Licensing & Certification Requirements in Nursing Homes

Instructor: Julie Eiler
This lesson describes the care provided in nursing home facilities and the licenses and certifications required for both the facility and the workers providing patient care.


When you drive a motor vehicle, you need a state-issued license. You also need a registration for the vehicle, and liability insurance. In most states you must ensure the vehicle is well-maintained by getting yearly emissions testing and an inspection. Now take that a step further, and imagine you also need to license and insure any passenger who rides with you.

Running a healthcare facility is far more complex than driving a car, and the various licensing and accreditation requirements are just one aspect of that complexity. In this lesson, we'll focus on the licensing and certification requirements of one type of facility: nursing homes, or skilled and unskilled nursing facilities, and their care workers.

The Facility

A skilled or unskilled nursing facility, commonly called a nursing home, is a healthcare facility that provides around the clock care to those who need full time nursing care of some kind, but do not have acute health problems that require hospitalization. Nursing home care can be permanent or short term. The difference between skilled and unskilled facilities depends on the availability of professional, licensed nurses. Many nursing homes also have rehabilitation areas where patients can receive full time therapy before going home.

There are two main certification requirements for nursing homes: Medicare certification and accreditation. Usually state agencies perform inspections for certification and report findings to the Centers for Medicare and Medicaid Services (CMS) for final approval. The specific requirements differ by state, but inspections generally focus on safe and efficient patient care, as well as things like safety plans, and facility maintenance.

Nursing homes may also seek accreditation by an approved (by CMS) accrediting body. The predominant accrediting agency is the Joint Commission; however, there are two other authorized accrediting bodies: the Healthcare Facilities Accreditation Program and the newer Det Norske Veritas (DNV) Healthcare organization. Accreditation agency site visits are unannounced, and re-certified is re-evaluated every one to three years.

Accreditation is a service that the facility pays to have done, but has distinct advantages. Being an accredited facility is a stamp of quality for the health consumer, and for professionals recruited for employment. Accrediting bodies also provide risk analysis and management based on their findings, and help facilities improve quality and safety. This can also help reduce liability insurance costs. Having approved accreditation may also substitute for some states' separate inspection/certification requirements, which reduces the burden of multiple inspections.

The Healthcare Providers

The caregivers that work within nursing homes must maintain their own specific licenses. Physicians are usually not present daily in nursing homes, and may only see patients once a week or even once a month. Nursing homes are primarily managed by nurses.

Registered Nurses

Registered nurses (RNs) are educated, trained, and licensed professionals that provide physical and holistic assessments and plan care for patients complex needs. In nursing homes, the registered nurse generally oversees patient admissions, plans care, and manages the work of other licensed and unlicensed personnel, such as practical nurses and nursing assistants.

Registered nurses must receive education through a nationally accredited nursing education program and earn a diploma, associate's, or bachelor's degree in nursing science. The registered nurse must then sit for an examination to get a state-issued license. Most states require approved continuing education credits in order to renew the nursing license every two years.

Licensed Practical Nurses

Licensed practical nurses (LPNs) are licensed skilled caregivers. LPNs provide direct patient care managing wounds, administering medications, and giving treatments at the discretion of the registered nurse and physician. Licensed practical nurses do not complete assessments or plan care, but perform the skilled technical tasks within their scope. Scopes of practice vary between states and levels of LPNs. LPNs are usually the main caregivers in a nursing home setting, managing a team of patients under the supervision of an RN, and delegating basic care tasks to a nursing assistant.

A licensed practical nurse is educated and receives a diploma from a technical school, and then sits for a state licensure exam. LPNs must renew their licenses every two years.

Certified Nursing Assistants

Certified nursing assistants (CNAs) provide direct patient care in the form of bathing, dressing, toileting, and feeding. Some nursing assistants may also obtain blood pressures, perform catheterizations, and assist with wound care. Nursing assistants are crucial in nursing homes to provide care for patients who do not need skilled medical interventions, but require help with the activities of daily living.

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