40% annually since the 1990s, and research links administrator turnover to lower operating margins and higher job dissatisfaction, often attributed to those low margins. Balancing the increasingly complex needs of residents under both nursing home regulatory requirements and corporate budget expectations is no easy feat —  which is why it can be difficult to find the right NHA for your nursing home. 

What Does a Nursing Home Administrator Do?

The responsibilities of a nursing home administrator are multifaceted, requiring them to oversee both daily operations and long-term planning.

Their typical duties include:

• Overseeing day-to-day functional operations, including staffing, budgeting, and ensuring appropriate facility maintenance.
• Ensuring patient and resident care complies with state and federal regulations.
• Developing and implementing policies and procedures to keep the facility running smoothly and safely.
• Coordinating with healthcare professionals and external agencies.
• Addressing family concerns and communicating with residents’ loved ones.
• Training staff and providing professional development opportunities.

Among these daily responsibilities, the NHA is the individual the state surveyor holds accountable for the facility’s compliance. If compliance or other issues arise at the facility, the NHA will answer for them and create and facilitate a path to resolution. 

Traits of an Excellent Nursing Home Administrator

When hiring a nursing home administrator, there are key traits to look for that  will set both your facility and your future NHA up for success: 

• Regulatory fluency: Your NHA needs to be completely fluent in the regulations they are responsible for upholding, and treat survey readiness as a daily discipline, not an annual scramble. This can reduce stress across the facility and ensure the proper level of care is provided. 
• Financial literacy: A successful NHA can read a census report, a labor variance, and a Medicaid reimbursement rate and act on all three confidently, weighing both business and patient interest in their decisions. 
• Staff retention instinct: A good administrator understands that staff stability and retention are their responsibility, and that meaningfully increasing retention helps protect both the business and residents’ best interests. 
• Family communication: A skilled NHA can both conduct and absorb difficult conversations with family members of residents without taking them personally. 
• Composure under pressure: Because the NHA is legally responsible for a facility’s operations, the ability to lead calmly through an outbreak, a complaint survey, or an immediate jeopardy finding is crucial. 
• Decisiveness: Administrators have many responsibilities and need to be able to act confidently and decisively. On the same note, the right administrator will know when they can handle something and when it’s time to seek higher leadership. 
• Ethical backbone:  An excellent NHA will view their job to report and correct noncompliance as a high priority, rather than an inconvenience or something that reflects poorly on them. Noncompliance will happen, and the ability to self-correct rather than crash and burn makes a successful administrator. 
• Presence on the floor: Finally, a successful administrator will understand that leading visibly on the floor supports staff success and the facility as a whole. Being present and familiar with the facility’s daily operations helps create an air of approachability and responsiveness that keeps facilities running smoothly. 

Determining these traits throughout the hiring process can help you make a more confident decision in your choice of NHA. Some of the ways you can do this are by using behavioral interview questions tied to real scenarios. This can include creating “What if” scenarios, utilizing professional reference checks that ask about survey history specifically, and validated assessments for certain skills or traits. 

Understanding NHA Licensure and State Requirements

When looking for an NHA, you must find one that has the proper licenses in your state. In most states, this includes having a bachelor’s degree in a related field and passing the state board’s required exams. Licenses do not automatically transfer between states, and this should be taken into consideration before hiring an NHA from out of state.  

When it comes to licensure reciprocity  —  meaning, if an NHA license is valid in a state other than the one it was obtained in  —  the rules can differ. Many states grant licensure endorsement or reciprocity if the applicant holds a current license in a state with “substantially equivalent” requirements. States like Delaware, Massachusetts, North Carolina, and Washington all operate versions of this —  in fact, Washington maintains a published list of states it considers substantially equivalent, and applicants from states not on that list must complete its AIT program.

Some states have no reciprocity at all. New York, for example, does not offer reciprocity, though the state may waive the examination requirement for an administrator already licensed elsewhere on a case-by-case basis. 

Even if your state does offer reciprocity, NAB score transfers between jurisdictions must be requested separately and carry a fee. If you are recruiting an out-of-state candidate, make sure that you confirm the licensure pathway is established and matches your timeline before you extend an offer. A candidate who needs to complete an AIT program is not going to be available in 30 days, so this will need to be a part of your hiring conversation. 

What’s Shaping the NHA Hiring Market Right Now

If you are looking to hire an NHA, you know that high turnover remains the defining problem. The 2024 research in Risk Management and Healthcare Policy found that facilities with one administrator turnover event saw a year-over-year operating margin decline of roughly 1.14%, and facilities with two or more events saw about 2.25%. When operating margins decline, the ability to offer competitive salaries and benefits packages to attract qualified candidates also declines, which only feeds the turnover issue. 

Another factor that’s shaping the market for Nursing Home Administrators and the facilities that hire them is federal staffing requirements. The Centers for Medicare & Medicaid Services (CMS) issued an interim final rule in December 2025, effective February 2, 2026, repealing the minimum hours-per-resident-day requirements and the 24/7 onsite RN requirement from the 2024 staffing rule, without rescinding the enhanced facility assessment requirement and the Medicaid institutional payment transparency provisions. This means that the federal floor moved, but the facility assessment requirement stayed, and enforcement pressure has shifted toward state legislatures and the survey process. That puts more weight on administrators  —  the NHA is now the person deciding and defending what adequate staffing looks like in their building. 

On top of that, demand for care, and therefore the need for care staff, is misaligned. Currently, an average of 11,200 people turn 65 and start thinking of their aging needs, including their plans for going to a nursing home. The Bureau of Labor Statistics projects 23% employment growth for medical and health services managers from 2024 to 2034, with a demand of 62,100 openings annually. The candidate pool is not growing to match the pool of those eligible for care, which is a problem for facility NHAs. 

These problems are shaping the hiring market for NHAs, as well as the daily work environment. 

How Long Does It Take To Fill a Nursing Home Administrator Role?

Most NHA hiring searches take 60 to 120 days, from role definition to start date. This can be longer if the candidate needs to relocate or obtain licensure in a new state.

While 60 to 120 days is an average, timelines may vary. The Society for Human Resource Management (SHRM) puts the median time-to-fill across all roles at just under six weeks, while executive-level searches consistently run two to three times longer. Regulated industries with licensure requirements sit at the long end of that range. 

Other factors that affect NHA hiring specifically are the smaller candidate pool, as well as considerations for out-of-state licensure. Facility-level issues that can impact hiring include a difficult survey history, below-market compensation offers, and slow internal decision-making. Leadership can work together to address some facility-level issues to expedite the hiring process when their NHA position opens. 

The Cost of an Open NHA Position

An unfilled administrator seat costs a facility on multiple lines at once, including census, agency labor, survey exposure, and downstream staff turnover. As mentioned earlier, repeated turnover reduces facility margins, showing that an open administrator seat can translate to some of the following costs: 

• Lost or stalled census: Facility admissions can slow when no one owns the referral relationships that bring in new residents.
• Agency and overtime spend: When the NHA seat is vacant, a regional director covering the building may ask for overtime to compensate, which may be higher than the NHA salary. 
• Survey exposure: 2023 research found a link between administrator turnover and higher deficiency counts, and morale and leadership instability. 
• Downstream turnover: As part of the deficiencies, the 2024 Risk Management and Healthcare Policy research shows that when the NHA position is unstable, that positions down the line, including the Director of Nursing (DON) and department heads, are more likely to leave as well. This has big implications for care and budget margins. 
• Recruitment restart: Restarting the recruitment process can cost time and money if the chosen NHA hire does not stay for any reason. 

Research from Gallup finds that replacing an employee costs 200% of annual salary. Applied to a real NHA salary, that is materially different from the $17,000 baseline figure quoted in the past.

This is why fostering retention through recognition, understanding the issues current NHAs face, and putting support systems in place benefits not only your employees but your bottom line. 

Comparing Your Recruitment Options

The right recruitment method depends on how fast you need the seat filled, how deep the local candidate pool is, and how much risk you can carry on a mis-hire. Once you determine your answer for each of these fields, you can start to look at the recruitment tools available. 

Retained Search

Retained search means an upfront retainer fee engages a recruitment firm exclusively. The firm then treats the search as a committed project, rather than a race against other recruiters. While this option can be more costly, it gives you access to passive candidates who are not applying anywhere, outsourced research and sourcing, structured vetting processes, and accountability for the placement. Retained search is a great option for hard-to-fill markets, facilities with a difficult history to overcome, and any search where a mis-hire would be expensive. 

Contingent Search

Contingent search is similar to retained search; however, you pay the recruiter only on a successful placement. This can be cheaper up front, but rather than committing to a single search like retained search, the firm typically runs several searches simultaneously and prioritizes whichever is most likely to close. Contingent searches are the best fit for roles in deeper candidate markets where recruitment speed matters more than exclusivity.

Job Boards and Industry Postings

Job boards, like LinkedIn and Indeed, and industry-specific board postings are highly common across all job markets. These boards reach active job seekers quickly and cheaply, and can return many applicants. However, they target only active job seekers. This can be a stalling point for hard-to-fill markets, or people who haven’t started looking yet. Job boards also create a screening burden because they are open to the public, so anyone can apply, regardless of their licensure. If you are on a tight turnaround, or looking to fill a highly skilled position, you shouldn’t rely solely on job board postings, but rather use them as one part of a larger recruiting strategy. 

Internal Promotion

Promoting a current Assistant Administrator or AIT graduate from within your facility can work well, but only if the licensure and readiness for the role are genuinely in place. Promoting existing employees is great for cultural continuity and is a strong retention signal to the rest of the team. Additionally, you don’t have to spend as much time or money recruiting. However, promoting someone without the proper licensure or readiness can create compliance exposures, overwhelm employees, and result in a loss of reputation and time if the promotion doesn’t work out. At the end of it all, you’re back to needing to hire.

When it comes to promoting internally, strong succession planning is always a wise investment. Creating the ability for mid-level employees to upskill into senior and executive roles ensures that you have internal options ready when a seat opens, even if only on an interim basis. You can think of succession planning as your emergency savings  —  it’s better to have it and not need it than to need it and not have it. 

Should You Hire an Interim Nursing Home Administrator?

An interim NHA makes sense when the position needs coverage, and a rushed permanent hire, or a mis-hire, would cost more than the interim will. An interim NHA is a licensed, experienced administrator who steps in to run the building, maintain survey readiness, and hold operations steady while the permanent search runs properly. 

You do not have to hire an interim NHA every time that the seat becomes available. With proper succession planning, you may not need one. However, there are times when an interim NHA is called for, such as:

• A sudden role departure with no licensed internal successor.
• A survey window approaching, or recovery from a difficult survey.
• Census or quality metrics slipping and needing immediate attention.
• A facility that is in mid-acquisition where a permanent hire would be premature.

The interim rate is higher than the equivalent salary line, but it is compared against 60 to 120 days of the vacancy costs described above, not against a filled seat. And as we’ve discussed, an empty NHA seat can be just as, or even more, costly than an interim administrator. 

Hiring a candidate for an interim position can even be a boon to the recruitment process. The interim-to-permanent position conversion, on average, sits at 1 in 4. Which means that interims aren’t always a temporary Band-Aid to avoid costly issues; they can also be an investment in the facility’s future. 

If you’re in need of an interim NHA or other senior position, MedBest has interim options ready in 1-2 business days. Contact us online or by calling (727) 526-1294.

How To Screen and Interview NHA Candidates

The following questions can help you screen your NHA candidates to find the right fit for your facility: 

1. Walk me through the last survey you led. What was cited, and what did you change afterward?
2. How do you know, on any given day, whether your building is adequately staffed?
3. Describe a time you had to reduce agency spend without losing coverage.
4. How have you handled a family complaint that escalated to the state?
5. What was your DON turnover during your last two roles?

These questions, coupled with licensure verification, CMS Care Compare history for the facilities they have run, and an inquiry to the state board for any disciplinary actions, are a great start to filling your NHA position. These don’t have to be your only screening questions, but they can help point you towards the information you’ll need to determine if a given candidate is the right fit. 

Assessing the Cultural Fit of Candidates

Technical skills are important, but so is finding someone who fits into your facility’s culture. You want a leader who shares your values and understands the environment you’re trying to create for residents and staff.

To determine if someone is a good cultural fit, ask about their approach to teamwork, how they’ve navigated conflicts in the past, and what motivates them. This can often be a science at times. For example, you may want to involve a few team members in the process to give you a sense of how the candidate will gel with others. Reference checks can also provide insight into how candidates interact with teams and handle challenges in similar environments. At MedBest, we use a DISC assessment to evaluate each candidate’s cultural fit. The goal is to find someone who not only gets the job done but also contributes to a positive and supportive workplace.

Writing a Job Advertisement That Attracts Qualified Administrators

Regardless of how you’re posting your NHA role, it’s important that you follow best job posting practices to attract the right candidates. Your job posting reflects the position therefore, you want it to be accurate and favorable. You should include what you’re looking for such as licensure, experience, or hard skills as well as answer some foundational questions for the candidates, like salary and benefits.

When it comes to salaries, post the real range. You may fear that this will drive candidates away if you’re under tight budget restraints, but it can actually be the opposite. Candidates at the administrator level tend to filter out postings that don’t disclose salaries, and those who do apply do so with that number in mind, reducing misalignment in the first interview. Furthermore, several states now require pay transparency in postings, so it’s best for all to include it. 

Other specifics worth naming in the job posting include: 

• Bed count.
• Payer mix.
• Current star rating (if it is a selling point).
• Reporting structure for those above and below the role. 

These specifics help your candidates form an accurate idea of the job, and come up with informed questions to ask in the interview stage.

Onboarding Your New Nursing Home Administrator

Once you’ve found the right person, onboarding is your chance to set them up for success. Start with a thorough orientation that covers the ins and outs of your facility — policies, procedures, and goals. Pair them with a team member who can show them the ropes and help them feel at home.

It can help to split the onboarding process into three sections — the first 30 days, 60 days, and 90 days. These date benchmarks offer convenient check-in points that can help new hires orient themselves and help you track their progress. Things to cover in this period include: 

• First 30 days: Introduce employees, contracts, and vendor relationships, tour the facility, set up access to all technology, and review workplace policies and training. 
• First 60 days: Join projects and meetings, schedule any necessary one-on-ones, such as with the director of nursing,  review of the facility’s most recent survey and plan of correction, and ask outstanding questions. 
• First 90 days: Work autonomously, start leading initiatives, begin future planning, and report successes. 

While you don’t have to limit onboarding to 90 days, this approach helps set up a roadmap. A thoughtful onboarding process helps new hires hit the ground running and shows them they’re valued, which is key to long-term retention.

Mistakes To Avoid When Hiring a Nursing Home Administrator

Now that we’ve covered best recruitment and onboarding practices, let’s talk about mistakes you want to avoid when hiring an NHA. These mistakes can be costly, but you can avoid them with a little foresight: 

• Rushing the hire: As we’ve mentioned, the wrong hire can be just as expensive as no hire. Be sure to do your due diligence on candidates to ensure they meet all the qualifications of the role and the state. 
• Relying only on job boards: Public job boards like LinkedIn are a great starting point and can be useful tools for candidate research. But for highly skilled positions like NHAs, it can be hard to tune out the oversaturation of applicants. 
• Skipping license and survey-history verification: Do not assume that an applicant has all the necessary licensure just because they are applying, especially if they come from a public job board. You should always check licensure and survey verification before hiring, as the consequences can be a cease-and-desist from the state, loss of certification, or terminal loss of funding. 
• Under-scoping compensation: Negotiating compensation can be a tricky balancing act, but losing a qualified final candidate over a gap smaller than a one-month vacancy cost can end up costing you more in the long run. 

By avoiding these common pitfalls, either through personal due diligence or using a trusted recruitment service, you can help make the hiring process smooth for both yourself and your potential hires. 

MedBest: Find Your Next Nursing Home Administrator

MedBest works exclusively in the senior living and long-term care industry. We assign both a researcher and a recruiter to interim and permanent  NHA searches to ensure you’re getting top candidates. Leadership stability at the NHA level protects census, survey performance, and staff retention simultaneously. Let MedBest support your facility’s success by connecting you with qualified NHA candidates. Contact us online or by calling (727) 526-1294.

FAQs About Hiring a Nursing Home Administrator

How Long Does It Take To Hire a Nursing Home Administrator?

SHRM benchmarks put median time-to-fill across non-executive roles at about six weeks, and executive-level searches typically take longer. Expect the longer end of that range if the position is rural, the facility has a difficult survey history, or the strongest candidate needs to obtain licensure in a new state. Working with a specialized search firm shortens the sourcing phase considerably, since qualified administrators are usually employed and not applying to postings.

How Much Does It Cost To Hire a Nursing Home Administrator?

Budget for more than the search fee. Gallup estimates that replacing an employee costs 50% to 200% of their annual salary, and the Center for American Progress puts the figure as high as 213% for executive roles. Applied to a $120,000 administrator salary, the total cost of a failed hire and restarted search runs well into six figures once you include recruitment, onboarding, lost productivity, and the operational disruption of a second vacancy. Search fees are typically a percentage of first-year compensation and vary by whether the engagement is retained or contingent.

Does a Nursing Home Administrator License Transfer Between States?

Not automatically. Every state licenses Nursing Home Administrators independently, and requirements vary. Many states — including Delaware, Massachusetts, and North Carolina— offer licensure by reciprocity or endorsement when an applicant holds a current license in a state with substantially equivalent standards. Others, such as New York, do not offer reciprocity at all, though they may waive the national examination requirement for an administrator already licensed elsewhere. Candidates coming from a state that is not recognized as substantially equivalent may need to complete an Administrator-in-Training program before they can be licensed. Confirm the pathway and the timeline before extending an offer to an out-of-state candidate.

What Qualifications Does a Nursing Home Administrator Need?

Most states require a bachelor’s degree, completion of a state-approved Administrator-in-Training program, and a passing score on the national examination administered by the National Association of Long Term Care Administrator Boards (NAB). Some states accept a master’s degree in health administration with a qualifying internship in place of part of the AIT requirement. Beyond the license, employers typically look for prior skilled nursing operations experience, a documented survey record, and financial management capability.

Should I Hire an Interim Nursing Home Administrator While I Search?

An interim administrator makes sense when the seat is open now, and a rushed permanent hire would create more risk than the interim costs. A licensed interim NHA can maintain survey readiness, hold census and staffing steady, and keep the building running while the permanent search proceeds on a proper timeline. This is especially worth considering when a survey window is approaching, when there is no licensed internal successor, or when the facility is mid-transaction. MedBest presents qualified interim administrator options within 1–2 business days.

Why Is Nursing Home Administrator Turnover So High?

Annual NHA turnover has hovered around 40% since the 1990s, considerably higher than turnover among hospital administrators. The role carries an unusual combination of pressures: regulatory accountability, thin operating margins, frontline staffing shortages, and around-the-clock responsibility for a vulnerable resident population. Research published in Risk Management and Healthcare Policy found that facilities experiencing administrator turnover saw measurably lower operating margins, and separate research has linked administrator turnover to higher survey deficiency counts.

Should I Work With a Recruiter To Fill This Position?

For most facilities, yes. Licensed administrators who are performing well are rarely applying to job postings, which means the strongest candidates are reached through direct outreach rather than advertising. A recruiter specializing in senior living also brings the ability to evaluate credentials, survey history, and cultural fit in ways a generalist HR team usually cannot. MedBest assigns both a researcher and a recruiter to each NHA search.

How Do I Retain a Nursing Home Administrator Once Hired?

Retention starts with competitive compensation benchmarked to your market, but pay alone does not hold administrators in the role. The factors that most often drive NHAs out are inadequate regional support, unrealistic expectations around staffing and budget, and the absence of a path forward. Regular check-ins during the first year, clear authority to make operational decisions, professional development support including CE requirements, and a realistic workload all contribute meaningfully to tenure.