The Buck Stops Here (or How To Select a Nursing Home)

Madame Hessel at her room at Clayes, painting by Vuilliard

Painting by Vuilliard–Madame Hessel at her room at Clayes

How’s my Mom?

Oh honey, she’s just fine

You know

Your Mother Will Outlive All of Us!

Of course, my Mother was not just fine;

dementia was obliterating her brain.

But time after time

the head nurse began our conversations

with a wink and a shrug;

a tip of the hat

to my Mother’s physical strength and spirited demeanor:

You know, honey

Your Mother Will Outlive All of Us!

We always laughed;

we knew better.

And laughter aside

during every visit,

I closely observed the head nurse in action.

She inspected her realm with a determined, confident stride. Her nursing home was clean, brisk, efficient; call buttons answered quickly; accidents cleaned immediately.

She was strict;

she was demanding;

she got results.

In the early days, I was a little scared of her.

She began each morning with a visit to every bed;

holding hands; studying charts.

And while I admired her high standards, it was her compassion that won my heart.

I witnessed her frustration when families ignored her patients.

I witnessed her camaraderie with her loyal staff.

I witnessed her struggle when death hit hard.

She had nursed elderly patients

in their final hours

for decades; and


death hit hard.

Watching her,

I came to understand—

the nursing home was like any business–

the tone and temper, ethics and morality, compassion and care were shaped by the person in the corner office–

the head nurse’s office.

She was direct; straightforward; uncompromising.

She always told me what I needed to know, even when I didn’t want to know it.

And whenever I asked how my Mom was doing,

I knew what she was going to say, even before she said it

Oh honey, your Mama is so strong, she’s going to outlive all of us!

We’d always laugh.

I didn’t see it coming.

The staff left a message: your Mom is fine but call as soon as you can.

I was in a hurry;

I dashed a note to my sister:

Can you find out what they need?

A few hours later,

I saw my sister’s reply:

Sit down before you open this.

You are not going to believe this.

My friend

was dead;

lung cancer.

I hadn’t seen her during my last few visits. I had asked the nurses to say hi.

Only then

I realized

they had looked away.

They did not say a word.

A new head nurse hired new staff. Walls were painted; carpets changed. Therapy dogs visited patient beds; but

the head nurse didn’t.

Some things were better;

some things not.

But one thing held true;

like any business,

the tone and temper, ethics and morality, care and compassion of the nursing home were shaped by the person in the corner office–

The buck stops here.

In memory of my friend, I offer an article from her monthly newsletter. Her newsletter reflected her personality: strongly opinionated; deeply empathetic. Her featured column, describing the life accomplishments of the Resident of the Month, was designed to remind the staff of their mission and reinforce her respectful approach to patient care.

Incidentally, her newsletter was called The Resident

which tells you all you need to know.

Here is her article, which I have reconfigured as a checklist. The title:


I suggest you visit early, around 9 AM.

From then on use your senses.

Your nose

If you walk in and smell urine or Pine Sol, walk back out.

There is no excuse for a strong urine odor. A strong urine odor is one indication that residents are dehydrated. It also tells you there is:

Not enough linen to keep residents clean and dry;

Not enough staff to change residents;

Not enough housekeepers to mop up spills.

But mainly, it tells you that the director of nurses and/or administrator have NO SHAME that their facility smells of urine.

Your eyes

While you tour the facility, don’t let them rush you.

Walk slowly and observe:

Are men shaved, eyebrows trimmed?

Do the women have hairs on their chins?

Are lips dry?

Are fingernails long and dirty?

Are rooms neat?

Are linens old and thread bare?

Watch the interaction between staff and residents

Are call lights answered promptly?

Read the activity calendar

Ask questions

Review a weekly menu

Your ears

How is the noise level?

Are the residents yelling?

Is the PA system constantly used?

If the facility is noisy, it means there is not enough staff.

Inspection Reports

Shake them up and ask to see their last inspection report. If it is in a locked cabinet, be wary.

Have them explain any deficiency. Remember: no one gets a perfect inspection report!

Talk to the Director of Nurses, not a marketing administrator or social worker

As the Director of Nurses, I am the most appropriate person to handle all inquiries. I have always felt a prospective family should talk to me, as I am the one responsible for the nursing care.

The family needs to establish a rapport with me. They need to know me and feel comfortable coming to me with questions. If you meet the director of nurses and feel insecure or have bad vibes, think twice.

The level of care in every nursing home rests on the shoulders of the Director of Nurses.

The buck stops here. 

Our last Mother's Day at the nursing home--  Photo by Hallie Swift

Our last Mother’s Day at the nursing home– Photo by Hallie Swift


10 thoughts on “The Buck Stops Here (or How To Select a Nursing Home)

    • And she was a wonderful, practical person! I deeply appreciate your support for my efforts. You know, I regret not saving all her newsletters, but I only have so much room in my NYC apartment. BUT for some reason I tore this article out and kept it with my Mom’s papers. You can imagine my surprise when I discovered it, and instantly felt it would make an informative post, plus a way to pay tribute to her.

      She lives in my heart, and now here too!


  1. This is an exceptional checklist that can be used at nursing homes – as you indicated – as well as other long-term care (LTC) residential settings: assisted living, group homes, rehab centers. Thank you for having your website, and thank you for following mine! It’s a joy to follow others similarly focused as I am in my blog:

    • I am thrilled to discover your writing.

      When I first began this effort last year, I consciously stayed away from any writing on the topic, lest other’s opinions or even language choices influence me. But now I feel confident that I am able to tell my story, and that we can only benefit from a dialogue. Thank you for following A Swift Current. I welcome your perspective. Hallie

  2. Kathleen, somehow in trying to reply to your comment I deleted it! In a nutshell, you said that you had never seen a nursing home that met all her criteria…and that was scary. I know there are varying levels…and in fact as I hinted, I even think some of the innovations by the new head nurse were improvements; I liked the therapy dogs; the new activities director (who I described in the previous post) was resourceful and engaged; the place was even wired for internet access! I suppose the old school dictums of my friend were replaced by a more modern (and academic) approach; each has its merits, though I will always think with fondness of the first iteration But most of all I like her willingness to address the “urine smell” issue directly and call out the homes that have “no shame.” I do hope the checklist is helpful. Thanks and sorry I deleted you! Hallie

  3. This will be a most helpful checklist when it comes time (soon I think) to start looking for a home for my step mother. I can only imagine what goes on in some of them. Scary.. Thank god your mother had such excellent care.
    Thank you for continuing to share your insight..

  4. Hi Hallie…I did leave a reply and somehow it disappeared but I thank you for the checklist and as always your posts make me ponder things I didn’t even realize were relevant to my life.

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