This institutional ethnographic research study investigates the health care process of placing older adults from hospital mental health units into nursing homes or assisted living arrangements. Placing older, mentally ill adults from hospital into alternate living facilities is fraught with challenges for older adults, family members and health care professionals. The complex work process of coming to a decision that older adults with mental illness require placement, and carrying out that process, confuses and frustrates many health care professionals, and absolutely befuddles older adults and family members. This research begins with the experiences of older adults in hospital mental health units who cannot return home and are going to be placed in nursing homes or DAL arrangements. I examine the hospital-based work of assessment ( of older adults) and placement as coordinated across different health care professions at varying levels (frontline and managerial). In particular, I focus upon specific tools that coordinate assessment, that validate decision-making about placement and that are used to facilitate placement across sites ( e.g. hospital units to nursing homes). This institutional ethnography reveals the extensive, time consuming work of health care professionals on mental health units in assessing and treating the illnesses of older adults, assessing abilities to live independently, and in some cases, deciding upon placement in nursing homes or DAL arrangements. The tools that are used to assess older adults and facilitate placement often rely upon numbers or categories that are not relevant to the mentally ill and do not accurately represent the complexities of these individuals, do not reveal the extensive and intricate work of health care professionals and can actual hinder the placement process. I propose changes to the tools used to assess older, mentally ill adults, increasing the verbal work between professionals across sites (hospital and nursing home) to facilitate placement and specific adaptations to nursing home/DAL arrangements that may assist mentally ill older adults.