As the Daughters of Israel Nursing Home in West Orange celebrates its 100th anniversary, Lawrence Gelfand is nursing personal memories about an institution he has been instrumental in shaping.

Gelfand is stepping down as the home's executive director, saying goodbye to an institution that he has served for 32 years. He expects to retire by the end of 2007.

In those three decades, he has seen the home's population change, along with the social and political climate for serving and funding the needs of the region's elderly.

When Gelfand began there as assistant director in 1972, Daughters had 168 residents; today it has about 300.

"Their average age when I started was late 60s to early 80s," he said, relaxing in a swivel chair at the corner of his long conference table. "Now we serve people in their late 80s. Eighty-eight or 89 is our average age now. They are living longer and staying out of institutions longer, and that's good. It is not good for business here, but it is good for people."

Gelfand said he was asked recently how he has stayed with the same institution for over 30 years.

"I said, 'Daughters is special because we never put money ahead of people. We focus on the care of the residents, not on the dollars,'" he explained.

And every time he turned to the federal government, United Jewish Communities of MetroWest NJ, or other philanthropies for funding, Gelfand said, he worked to balance fiscal integrity with making Daughters a safe and pleasant place for its residents.

"It is not to say you can do whatever you want whenever you want without answering for what you do, but what's good for the residents is what we've got to look at. Quality of life, making life meaningful for frail, elderly sick people, is our business."

While Daughters is a beneficiary agency of UJC MetroWest NJ, the agency, like most nursing homes, is heavily dependent on federal funding.

"The philanthropy of Jewish communities across the country is diminishing," Gelfand said, "and we've always struggled with the Medicaid program. Some people think that too much money goes into it. In my view, it is not enough."

According to Gelfand, the industry has never recovered from the case of Bernard Bergman, a New York rabbi who pleaded guilty in the 1970s to fraud charges involving unsanitary and inhumane conditions in nursing homes he operated.

"From then on, the industry has been under scrutiny," Gelfand said. "There have been and unfortunately there still are some operators who put the dollar in front of good care and will look to do anything they can on the cheap. You know, you put more water in the soup and you save a few bucks on lunch. There are guys like that. Unfortunately, the view of many people is that is the whole industry. It is not."

The Bergman case triggered increased government regulation; as a result, said Daughters' chief executive, "skilled nursing facilities are the most heavily regulated industry in the country."

Some moments have been more difficult than others, Gelfand recalled.

"We've had our crises – when air-conditioning has gone out and fire alarms have gone off in the middle of the night. We've had to cut some full-time positions back to part-time positions. But when do you have enough staff? My answer to that is 'probably never.' But in my 32 years, we've never been to the point where we believed we could fold," he said.

The world of eldercare has expanded during his term, and in addition to nursing homes there are now assisted-living facilities and so-called NORCs (naturally occurring retirement communities), whose stewards are seeking services for those who would prefer to "age in place."

"I wouldn't call the assisted-living facilities and the NORCs threats," Gelfand said. "I think they have their place. For many people in nursing homes, the choice is made by their children. Many of the assisted-living places are brand-new, and the children choose by what they see. If we don't compete with that, we are going to lose some of our market share."

To cope with competition, Gelfand is supervising the upgrading of 108 living quarters and launching outpatient programs in rehabilitation and physical therapy.

"We are looking to raise our income rather than cut back on our services," he said.

A native of Brooklyn, Gelfand was a Midwood High School classmate of Barbra Streisand, chess champion Bobby Fischer, and pro basketball player and coach Billy Cunningham. Gelfand received a master's degree in social work from Yeshiva University and spent two years working at the Newark YMHA.

"I decided it wasn't for me, and they agreed," he said.

He went to work with children at the Jewish Guild for the Blind before promotion to assistant director the guild's Home for the Jewish Blind in Yonkers, NY. In 1972, he was offered a position as assistant director at Daughters of Israel, received another promotion to associate director, then left in 1984 to run two nursing homes and two Jewish community housing projects in Virginia.

Eight years later he returned to West Orange for the "top spot" at Daughters.

As a search committee works to find his successor, Gelfand contemplates a life in retirement.

"Every day I'm going to get up and decide what I want to do until the money runs out," he joked.

With a daughter in Pennsylvania, one son in south Jersey, and another in California, the Parsippany resident expects to do "a lot of baby-sitting" at the homes of his children and four grandchildren.

He will be missed by Gary Beinhaker of West Orange, the nursing home's board president.

"My presidency has been enhanced as a result of working with such an experienced and dedicated CEO," said Beinhaker. "Larry always puts the residents' care and dignity before anything else."

As he looked back on a career largely dedicated to people nearing the ends of their lives, Gelfand conceded that it was "sometimes very depressing. There are some people that when you lose them it is almost like losing a member of your family.

"But the positive side is, you say, "Where would these people here be without the institution? What would their lives be like? Who would care for them? How would they get their nutrition?' If you can say with confidence that you've definitely improved their situation, that's what keeps you going."