Domains of Practice - New

Domains of Practice

Every five years, the National Association of Long Term Care Administrator Boards (NAB) conducts a Professional Practice Analysis (PPA) to ensure that NAB’s licensure exams accurately represent the current scope of practice of Senior Living and Health Services administrators. The PPA also serves as the foundation for NAB examinations and informs related work across continuing education, academic programs, exam preparation resources, and standards used by state licensing boards and HSE accredited programs.

NAB has completed the 2026 Professional Practice Analysis (PPA) and released the updated Domains of Practice. This review builds on the previous exam blueprint and reflects direct feedback from professionals working in the field. While much of the knowledge remains the same, the updated PPA makes several improvements to help clarify how content is organized and assessed across NAB exams. The most significant change is a move from domains with subdomains to nine stand‑alone Domains of Practice, which will allow for clearer exam reporting and stronger alignment across exams and related resources.

What changed in 2026?

1) Moving from subdomains to nine stand‑alone Domains of Practice

NAB is moving away from a domain/subdomain structure and adopting nine stand‑alone Domains of Practice. Previously, domains were organized with subdomains (for example, a single domain area with multiple subdomains underneath). This change will allow NAB to report to states and candidates across all nine domains, providing additional detail on content mastery beginning with the July 1, 2027, examinations.

2) Adding a third level of detail to the examination blueprint: Task Statements

The 2020 blueprint included two levels of content:

  • Domain/Subdomain, and
  • Knowledge, Skills, and Abilities (KSAs)

The 2026 blueprint adds a third level: task statements. Task statements are specific, action‑oriented descriptions of duties, behaviors, and responsibilities that a professional must perform competently to practice safely. Each task statement is unique and helps explain why a specific KSA appears on an examination.

Domains of Practice: 2022 vs. 2026

2022 Domains (Effective through June 30, 2027, exams)

2026 Domains, (Effective with July 1, 2027, exams.)

Explanation

Domain 1: Care, Services, and Supports

Domain 1: Quality of Care
Domain 2: Quality of Life

Resident care and services are now separated to clearly distinguish clinical care responsibilities from quality‑of‑life and person‑centered practices.

Domain 2: Operations

Domain 3: Financial Management
Domain 4: Risk Management
Domain 5: Human Resources

Operational responsibilities are divided into financial oversight, organizational risk and safety, and workforce management to better reflect distinct areas of practice.

Domain 3: Environment and Quality

Domain 6: Care Setting
Domain 7: Regulatory Compliance

Physical environment and safety requirements are separated from regulatory and compliance responsibilities for greater clarity.

Domain 4: Leadership and Strategy

Domain 8: Leadership
Domain 9: Organizational Strategy
Leadership behaviors and organizational strategy are distinguished to better reflect day‑to‑day leadership versus long‑term planning and organizational direction.

The 2026 Domains do not change what administrators are expected to know, but they organize practice areas in a more detailed and transparent way. If you prepared under the 2022 Domains, your foundational knowledge still applies, the content has been clarified and restructured, not replaced.

Please download the new 2026 domains of practice:

How will this affect….

  • Exams: Updated domains will be reflected in the exams published July 1, 2027; score reporting will also be updated at that time to support expanded domain reporting.
  • Continuing Education (NCERS): New domains will be added in the CE system in fall 2026 for new and renewed programs.
  • Academic Accreditation: Programs beginning or renewing accreditation in 2027 will be asked to use the new domains; key accreditation tools, like the self-assessment and crosswalk, are targeted for update in fall 2026.
  • Study Guide: Updates will begin in fall 2026, with a goal to launch revised organization aligned to the new domains by early 2027.
  • Administrator Residence (AR)/AIT Preceptor Manual: Materials are expected to be updated in 2027 to reflect the updated Domains of Practice and related KSAs.

 Click here to access NAB's current Domains of Practice, effective July 2022 to June 30, 2026.

Exam Score History

Prior to July 1, 2017, the national NHA and RCAL exams included a single score encompassing both NHA and CORE or RCAL and CORE content. Beginning July 1, 2017, the exams were separated and results for the NHA, RCAL, and CORE content were all reported separately. Therefore before July 1, 2017 there will only be one score available for the NHA or RCAL and two scores (NHA & CORE or RCAL & CORE) starting July 1, 2017.