Careers in Long-Term Care

Find a career path uniquely suited to you. Below you will find a general overview of positions and career paths that may be available. The actual job titles and descriptions will vary by employer. See this Career Tracks Flyer for more information on long-term care paths.


  • Activity aide – The activity aide assists the activity director in planning and implementing activity programming in both group and individual settings.
  • Activity director – The activity director is responsible for planning, organizing and implementing a program of therapeutic activities designed to meet the social, spiritual, intellectual, emotional, educational and physical needs and interests of residents in both group and individual settings, in accordance with the comprehensive resident care plan and federal and state requirements. Tasks typically include planning a monthly calendar of activity events, memory care programming, outing events, inside and outside activities, in-house holiday events and managing activity assistants and volunteers. Activity directors employed in nursing facilities must have completed a state-approved activity professional’s course, such as IHCA’s Activity Professionals Qualification Course.

Business Operations

  • Accounting – An accounting professional provides services that may include, but not be limited to, financial, accounting, payroll, human resources and accounts payable. They may also maintain trust accounting records, census information, medical billing and resident accounts receivable statements, wages paid to employees’ payroll and invoice processing for the facility.
  • Administrator or director
    • Assisted living directors – Assisted living directors manage, outline and coordinate services geared toward older adults who may require assistance with eating, bathing, taking medication and other basic functions. They oversee the day-to-day operations of assisted living communities and ensure that all staff are providing the best service possible. Directors supervise all security, transportation, and monitoring of needs at their location. This position typically requires a two-year college degree and assisted living certification such as the IHCA Assisted Living Management Certification Course.
    • Home health administrators – Home health administrators supervise home health agency employees, including nurses who provide medical treatment, CNAs and home care aides who provide support services to in-home patients, and the agency’s office staff. As manager of the agency, the home health administrator is responsible for improving the quality of health care provided, ensuring the agency is in compliance with health care laws and regulations and overseeing financial expenditures. They also work on expanding the client base, negotiating with insurance companies and evaluating staff members. Employers’ requirements for the position may vary, but state regulations require a physician, RN or a person with training and experience in health service administration and at least one year of supervisory or administrative experience in home health care or related health programs.
    • Nursing home administrators – Nursing home administrators supervise clinical and administrative affairs of nursing and rehabilitation facilities. Typical duties of nursing home administrators include overseeing staff and personnel, financial matters, medical care, medical supplies, facilities and other duties as specific positions demand. This position requires a four-year college degree and a state nursing home administrator license.
  • Business office manager – A business office manager typically provides clerical, bookkeeping, financial reporting, human resources, and accounting support to the leadership team and residents. They may also maintain trust accounting records, census information, medical billing and resident accounts receivable statements, wages paid to employees’ payroll and invoice processing for the facility.
  • Human resources – A human resources professional implements human resources systems, including effective staff recruitment and retention, benefits administration, human resources management programs, communication programs, conflict resolution, training and maintains compliance with applicable state and federal laws. They also mentor department supervisors on human resource related issues and programs.
  • Information technology – An informational technology professional oversees internal user networking/computer/phone support, as well as provides communication, documentation, maintenance and support of company computers, portable devices, etc. Experience in health care technology and HIPAA requirements will be a plus.
  • Marketing and sales – The marketing and sales professional is a central point of contact for all prospective residents, tenants and clients. They need the ability to develop a marketing plan and be comfortable talking with community groups, hospitals, physicians, prospective clients and family members in admissions, as well as providing support and education regarding payer sources such as Medicare, Medicaid and private insurances.
  • Receptionist – This position requires a polished and professional representative with clear and effective communication skills to greet and direct visitors and family members. Responsibilities may include phone reception, directing new admissions and family members, announcing building codes and facility emergency paging.

Facility Operations

  • Building and grounds maintenance – This position’s responsibilities include, but are not limited to, the general maintenance and upkeep of the organization’s building(s), including all common areas, resident apartments, grounds, equipment and mechanical systems, as well as driving the community van.
  • Environmental manager – This position is responsible for the routine and preventative maintenance of the organization’s building(s) inside and outside. It requires the ability to capture work via documentation to maintain preventative logs, solve operational problems, diagnose the cause of malfunctioning equipment, develop and maintain vendor relations, as well as plan, prioritize and direct projects. The environmental manager may supervise building and grounds maintenance staff, as well as hospitality staff in housekeeping and laundry, to ensure rules, regulations, policies and procedures are carried out and met.

Food services

  • Chef/cook – Under the supervision of the dietary manager, a chef/cook prepares and serves nourishing and attractive meals and other foods as required to support the menu specific to diet orders and other events for residents, staff and guests. Duties also include reviewing food menus and work orders to determine type and quantities of food to be prepared, preparing meals according to planned menus and standardizing recipes in a sanitary manner to ensure the utmost in quality with a minimum of waste. A chef/cook also reviews menus to identify all foods required for therapeutic diets before preparing food. Advanced education or kitchen experience may be required.
  • Dietary aide – The dietary aide performs a variety of food service-related tasks – usually not requiring cooking skills – in the preparation, service and cleanup for meals and snacks served to residents and staff and other special events. Responsibilities may include ensuring compliance with all laws, rules, regulations, policies, and procedures as they relate to food service, maintaining kitchen sanitation and safety standards, ensuring that all work/storage areas are clean, free of hazards and properly arranged, as well as preparing food and assisting with serving meals.
  • Dietary manager – The dietary manager implements dietary and food service policies and procedures to meet residents’ needs and ensure compliance with federal, state and local requirements while supervising food service for residents, employees and visitors. Responsibilities typically include reviewing menus and supervising the handling, preparation and storage of food, overseeing equipment maintenance and kitchen sanitation and assigning work schedules for food services staff. The job typically requires state certification as a Qualified Dietary Supervisor. Check out IHCA’s online Iowa Food Manager Certification Course, which is available on-demand.

Health Services

  • Certified nursing assistants (CNA) – CNAs assist patients with daily activities and record and communicate all issues to the nursing staff. Typical job responsibilities include assisting with personal hygiene, dressing, eating, transferring (walking) and continence. Other responsibilities may include housekeeping duties and collecting and reporting information about conditions and treatment plans to other caregivers and nurses. To become a CNA in Iowa, you must complete the 75-hour CNA course and pass written and skills competency exams. The training and testing are typically available through community colleges and often through facilities. The employer can assist you in finding access to the required training.
  • Certified medication aide (CMA) – A CNA can become a CMA by completing additional state regulated training and a certification program to administer medications in a long-term service and support setting. Most employers will assist in finding and covering the cost of this training. View IHCA’s on-demand Certified Medication Aide Course here.
  • Certified rehabilitation assistant (CRA) – A CNA can become a CRA by completing the additional state required training to safely and effectively provide rehabilitative/restorative therapies under the direction of a licensed physical or occupational therapist.
  • Health care assistant (HCA) – Health care assistant is a generic title for the frontline direct caregiver who serves the elderly and people with disabilities in the long-term services and supports a continuum of providers. Health care assistants provide basic care to patients and assist them in daily activities such as bathing and dressing. Because of the personal nature of the job, health care assistants should be compassionate and patient and enjoy helping others. Most employers will pay for the required training for people wanting to work in any of the health care assistant positions discussed below. While completing training, employers may allow the candidate to work at the facility to gain on-the-job training and experience in the care setting.
  • Home health aide – Home health aides (HHA) or home care aides provide a broad range of social, environmental and personal care as necessary to meet a client’s needs in the client’s own home. They assist with bathing, dressing and grooming, following a plan of care written by their supervising RN. They are responsible for observing clients, reporting and documenting observations and care performed. Tasks may include household duties like cooking, cleaning, laundry, as well as assisting with medications, wound care and bandaging, personal care and providing transportation, shopping and running errands. They may also provide much-needed respite care to help family members or other volunteers take a break from their caregiving responsibilities. Depending on the individual job description, employers may require CNA or HHA training and certification, which they are often willing to provide as part of their employment.
  • Rehab/restorative aides – Under the supervision of the physical therapist or certified rehab assistant, a rehab/restorative aide helps patients gain an improved quality of life by increasing their level of strength and mobility.
  • Universal worker or resident assistant – A blended caregiver role often found in assisted living programs, the universal worker/resident assistant typically assists residents in all aspects of their daily life as indicated in the resident service plan, including personal care, food service, housekeeping, laundry, behavior management, socialization, activities, orientation and information needs. A universal worker/resident assistant may also monitor a resident’s condition and recommend adjustments in the level of care and services to the program nurse and, in some cases, may also be trained to administer medications.

Hospitality Services

  • Homemaker/companion – A homemaker/companion typically works for a home health agency and provides for the maintenance of a safe and clean environment for clients. They perform various housekeeping tasks, meal preparation and provide companionship activities for clients in their residences.
  • Housekeeping – This position performs housekeeping and cleaning activities of public and private areas in the organization’s building(s), including patient rooms, public lobbies, restrooms, and offices. They perform assigned housekeeping duties to ensure clean, sanitary, comfortable, orderly and satisfying surroundings for the residents, employees and public, while maintaining compliance with all applicable laws, regulatory and organizational standards.
  • Laundry aide – This position implements laundry procedures to meet residents’ needs in compliance with federal, state and organizational requirements. Responsibilities include seeing to the laundry and care of residents’ laundry, including clothing and linens, and communicating with a supervisor when laundry supplies or equipment repair is needed.
  • Transportation coordinator – The transportation coordinator plans transportation schedules and transports residents on activity outings and medical appointments. The position requires a valid driver’s license (sometimes a CDL license) and clean driving record, as well as a pleasant and upbeat personality. It may also require CNA certification and/or current CPR certification.

Nursing and Medical

  • Case Manager (RN) – A case manager assesses the overall health of patients with serious chronic illnesses by reviewing medical records and previous treatment history to create a long-term plan of care for patients. They monitor the progress of the plan, conferring with medical professionals, the patient and caregivers to evaluate progress and make changes as dictated by the patient’s changing condition. This position remains in contact with the physician, caregivers and insurance companies or government health agencies to make sure that progress is in line with expectations and requirements for payment are met.
  • Charge Nurse (RN or LPN) – A charge nurse is responsible for monitoring patients, assisting in developing and implementing patient care plans and treatments, as well as providing guidance to health care assistants. They may supervise the work of LPNs, nursing assistants or home care aides.
  • Home health and private duty nurses – These nurses provide care in the homes of their patients. Patients who need home health nursing are usually elderly or disabled, but they may also be recovering from an accident or suffering from a serious illness. Home health care involves assisting patients with basic needs such as bathing and dressing, as well as more specialized care, such as wound care, medication management and IV therapy. Home health nurses work primarily for home health care agencies and report to the home health agency administrator. They may work directly with patients or serve as administrators or policy developers.
  • Minimum Data Set (MDS) coordinator – Also known as a resident assessment coordinator or nurse assessment coordinator, an MDS coordinator works in a nursing and rehab facility to ensure the facility meets state and federal regulations for Medicare and Medicaid certified nursing homes. MDS is a federally mandated clinical-assessment process for residents of long-term care facilities. Most long-term care facilities have an RN who fills the role of MDS coordinator to administer the assessment process for patients and residents.
  • Nurse leader or Director of Nursing (RN) – This individual directs nursing care to the residents and supervises the day-to-day nursing activities performed by the staff nurses and health care assistants. Supervision must be carried out in accordance with current federal, state and local standards, guidelines and regulations to ensure that the highest degree of quality care is maintained at all times. A registered nurse (RN) is responsible for monitoring patients, developing patient care plans, implementing treatments and providing guidance. RNs who provide in-home care or who work in a care facility can supervise the work of licensed practical nurses (LPNs), nursing assistants or home care aides.

Social services

  • Social services – The social services director coordinates admission and discharge procedures with residents and their family members. The social services staff also provides counseling and social services to residents and their families, helping them make the transition from a previous living environment to life in a care setting. Once the resident is established, the social services staff assures the resident’s continuing needs are met and that the person is given the opportunity to participate in planning for continued care in the facility, transfer or discharge back into the community. Some employers (but not all) may prefer candidates with a college degree in social work.