Who Runs a Nursing Home? Management Roles Explained

Reviewed by the RBNH Editorial Team. Last updated October 2026.

Families touring a nursing home often hear several job titles in a short conversation and come away unsure who actually handles what. This page explains the core leadership roles found in a typical licensed nursing home, in general terms that apply across Illinois facilities, not any single named institution or individual.

The Administrator

The nursing home administrator is responsible for the overall day-to-day operation of the facility: staffing, budget, regulatory compliance, and ensuring the building and its programs meet licensing requirements. In Illinois, nursing home administrators must be licensed through the Illinois Department of Financial and Professional Regulation (IDFPR), which requires specific education, supervised experience, and passing a licensing exam. Families can reasonably ask how long the current administrator has been in place, since frequent administrator turnover can be a sign of underlying operational instability worth asking more questions about.

The Director of Nursing (DON)

The Director of Nursing is a registered nurse who leads the nursing department: supervising nursing staff, overseeing care planning for every resident, and acting as the clinical lead who typically works most closely with the administrator on day-to-day care quality. When a family has a clinical concern that a bedside nurse cannot resolve, the DON (or an assistant director of nursing on a given shift) is usually the next point of contact.

The Medical Director

Federal rules require every nursing home to have a physician serve as medical director, responsible for implementing medical care policies and helping coordinate medical care across the facility. This does not mean the medical director personally treats every resident. Most residents keep their own existing primary care physician, or are assigned an attending physician who regularly visits the facility, with the medical director functioning more as a policy and oversight role unless a resident specifically does not have another attending physician.

Other Key Roles Worth Knowing

• Social Services Director - helps residents and families navigate psychosocial needs, discharge planning, and connecting to outside resources; required under federal nursing home rules.
• Dietary/Food Services Director - oversees meal planning, including physician-ordered therapeutic diets and management of allergies or swallowing precautions.
• Activities Director - designs and runs the facility's activities program, discussed in more detail on our activities page.

Questions Worth Asking During a Tour

• How long has the current administrator and director of nursing been in their roles?
• Who is the point of contact for a clinical question versus a billing or administrative question?
• How quickly can a family expect a callback from nursing leadership about a non-urgent concern?
• How does the attending physician structure work, and how often does a resident typically see their attending physician?

For how all of this fits into Illinois' broader oversight system, including how to check whether current leadership has a track record of resolved or unresolved inspection findings, see our page on nursing home compliance and oversight.