Home, Sweet Home : Ivy House Provides Elderly With Alternative to Institutionalized Care

Ernest Greger held five medical degrees from the University of Vienna. He was a concentration camp survivor, a musician and art collector. He saved lives and, according to daughter Susan Leeds, lived his own with grace.

But the six years until his death in 1986 were marked by the slow, unrelenting decline typical of Alzheimer’s disease. Leeds, for one, will never forget it.

“Once you go through something like Alzheimer’s disease with someone you love, it changes you forever,” she said.

Greger’s legacy lives on in many ways, but perhaps nowhere as dramatically as Ivy House, a residential care facility specializing in individualized care and concern for the elderly that Leeds recently opened in Santa Monica.

Ivy House is classified as a board-and-care home, one of 4,320 in the state. Its distinction is that it is significantly cheaper than most others that are anywhere near as nice, and much nicer than most that are anywhere near as cheap. While the best facilities range in price from $3,000 to $5,000 monthly, Ivy House costs $1,900 to $2,500. Leeds says it still makes a respectable profit.

Experts on aging and the elderly predict a severe shortage of adequate, affordable housing for the elderly as the nation’s population ages. If a solution is found, it may be more as a result of efforts by people such as Leeds, than those of government and institutions. As Leeds has found, a personal, non-institutional approach is vital in creating a good home.

There’s no great secret to operating a good board-and-care home, Leeds says, but that doesn’t mean it’s easy. It takes a good on-site manager, a deep reservoir of patience for dealing with bureaucrats and regulators, and a commitment to fostering an atmosphere of care and love.

Ivy House, designed for six residents and a staff of three, even looks different from conventional homes. Fine art decorates the walls. Antiques grace the living room area. Furniture is upholstered in bright chintz prints, and the wallpaper picks up the ivy theme. Each room is bright and individually decorated.

“If I wanted just a business I wouldn’t do this,” Leeds said.

And although she expresses delight at the way Ivy House has turned out, she says it will be at least several years before she considers starting up another home.

“I need that amount of time to recover just from the licensing process,” she said.

Experts say the process is especially difficult in California.

“There is so much regulation in California that it is impossible to be innovative,” said Victor Regnier, professor at USC’s Andrus Center of Gerontology. “What costs $1,800 in Minnesota costs $3,000 in Los Angeles.”

The elderly housing crunch, however, is by no means confined to California, Regnier said.

“By the year 2010 we’re going to double the number of people over 85, and from 2010 to 2030 we double again,” he said. “There are no systems in place for this population. The fact is we’re going to have a housing crisis for the 85-plus age group,” he said.

The federal government has done little to plan for the crisis, Regnier said. “HUD can’t figure out how to make it work--they keep nursing homes as awful as possible to discourage people from moving in. Increased longevity is going to be a gigantic problem, and since women outlive men it is a real feminist item.”

Local research underscores the point--and the older the category, the greater the preponderance of women. A recent study of the elderly on the Westside by Rand Corp. and WISE Senior Services found, for example, that the ratio of women to men in the 85-plus group was 2 to 1 in Beverly Hills and more than 3 to 1 in Santa Monica.

Experts say the market should take heed. Diane Y. Caretens of Gerontological Services Inc., a Santa Monica-based consulting firm that specializes in the elder market, says her surveys show older women who are used to taking charge.

“The 75-plus group are the ones whose husbands went off to World War II and left them behind to manage--which they did very well,” she said. “They are not going to accept these 550-square-foot storage rooms built during the ‘80s by developers for a tax write-off. We’re seeing an increased demand from the . . . aging for a more holistic approach” to housing.

Susan Leeds had no access to such research and expertise when she and her mother, Sheila Greger, began to look for the right place for Ernest Greger to live. All she knew was that she was dissatisfied with what she was finding.

For five years, Sheila Greger had cared for her husband as his condition deteriorated. After awhile, she sold their home and moved with her husband into the safer environment of a Santa Monica apartment.

Finally, the day came when Ernest Greger could no longer walk, and Leeds’ search for a board-and-care home took on new urgency. Her mother, meanwhile, participated in a support group at a nearby church.

“I visited 30 homes and was very upset at the choices,” Leeds said. “The lack of aesthetics tormented me. The lack of dignity--especially for a man who had treated his patients with so much respect--was terrible. I remember the first place I visited was so ugly. It was located in an area which looked unsafe. . . . I also remember the odor.

“There were people in the hallway with trays of food which wouldn’t even be served on an airplane. The other places kind of fade together into one mass of staff and medical personnel who lacked connections to the patients. And these were the best places.”

Through the support group, however, they got a break. Sheila Greger heard about a woman named Irma Bravo who owned and operated a small board-and-care home in Venice.

“It was an enormous relief,” Leeds said. “Irma was accepting, cheerful, capable and natural. It was comforting to bring him to her home.”

It was also a great relief to Sheila Greger to find a good, caring home for her husband.

“Alzheimer’s disease opens up the psyche and allows hidden emotions and talents to come out,” she said. “I shared it and it wasn’t all awful. At the end, he still recognized me and he still behaved like a doctor. His world wasn’t that sad, at least from my point of view, because of the surroundings he was in.”

Leeds and Bravo remained friends after Ernest Greger died a year later. And when Leeds decided to start Ivy House and needed an administrator, no one but Bravo would do.

Leeds, formerly in the fine art business, brought her sense of design to the concept of Ivy House. She combined the atmosphere of a favorite restaurant with the comfort of what she envisioned as a grandmother’s house. “It was a marriage between tradition with what is considered chic,” she said, “but I also thought about where I wanted to live.”

Still, it was an arduous process, taking nearly two years from conception to the opening of Ivy House in early fall. Leeds spent six months doing the paperwork and learning how to satisfy fire department requirements. She took seminars and classes to qualify as a home operator. The house cost $400,000 and needed $50,000 for refurbishing.

But for Leeds, Ivy House is proof that imagination, love and tenacity can make a difference, although she will never forget what a struggle it was.

“Younger people need to look at aging squarely,” she said. “Caring about the elderly is a direct consideration for our immediate future. If we can tackle this problem now while we are young, full of energy and connected to our parents and grandparents, our own old age will be more satisfying.”