Domains of Practice

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 Transition to nine stand-alone Domains of Practice

NAB has moved from a domain/subdomain structure to nine stand-alone Domains of Practice. 
Previously, content was grouped under broader domains with multiple subdomains beneath them. This new structure simplifies the framework and improves clarity.

What this means:

  • Each of the nine domains now stands independently
  • Reporting will provide more detailed insights across all domains
  • States and candidates will gain clearer visibility into content mastery

When it takes effect:

  • Enhanced reporting will begin with examinations starting July 1, 2027.

#2 Addition of Task Statements to the Examination Blueprint

The 2026 blueprint introduces a third level of detail: Task Statements.

Previously, the 2020 blueprint included two levels:

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

The updated structure now includes:

  • Domains of Practice
  • KSAs
  • Task Statements

What are Task Statements?

Task statements are specific, action-oriented descriptions of the duties, behaviors, and responsibilities professionals must perform to practice safely and competently.

 Why this matters:

  • Provides clearer context for each KSA
  • Explains why specific content appears on the exam
  • Better connects exam material to real-world practice

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.

Download the new 2026 domains of practice:

Why This Matters:

  • 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.

Download the current Domains of Practice, effective July 2022 to June 30, 2026.