​Almost five years after the American College of Health Care Administrators (ACHCA) stopped offering its certifications for nursing home and assisted living administrators, the professional association for acute and aging services is bringing them out of retirement.

The ACHCA originally offered its certification program in 1981, sunsetting it in 2019 when the administration process became too cost prohibitive compared to the level of interest. “What we had found was that the exam had basically gone stale,” said Bob Lane, ACHCA president and CEO. “That was because the content hadn't continued to be updated.”

As the long term care industry underwent tectonic changes in recent years, ACHCA’s membership expressed increasing interest in the program’s renewal. Lane’s team knew, however, that they would have to make some changes. 

“We used to have fairly prescriptive requirements, which we have now eliminated,” explained Dr. David Wolf, who chairs the ACHCA’s Certification Committee. The program no longer requires an active administrator’s license, broadening eligibility to academics, consultants, and others who wish to be certified non-practicing administrators. Nor does it require a set amount of experience in the industry or membership in ACHCA, though Wolf said he hopes administrators—practicing or non-practicing—recognize the value of membership. “Our goal is to help the administrator be the best they can be,” he said. “We offer lots of resources and support specifically for the administrator.”

Proof of Mastery

The rebooted certification program was developed by a certification committee, with extensive input from subject matter experts. The Nursing Home Administrator Certification (CHNA) exam is based on the four Domains of Practice established by the National Long-Term Care Administrator Boards (NAB): Care, Services, and Supports; Operations; Environment and Quality; and Leadership and Strategy. The Assisted Living Administrator Certification (CALA) exam, meanwhile, draws on NAB resources specifically tailored to assisted living. To receive certification, administrators must take a core exam with 100 questions, regardless of whether they’re pursuing CHNA or CALA certification. Then they must take a specific line-of-services exam for their desired certification, comprising 50 additional questions each.

Both Lane and Wolf stressed that the exam is far from easy. “We are looking for mastery, so the level of rigor of these questions is significantly more difficult than the licensure exam,” Lane explained. To that end, the ACHCA offers study materials, including both online and in-person boot camps. Wolf was careful to distinguish the program from the NAB’s Health Services Executive (HSE) qualification, which is an entry-to-practice exam rather than a demonstration of proficiency.

“We are offering a credential, which is a mastery of our profession, which is a higher level than the qualification that NAB offers through its HSE,” he said. “Once you become HSE-certified and you believe you fully understand our industry, you are welcome to take the certification examination.”

Applicants who take the exam immediately receive a pass/fail result, followed by a longer report from the ACHCA unpacking their performance in each domain. “I analogize it to lighting the runway. It helps light the path for that individual in terms of what their professional development needs are and where to focus,” Lane said.

Paths to Recertification

Whereas the original certification program required recertification every five years, the new one tightens that window to three, in keeping with the rapid pace of change in the industry. Recertification requires a total of 90 continuing education (CE) credits, with at least 18 in each of the NAB’s four domains of practice. That said, the ACHCA offers differing weights to various types of CE credits, creating several potential pathways to recertification. 

For instance, the completion of a master’s or doctoral program in a relevant area generally constitutes an entire period’s CE requirements. Attendance at industry conferences like the LeadingAge Annual Meeting and Expo, the Argentum Senior Living Executive Conference, and the AHCA/NCAL Convention and Expo also constitute CE credits, provided the sessions are approved by the NAB or other relevant authorities. Service as a Bronze, Silver, or Gold Award Examiner with the AHCA/NCAL National Quality Award Program constitutes three CE credits, while presenters can earn six credits for the receipt of a Gold Award from the AHCA/NCAL’s National Quality Award Program. Other CE alternatives are explained on the ACHCA’s website.

“It’s a Completely Different World”

Matthew Lessard worked as a nursing home administrator in Maine before becoming Regional Director of Operations at National Health Care Associates. An ACHCA Fellow and recipient of its CHNA certification, he spoke highly of the certification program. “What becoming certified has meant for me is it is a testament to peers—others in the industry and even those outside of the industry—that the individual with certification has that level of mastery of the subject matter to be able to successfully operate a post-acute facility,” he said. “It’s a completely different world than it was 20 years ago when I started out as an administrator. Everything from reimbursement to the patients we take care of—they're the children of the patients we were taking care of 20 years ago.”

Asked what advice he’d offer to administrators early in their careers, he urged them to get involved in professional organizations. “You need to network, and you need to be connected to others, because—let's face it—the administrator of the facility doesn't have any peers within the facility,” he said. “Only another administrator is going to understand you, because no one else in any industry has the specific pressures that we have.”

Steve Manning is a journalist based in New York City.