As nursing facilities continue to serve sicker, more complex patients and assisted living facilities take on residents with more long term care needs, such as help with activities of daily living and medication management, the demand for administrators across the entire spectrum of long term care is almost certain to grow as baby boomers begin tapping into long term care over the next two decades.

States are preparing for the onslaught with more regulatory oversight of assisted living facilities and the development of requirements for administrators and executive directors in this setting.

Many states already require some type of licensure or certification for the position.

Randy Lindner, executive director of the National Association of Boards of Examiners for Long Term Care Administrators (NAB), has expressed concern that licensing problems similar to those for nursing facility administrators are surfacing today as states grapple with the development of requirements in the assisted living setting.

“Although there is not currently a federal requirement for licensure, more and more states are establishing regulatory requirements for education, training, certification, or licensure of assisted living administrators, with each state’s standards being different,” he says.

In an effort to ward off such problems, NAB is considering the development of a model practice act for assisted living administrators that will give state boards and agencies information on how to support licensure competencies.

The National Center for Assisted Living (NCAL) will be providing NAB with comments about its proposed model practice act when it is published.

“An important factor to keep in mind is that since assisted living is regulated on the state level, any national exam cannot take into account each state’s rules and regulations for operating an assisted living community,” says David Kyllo, NCAL executive director.

NAB has taken steps to even the playing field for applicants and for states with a national licensure exam—the Resident Care/Assisted Living Administrators (RC/AL) exam—that covers five assisted living knowledge areas: management, resident care, regulatory issues, human resources, and finances.

The exam is currently required by three states that license administrators of residential care or assisted living facilities: Idaho, Nevada, and South Carolina.

Similar licensure requirements soon will begin in Virginia, while two states, Maine and Oregon, have made it optional for licensure applicants.

Residents of all other states may voluntarily apply to take the RC/AL exam for entry-level competency, after meeting certain qualifications.

Although degree programs specific to assisted living administration are sparse, many community colleges and universities offer undergraduate degrees, and even graduate certificates, in long term care administration. NAB also has its own academic accreditation program that is open to colleges and universities.