Near Melrose, a national healthcare predicament plays out

Just off the trendy Melrose strip, on the western edge of Hollywood, is a refuge of tree-lined streets where neighbors greet each other by name and young couples start families and stick around into their golden years.

Lately, it has also become a battlefront in a broader clash of conflicting imperatives: how to balance a government push to keep the aging and disabled out of institutions against community desires to protect the character and value of residential neighborhoods, particularly in a shaky housing market.

When news spread on a tranquil block of Sierra Bonita Avenue that a developer wanted to tear down a modest 1920s duplex and build an 11-bed board and care facility for people with dementia, the outcry began.

Neighbors were already concerned about the growing number of group homes for the elderly and recovering addicts in the area, many of them for profit.

A Times analysis found 24 licensed facilities offering residential care for the elderly within a mile of the proposed project and three more waiting for state approval. It is one of several such clusters that have emerged in Los Angeles County — including parts of the San Fernando Valley and South Bay — where families can afford fees that run into thousands of dollars per month. Large swaths of the county’s less affluent areas have no such facilities.

Some neighbors on Sierra Bonita worry that another care home will mean more parking headaches, more ambulance sirens and increased downward pressure on property values that have tumbled about 25% in six years.

Douglas Madore, who has owned a duplex on the street for nearly 50 years, recalled two disturbing encounters with elderly residents who wandered from another nearby care facility. One woman showed up on his doorstep insisting he vacate “her” house. Another time, a man walked by screaming for help.

“I feel for these people,” Madore said. “I’m not a kid myself.” But he said he spent $200,000 upgrading his property — an “investment wasted” if he can’t find a buyer.

Other residents argue that such facilities help people age with dignity in their own communities.

“Where are they going to end up? On Melrose with pot shops?” asked Alla Tenina, who owns a house on nearby Vista Street. “I personally don’t want to be pushed into a commercial area.”

The issue’s sensitivity is reflected in the reluctance of some fierce opponents of the project to have their names published. Several said they did not want to offend elderly neighbors or be accused of NIMBYism.

“I have nothing against people in rehab. I have nothing against older people,” said a 20-year resident. “It’s still a business.... If I wanted to live downtown, I’d live downtown.”

Debra Cherry, executive vice president of the California Southland Chapter of the Alzheimer’s Assn., said such conflicts aren’t unusual. In March, in response to residents’ complaints, the South Valley Area Planning Commission rejected plans for a 156-bed elder-care facility in Tarzana after a zoning administrator had approved it.

Advocates for the elderly say more needs to be done quickly to ensure that a growing Alzheimer’s population has appropriate housing and care. An estimated 155,575 Los Angeles County residents had Alzheimer’s in 2008, a figure that is expected to nearly double by 2030 and triple by 2050, according to Cherry’s group.

“The first of the baby boomers turned 65 this past year, so what we are going to see is a ballooning in the numbers of people who have Alzheimer’s disease and age-related cognitive impairment,” she said.

The bulk of Alzheimer’s care is provided by family members. But as the disease progresses, those afflicted need help with basic tasks like getting dressed or preparing a meal, Cherry said. Family members can’t always provide that level of care, and hiring help typically costs $10 to $20 an hour. Funding for in-home aides and other support has been slashed because of state budget shortfalls.

Families may be left with a single choice: a more expensive government-funded nursing home.

That’s not necessarily the best or most cost-effective option for people with dementia when they don’t need the medical services, said Dr. Linda Ercoli, director of geriatric psychology at UCLA.

Studies show that smaller, more home-like facilities can offer a more familiar environment, often with better staff ratios and more personalized care, said Ercoli, who has urged city officials to support the concept proposed on Sierra Bonita.

State law exempts facilities with fewer than seven residents from special permitting requirements in single-family neighborhoods. Costs at small facilities can be prohibitive, however.

“If you’re lucky, you’ll find something around $3,500,” said Majid Ali, a 57-year-old acupuncturist whose mother has Alzheimer’s. “More often than not it’s $6,000 to $7,000 per month and up.”

It took Ali two years to find the right place for his mother and her sister, who is deaf. Even with long-term care insurance policies, some facilities were too expensive. Others didn’t provide the specialized dementia care his mother needs.

A social worker suggested he visit the homes operated by Raya’s Paradise Inc., which proposed the Sierra Bonita facility. Ali’s mother and aunt now share a room in a Mediterranean-style house with lush landscaping and homey cooking smells wafting from the kitchen. There are weekly exercise classes, and an accordion player drops by to serenade the residents.

“They’re far better,” Ali said. “My mom has moments of being more lucid.... My aunt is a bit more sociable. She has other people to talk to.”

Los Angeles County is one of six in California where low-income seniors who would otherwise be in nursing homes can use their Medi-Cal benefits to help pay for such care.

But the program is expected to serve only about 1,790 people this year, according to the California Department of Health Care Services.

Just 55 of the county’s 1,356 licensed facilities participate in the program. Operators have been slow to sign on, saying reimbursement rates are too low.

Moti Gamburd, executive director of Raya’s Paradise, said sharing staff and amenities at what already could legally be operated as two side-by-side six-bed care homes would help keep costs down. He could charge $2,500 to $5,000 a month and offer at least one bed to a low-income resident at half price, he said.

L.A. City Councilman Paul Koretz, who represents the area, said the developer did not do enough to address neighborhood concerns about the facility. “I don’t know how many of them you even want in one neighborhood,” he said.

City planning officials believe the project could encourage other group homes in the area to expand.

“Such a precedent would incrementally begin to erode the low-density character and appearance of the area,” Associate Zoning Administrator Lourdes Green wrote in an Oct. 4 decision rejecting the project.

Robert Cherno, a land use consultant hired by the developer, points to a city ordinance that allows people with disabilities to apply for “reasonable accommodation” to ensure equal housing access. His client should not have had to apply for a variance, a process that took nearly two years and cost $8,843.50, Cherno said.

Another city official agreed with Cherno on the applicability of the law but said in this case a larger facility was not needed to reduce housing barriers. Chief Zoning Administrator Linn K. Wyatt noted in a March 6 decision that the developer already operates five facilities in the vicinity.

Raya’s Paradise has appealed the decision and filed a complaint with the California Department of Fair Employment and Housing alleging discrimination by the city.

The conflict over where group homes should be allowed and how to control them has spread to City Hall. A controversial proposed ordinance would designate licensed care facilities with more than six beds as “public benefits,” meaning they would no longer need special permits to operate in low-density areas if they meet parking, noise and other city standards.

But the same measure could create problems for some smaller homes that can now operate without city or state approval. A provision barring multiple tenant lease agreements in single-family zones could force many to shut down, according to advocates for the disabled.

Koretz said the city needs to find a way to crack down on problem facilities without interfering with ones providing valuable services.

On Sierra Bonita, some residents now wonder if opposing the Alzheimer’s home was the best course. Like her neighbors, Rita Tateel had concerns about the project. Then she agreed to tour one of the other facilities operated by Raya’s Paradise.

“I have to say what they did there is beautifully done,” she said. “You can’t even tell that it’s a care facility from the outside.”

She started thinking of her 92-year-old mother-in-law.

“If her dementia gets worse,” Tateel said, “I’d want her in a facility right across the street from us that I know is nice.”

alexandra.zavis@latimes.com

Times staff writer Doug Smith and researcher Scott J. Wilson contributed to this report.