State Representative

Domains of Practice

New Domains of Practice – 2022

Every five years the National Association of Long Term Care Administrator Boards (NAB) conducts a Professional Practice Analysis (PPA) to ensure that the NAB licensure exams accurately represent the current scope of practice of the profession of Senior Living and Health Services. The new PPA serves as the foundation for the exams, as well as content for continuing education, academic programs, exam prep study material, and standards of practice for state licensing boards.

While most of the knowledge and tasks have not changed significantly, they have been realigned under four content domains, where there were previously five.

New Domains, effective with July 1, 2022 Exams

  1. Care, Services, and Supports
  2. Operations
  3. Environment and Quality
  4. Leadership and Strategy

Former Domains, effective July 5, 2017 to June 30, 2022

  1. Customer Care, Supports, and Services
  2. Human Resource
  3. Finance
  4. Environment
  5. Management and Leadership

How will this affect….


The new domains are in effect with exams starting July 1st, 2022. This includes the CORE, NHA, RCAL, & HCBS line of service exams. The CORE exam has four domains. The Line of Service exams (NHA, RCAL, & HCBS) have only have 3 domains. You will not see a score for Leadership and Strategy, for the any of the Line Of Service exams, this is only a CORE domain.

Study Guide

The study guide should be one of many resources used to prepare for the NAB exams. Please see the recommended reference list and practice exams, as other sources. An updated version of the study guide was launched in November 2022. Continued access to the updated study guide is available to those who purchased the previous version, for the duration of their one year subscription. If you need access to the new study guide, please email

Continuing Education (NCERS Program)

The new domains will be present in NCERS program submission forms in November 2021. Sponsors will have to choose new domains when renewing a program. Programs with the current domains submitted prior to November 2021 will still be valid. The online CE database will be updated with the new domains in November 2021. The NCERS handbook will be updated with the new domains before November. New or renewed Third Party Certification programs will also need to reflect the new domains in November 2021.

Academic Accreditation

Schools who are accredited by NAB can start incorporating the new domains into their curriculum at any time. An updated Academic Accreditation Workbook has been posted the NAB website. Schools seeking accreditation or renewal in 2022 and beyond should use the updated workbook.

AIT Program Manual

The AIT program manual was updated in the Fall of 2022 to reflect the updated domains. 

Online Preceptor Modules Courses

The online preceptor modules will have minor updates as needed. As these relate more to leadership principles and are not directly tied to the domains of practice, any updates to the courses will be posted in 2023.


HSE applications will not change, but the exams required to obtain the HSE qualification will be part of the examinations update. As mentioned previously, the new domains will be included on exams starting in July 2022.

 Click here to access NAB's previous Domains of Practice, effective July 2017 to July 1, 2022.