Careers in Long Term Care

Long term care is a fast-growing profession nationally and in North Carolina, offering fulfilling careers, continuing education, and plentiful opportunities for advancement. Professional care providers at all levels deliver vital care and help ensure a positive quality of life, offering compassion, companionship, and comfort to seniors and people with disabilities.

Just a few of the fulfilling careers in the long term care profession include licensed nursing home administrator, nurse aide, licensed practical nurse (LPN), registered nurse (RN), therapist, dietitian, activities director, and social worker. Learn more below:

  • Nursing Home Administrator
  • Nurse Aides & Medication Aides
  • Nursing
  • Rehabilitation Professionals
  • Other Long Term Care Professionals
  • Physician Services (AMDA)

Nursing Home Administrator

The licensed nursing home administrator has ultimate responsibility for the overall operations of the skilled nursing facility. The culture of the facility and the expectations of quality begin at the top. The nursing home administrator is the person who sets the pace and leads the management team to provide a holistic approach to care and residency. Knowledge, skill, ability, and compassion are the traits of successful administrators.

Nursing home administrators organize and direct the operation of a skilled nursing facility, following federal and state guidelines. They coordinate the activities of the medical, nursing, technical, clerical, volunteer, and service staffs of the facility and direct the hiring and training of employees. Some administrators may also take care of patients, teach programs, or conduct research.

The increasing aging population and popularity of North Carolina as a retirement state make this a very promising career that offers personal satisfaction.

All nursing home administrators are licensed by the State of North Carolina. Learn more about becoming a nursing home administrator, including the application process, from the NC State Board of Examiners for Nursing Home Administrators.

Nurse Aides & Medication Aides

Nurse Aide
Nurse aides are often described as the backbone of skilled nursing care. Nurse aides take care of basic physical needs under the supervision of a licensed nurse. Just as important, they tend to the emotional and spiritual needs of residents. They can become like a “second family” to nursing home residents. See a nurse aide in action below!

Many nurse aides go on to acquire advanced skills and training to become Nurse Aide IIs, licensed practical nurses, registered nurses, and therapists. Through training and/or competency validation, Nurse Aides become eligible for employment through listing on a registry under the NC Department of Health and Human Services, Division of Health Service Regulation (DHSR).

The roles of Nurse Aide I and Nurse Aide II are regulated by the NC Board of Nursing and the Division of Health Service Regulation (DHSR) Nurse Aide Registry.

Learn more about Nurse Aide I tasks
Learn more about Nurse Aide II tasks
Learn more at the NC Nurse Aide Registry

Medication Aide
Nurse Aides I and II may take special training and a competency exam to assist licensed nurses in administrating medications in a skilled nursing facility. This function is regulated by the NC Board of Nursing as well as the Division of Health Service Regulation (DHSR) Nurse Aide Registry.

Learn more at the NC Medication Aide Registry

Rehabilitation Aide
This is a position for individuals who are interested in rehabilitation services such as physical, occupational, and speech therapy. Rehabilitation aides are nurse aides who work under the supervision of a licensed therapist, or under the supervision of a registered nurse who works closely with the therapist, to assist elderly and disabled individuals in regaining their strength and function after an illness or operation. Many rehabilitation aides go on to become licensed physical, occupational, or speech therapists.

Additional Resources
Testing for Nurse Aide and Medication Aide


Nurses will find many opportunities for both licensed practical nurses (LPNs) and registered nurses (RNs) in skilled nursing facilities. As people live longer and the number of our elderly increases, geriatric nursing will play a significant role in health care. The aging population will far outpace the numbers of RNs and LPNs who currently fill positions in skilled nursing facilities.

Registered Nurses (RNs)
Registered Nurses (RNs) practice in an autonomous environment where nursing assessment, judgment, and delegation skills are utilized on a continuous basis. Working in a skilled nursing facility offers an opportunity to develop long term relationships with a patient population second to none in sincere appreciation.

RNs perform basic duties that include treating patients and providing advice and emotional support to patients’ family members. RNs record patients’ medical histories and symptoms, help to perform diagnostic tests and analyze results, operate medical machinery, administer treatment and medications, and help with patient follow-up and rehabilitation.

NCHCFA encourages Registered Nurses to become credentialed in Gerontological Nursing by the American Nurses Credentialing Center (ANCC). Advancement opportunities to administrative nursing positions are not uncommon as well as to positions requiring unique skills such as the federally mandated Resident Assessment Coordinator.

Registered nurses practice in accordance with the NC Board of Nursing RN Rules and the Nurse Practice Act.

Advanced Practice Nurses – Nurse Practitioners
Some RNs choose to become advanced practice nurses, also called nurse practitioners, and work independently or in collaboration with physicians. For example, they may provide direct patient care and expert consultations. In most states, advanced practice nurses can prescribe medications.

Licensed Practical Nurses (LPNs)
Licensed Practical Nurses (LPNs) fill an important role in providing skilled services and valued relationships. Caring really is job one.

LPNs care for the sick, injured, convalescent, and disabled under the direction of physicians and registered nurses. Most LPNs provide basic bedside care, taking vital signs such as temperature, blood pressure, pulse, and respiration. They also prepare and give injections, monitor catheters, apply dressings, treat bedsores, and give alcohol rubs and massages. LPNs monitor their patients and report adverse reactions to medications or treatments. They collect samples for testing, perform routine laboratory tests, feed patients, and record food and fluid intake and output. To help keep patients comfortable, LPNs assist with bathing, dressing, and personal hygiene.

In addition to providing routine bedside care, LPNs in skilled nursing facilities help to evaluate residents’ needs, develop care plans, and supervise the care provided by nurse aides.

Licensed nurses practice in accordance with the Nurse Practice Act, LPN Rules, and rules provided by the NC Board of Nursing.

Professional Development with NCHCFA
NCHCFA is committed to the professional growth of long term care nurses. We work collaboratively with nursing organizations and institutes of higher learning to provide development and advancement opportunities. For example, NCHCFA partnered with the Continuing Education Department of the University of North Carolina School of Nursing to develop a Certificate In Executive Nursing Leadership In Long Term Care. This course is designed for nurses pursuing a career in nursing administration. For course information, please visit the UNC Continuing Education course site.

Additional Resources
National Association Directors of Nursing Administration in Long Term Care

Rehabilitation Professionals

Professionals who specialize in rehabilitation are in top demand in skilled nursing facilities. Nothing is more rewarding than seeing improvement in function and independence gained of the residents being rehabbed. Many nursing home residents progress to a point of greater mobility and self-sufficiency. Some can even return home. These therapists make it possible.

Physical Therapist (PT)
Physical Therapists (PTs) help patients who have disabilities. PTs plan and carry out programs to help these people gain strength, flexibility, endurance, coordination, and overall physical functioning. A physical therapist also provides programs to lessen pain and to prevent injury.

Physical Therapy Assistant (PTA)
A Physical Therapy Assistant (PTA) performs routine treatment procedures as directed by physical therapists and assists them with more complex procedures. A PTA may monitor a patient’s progress on exercise equipment; perform massage; provide heat/cold, electrical, and ultrasound therapy; and provide the therapist with a detailed account of all therapeutic sessions.

Occupational Therapist (OT)
An Occupational Therapist (OT) helps people learn or re-learn the activities of daily life such as eating, dressing, and writing. OTs evaluate functional skills, train people to do things such as dress or use a wheelchair, identify barriers to meaningful activities, and help people adapt activities or use adaptive equipment to achieve self-sufficiency.

Certified Occupational Therapy Assistant (COTA)
A Certified Occupational Therapy Assistant (COTA) works under the supervision of a registered occupational therapist. COTAs help individuals handle the activities of daily living, such as dressing, eating, or maintaining their home. They carry out treatment plans established by the occupational therapist.

Speech Therapist
A Speech Therapist is a specialist in communication who evaluates and treats problems with speech, language, and swallowing. Such problems include difficulties with articulation (pronunciation of the speech sounds), fluency (such as stuttering), vocal nodules caused by improper voice use, as well as problems with organizing heard or spoken language that results from brain disorders or strokes. Speech therapists work closely with hearing specialists to treat patients whose hearing problems affect their communication skills.

Respiratory Therapist
A Respiratory Therapist participates in the development, modification, and evaluation of care plans, protocol administration, disease management, and patient education involving such disease states or conditions such asthma, emphysema, chronic obstructive lung disease, pneumonia, and conditions brought on by shock, trauma, or postoperative surgical complications.

Other Long Term Care Professionals

It takes a lot of different people to keep a skilled nursing facility running smoothly. These individuals ensure the comfort and safety of residents by preparing delicious meals, ensuring a clean and hospitable environment, and taking care of the physical plant and equipment.

Housekeeping/Laundry Supervisor
The Housekeeping/Laundry Supervisor oversees planning, organizing, directing and managing housekeeping services. They ensure the cleanliness and sanitation of the facility and the laundering of resident clothing and linens used at the facility. They are also responsible for providing residents a clean, comfortable place to call home while playing an important role in infection control.

Maintenance Supervisor
The Maintenance Supervisor oversees schedules and performs skilled technical and preventive maintenance tasks in building and grounds maintenance. In addition, they are responsible for keeping the physical building and grounds functioning at maximum capacity.

Food Service Supervisor
The Food Service Supervisor oversees food service for residents, employees, and visitors in a skilled nursing facility. They also review menus and supervise the handling, preparation, and storage of food. Food Service Supervisors must complete an approved program by the Dietary Managers Association.

Registered Dietician
Registered Dieticians find rewarding opportunities in managing the environment in which residents live and fulfilling some of the greatest health care needs: nutrition and hydration. The basic needs for comfort and nutrition must be met around the clock, and the specific dietary needs of residents can be challenging. The quality of meals and the dining experience are one of the most important aspects of the facility for residents. Dieticians are on the cutting edge of the innovations in the area of food preparation and service. Learn more about licensure requirements from the NC Board of Dietetics/Nutrition.

Activity Professional
Activities provide enjoyment, physical and mental stimulation, spiritual nourishment and connection to the community. The Activity Professional is responsible for planning a complete program for the residents of the skilled nursing facility but more importantly, resident-centered approaches to meet each individual’s needs and preferences. Activity Professionals must complete a course approved by the North Carolina Division of Health Service Regulation. Additional resources are available at the North Carolina Activity Professional Association (NCAPA).

Social Worker
Social Workers are often the first person families and residents have contact with. The social worker helps them make difficult decisions under pressure. Social workers help interpret any technical information, answer questions, explain the admissions process, and thoroughly discuss the rights of residents. Once admitted, families and residents can look to the social worker for continued support and assistance. Social workers are a key member of the interdisciplinary team that plans and provides services to all residents. Certification and licensure information can be obtained from the North Carolina Social Work Certification and Licensure Board.

Physician Services (AMDA)

Federal and state laws require physician services and medical care be provided under the management and clinical supervision of a skilled nursing facility medical director. The functions of a medical director are to implement resident care policies and coordinate medical care in the facility. Medical directors work closely with the administrator and director of nursing and participate in the nursing home quality improvement process. They create and approve facility medical policies and procedures as well as oversee the practice of all physicians and mid-level providers such as nurse practitioners. The medical director may be the attending physician for many of the residents in the facility but is not required to care for patients in the facility.

The American Medical Directors Association offers a certification program that recognizes the dual clinical and managerial roles of the medical director. Certification requires indicators of competence in clinical and medical management in long term care. It emphasizes specialized training in infection control, geriatric syndromes, quality improvement methodology, and federal nursing home regulations. Learn more about medical director certification from AMDA.

North Carolina has its own chapter of the American Medical Directors Association. It offers continuing education, annual meetings, and many other resources. Learn more about NCAMDA.