Behind the Five-Star Lobby

One advocate’s fight for dignity in elder care

At SVEA, we believe the people closest to daily care often see what policy documents and rating systems miss. In this spirit, we’re featuring the firsthand experience of a contributor who has spent decades working across nursing homes, hospitals, and memory-care settings. Patricia Pingitore is a Healthcare Beautician Consultant, Educator, Senior Care Advocate, and founder of Healthcare Beauticians. What follows is her perspective and her work, drawn from her own published writing. SVEA has not independently investigated the specific facilities she describes. We’re presenting her account because it raises questions every family should be asking, and because she didn’t stop at naming a problem. She built something to address it.

What she sees behind the lobby

By her own account, Patricia has spent more than 40 years in healthcare, including five years in nursing and five years as an Activities Director in long-term care, before building the work she does now helping older adults with grooming and personal care.

Patricia describes entering senior living communities with beautiful landscaping, elegant dining rooms, and five-star ratings. She reports similar concerns at two facilities where she worked, which she says carried five-star ratings. Beyond the public areas, she describes residents with long, dirty, matted hair and neglected fingernails, as well as an aide she observed scrolling her phone rather than engaging residents.

“What exactly is a five-star rating measuring?”

Her point isn’t that attractive buildings are the problem, and it isn’t a claim that every five-star facility is failing residents behind closed doors. It’s that a beautiful lobby can’t tell a family whether the person down the hall had their hair washed this week, or whether anyone checked in on them today. That’s a separate question families have to ask for themselves, on every visit, regardless of what the rating says.

What she built instead

Patricia didn’t stop at naming the problem. She writes that, with the support of Diane McGree, Nursing Home Administrator at Briarleaf Nursing Home in Doylestown, Pennsylvania, and Patricia Coyne, President of the Ladies Auxiliary at the Philadelphia Protestant Home, she helped create Alzheimer’s-friendly salons at two facilities.

The approach addressed a problem Patricia describes encountering in dementia care. Some residents found bathing and grooming frightening or confusing, making personal care more difficult. Rather than treating that resistance as simply “difficult behavior,” she designed an environment meant to calm it: vintage black-and-white photographs of babies, weddings, and grandparents on the walls, softer Victorian lighting, women folding towels and sorting roller trays and perm rods by color, men joining sing-alongs to Perry Como, Frank Sinatra, and big-band music from their own generation. At Briarleaf, an old Victorian pram filled with lifelike baby dolls for residents to hold, along with lifelike cats and dogs, a life-size owl, and a singing flamingo.

According to Patricia, some residents came to recognize the salon and look forward to it, a place they felt safe enough to let someone care for them again. That’s her account of the outcome, not an independently measured result, and SVEA isn’t presenting it as a clinically proven intervention. What it does show is a working principle worth taking seriously: personal care works better when it accounts for a resident’s individual fears, preferences, and history, instead of treating resistance as a behavior problem to manage.

A concern that goes beyond grooming

Patricia’s observations don’t stop at hair and nails. In her own writing, she describes a pattern from her client base: people leaving hospitals or nursing homes feeling unwashed and distressed after not being offered help with bathing or oral care, some willing to pay extra out of pocket just to have their hair cleaned.

That distinction matters, and so does what the research does and doesn’t show. A 2024 paper in Frontiers in Rehabilitation Sciences found that oral hygiene care is frequently overlooked in hospitals and nursing facilities, despite its role in preventing complications like aspiration pneumonia in older adults (Ashford, 2024). A separate 2024 cross-sectional study of nurses found oral care was the third-most commonly missed nursing task, skipped by more than a quarter of nurses surveyed, and tied the gaps mainly to staffing shortages and high patient turnover rather than a lack of awareness among nurses (Gallione et al., 2024). These findings provide relevant context, although they do not establish how frequently the specific experiences Patricia describes occur.

Why the small stuff isn’t small

It would be easy to hear all of this and think: grooming and bathing are nice-to-haves, not real care, something separate from a resident’s actual medical treatment. The research says otherwise, without suggesting personal care can substitute for clinical care. A 2025 systematic review of 27 qualitative studies on dignity in long-term care found that dignity wasn’t shaped by policy statements alone. It came down to institutional conditions, staffing and workload, caregiving practices, whether care was person-centered, and family involvement, meaning whether staff had the time and support to see a resident’s actual preferences and needs (Xue, Wang, & Bian, 2025).

That’s close to what Patricia has been saying through her writing: a shampoo, a shave, a few extra minutes of someone’s attention, these aren’t cosmetic extras layered on top of real care. They’re one part of it, and often where dignity is either protected or quietly lost.

What she’s asking for

Patricia hasn’t only written about these concerns. In a letter dated October 9, 2026, addressed to the Pennsylvania Department of Health, the Pennsylvania State Board of Nursing, and the Pennsylvania Department of Aging, she asked for a statewide review of bathing, oral hygiene, and personal-care practices in hospitals and nursing homes. In a separate letter to the Pennsylvania Department of Health and state legislators, she proposed a specific policy: a preventive personal-grooming assessment for every nursing-home resident, completed by a qualified healthcare beautician, reported to the Director of Nursing, and discussed at the resident’s monthly care-plan meeting.

These are her proposals and her request, addressed in her own name to the people with the power to act on them. SVEA has no information indicating that Pennsylvania has acted on either recommendation.

Where this leaves the rest of us

Not everyone reading this has the power to change state regulations. But everyone visiting a loved one in a facility can look past the lobby and ask direct questions:

• How often is grooming assessed, and is it written into the care plan?
• Who helps with bathing and oral care, and how often?
• What happens when a resident resists personal care, and is there a plan beyond “difficult behavior”?
• What activities exist for residents living with dementia, and who runs them?

If an answer feels vague, or the same concern comes up visit after visit, write it down with dates, and raise it directly with facility staff or administration. A single odd day isn’t a pattern. A repeated one is worth documenting and escalating. And to be clear, the responsibility for providing that care sits with the facility, not with the family who happened to notice the gap. Asking questions helps families catch problems early. It isn’t a substitute for facilities doing their job.