As she assumes the reins of the Daughters of Israel nursing home, Susan Grosser has reached a high point in the career path she began as a teenager, when she went to work with the elderly in Dania, Fla.

"I started out in a nursing home where my mother was the office manager," Grosser recalled, sitting at the head of a conference table at the Daughters' Plafsky Family Campus in West Orange. "Her receptionist had left and my mother asked me to come in and help out temporarily, and I said ‘sure.'"

So began a lifetime of service to seniors that has culminated in her appointment as successor to Lawrence Gelfand, whose retirement as Daughters' executive director takes effect at the end of the month.

Grosser, the home's former associate director, inherits the 100-year-old institution in the midst of "a number of big challenges and opportunities," as she put it. Key among them is the 114-bed expansion project that is slated to be completed by the spring of 2009.

"Keeping the beds full during construction is a challenge, and right now we are about 97 or 98 percent full," she said. "Some of our rooms are very old and not as beautiful as the others. It is a hard sell, but people go into the older rooms because of our reputation and our care."

Once construction is completed, the home plans to upgrade what Grosser called "sub-acute rehab," a short-term residential program for people recovering from fractures and bone breaks.

"They would live here for maybe 20 or 30 days, get rehabilitation, and then go back home," she said. "We want to promote that more."

Responsibility for such change is a far cry from her very first job.

"I did admissions. I was a receptionist. I did medical records. I did a lot of little tasks," she remembered. "It was a small home, and we all multitasked. I worked some evenings, some weekends, sometimes after school. I lived at home when I went to college, and I worked off-hours during school."

Then a new administrator took over and offered to train Grosser on a management track.

"I began to see how much I loved the elderly and what I could do to help make their lives better," she said.

After finishing school in Florida, Grosser moved to New Jersey and began a 12-year stint in the profit-making end of the nursing home industry. At these for-profit facilities, "bottom line considerations" mitigated against her "having as much independence or availability to do what I wanted to for the home itself. There is a lot of turnover in management, so you really don't have time to build your team and keep it together."

Nine years ago, Grosser met Gelfand at a seminar held at Daughters of Israel. When the seminar ended, they discussed the open position of associate executive director. That started a chain of interviews with other nursing home officials, and Grosser began working at Daughters on Feb. 1, 1999, commuting from her home in Pompton Lakes, where she and her husband, Brian, raised three sons.

"It has been an amazing time. There is such a sense of family here and a real sense of caring about what we do for the 300 elderly people here. You don't always see that in other nursing homes."

But as with other nursing homes, fiscal considerations are ever present.

"We always have to worry about the bottom line. I have a budget to follow," she said. "But I don't have an owner looking at the black and the red. I absolutely have a board, but the board has our same philosophy — that everything we do here is about patient care."

To Grosser, such commitment to care is often not the highest priority in other nursing homes.

"Some facilities out there have crystal chandeliers. That's important to them. Esthetics is very important. But I would rather take the money for those crystal chandeliers and have another nursing assistant out there doing hands-on care. A crystal chandelier can't feed my residents," she said.

Surveying Daughters' fiscal condition, Grosser proclaimed, "We're doing fine." She said the facility's relationship with United Jewish Communities of MetroWest NJ is "strong," adding, "We are still in the midst of our budget allocations process for 2008. We are also trying to build an independent endowment, which Larry began a few years ago. We are trying to build a financial future for ourselves so we can become less dependent on the community."

In the executive director's office, where Gelfand sat behind the desk he will soon vacate, he looked up at Grosser and said, "My replacement? I feel wonderful about her. I'm giving over the ship to a terrific person who I believe shares my ethic and my goals for the home. If I have to leave, I couldn't leave it to a better person."

Grosser related what she has learned from Gelfand.

"Larry has been a great mentor, and he has taught me a lot — not only about community relations but about changing my style a little in dealing with the staff. I'm a tough cookie, but sometimes it's OK to let other people come up with the big idea or feed them the big idea. Let them take the credit for it. It's a feel-good for them."