Los Angeles Jewish Home's Blog

How to Help the Medically Needy

If you're interested in giving aid to Medically Needy beneficiaries, we suggest doing one of the following:

·         Write and mail a personal letter to your California Representative
o   If you don’t know who your representative is, visit one of these websites:
·         Spread the word to your friends and family members about our cause and get them involved
·         Send The Home a letter of support from yourself or your business that we can pass onto our elected officials on your behalf
o   Mail your letter of support:
§  Attn: Amanda Powell, Activities Team Leader
18855 Victory Blvd.
Reseda, CA, 91335

·         Participate in The Home’s activities to support our cause - See our blog for calendar details and dates on our website: www.jha.org

The Welfare of Medically Needy

There are approximately 75 residents in the Los Angeles Jewish Home’s assisted living that qualify for the welfare (Medi-Cal) Medically Needy Only (MNO) program.  There are close to 12000 individuals across the state that qualify, and that would greatly benefit if this program is expanded.  The MNO program recipients are provided just $20/month as a personal spending allowance.  This $20 must cover over the counter drugs, clothing, shampoo and a variety of personal items such as hearing aid batteries and denture repairs.  Twenty dollars is insufficient to cover these basic necessities. This amount does not even begin to address the various drug store sundries essential to keeping up one’s health.  The dignity of our MNO recipient population is not being preserved by only providing $20 as a monthly stipend for their needs.  Join the Jewish Home’s efforts, and spread the word about our initiative to help our residents get what they need. 

A Generation Apart

In 1983 a documentary was made entitled “A Generation Apart,” which explored the impact of the Holocaust on the survivors’ families. It was described as a “testimony to the power of love.” Over 30 years later, as I walked through the Los Angeles Jewish Home’s Eisenberg Village, I witnessed another testimony to the power of love related to the Shoah. A small group of the Holocaust survivors who live at the Jewish Home were meeting.

The group was led by resident Ernest Braunstein. Although I had only been CMO at the Home for a few weeks, I knew several of the participants. One was even from my mother’s city of Lodz, Poland. He and his wife are now my patients. Their daughter was also participating in the group discussion.

The number of living Holocaust survivors is dropping dramatically. Resident survivors of the Home may number less than 20 in a community of 1000.

The deaths they once barely escaped are now palpably close again, and they react to that in different ways. Some exude their exuberance for just being alive, and a few live in a perpetual fog of fear. In others their paranoia is paramount, and in many the guilt of survival continues to germinate.

Author Jane Gross quoted Rabbi Simon Hirschhorn in an article published Oct. 23, 2014 in The New Old Age. “Some of the elderly survivors cry inconsolably but wordlessly, incapable or unwilling to articulate anything about the past. Others, often dry-eyed, incessantly discuss the terrible things they saw and had to do to save their lives. And they often flip, all but overnight, from one way of coping to the other as the end of life approaches.”

In senior communities around the world that have a significant number of survivors, support groups try to help them cope. One challenge the facilitators face is that many survivors have spent their entire lives not talking about their psychological pain and are not going to “open up” as the facilitators encourage them to do.

Regardless of the town they came from or the camp they were in, Shoah survivors are not like other aged residents in senior living. They are truly a generation apart.

The survivors’ adult children, like myself, are also unlike their generation. We are also a generation apart. In Gross’s article, Rabbi Hirschhorn, who is the son and grandson of survivors and is a nursing home clergy, said survivors’ children struggle more than others with the guilt of placing a parent in an institutional setting.

According to Rabbi Hirschhorn, survivors’ children, often called Second Generation or “2G” for short, “grow up, from the time they are little, with the unconscious wish to make it better, to take away the pain.’’ Both my wife’s parents and my parents were survivors of the Shoah, and we also had the desire not to add any pain to our parents’ lives by our decisions. We, like Charlotte Dell in the article by Gross, always had “an overwhelming feeling of responsibility that there is no additional suffering.’’

Staff that care for survivors and their adult children have a significant task to guide these families through what is likely the most difficult transition of their lives.

Perhaps the most challenging medical issue adult children struggle with is whether or not to consent to a feeding tube when their parent can no longer safely eat. Many encouraged by their clinicians choose to have a feeding tube placed. I once overheard a doctor yell at a daughter of a patient with advanced dementia, “You don’t want your Mother to starve to death, do you?” In addition to the bias of some doctors, survivors and their surrogates typically choose any medical interventions that have the goal to prolong life. Unfortunately, what this daughter was not told, and what many children struggling with this decision are not told, is that placing a feeding tube typically means their parent will not be allowed to eat ever again. In addition, numerous medical studies have shown feeding tubes in patients with advanced dementia may increase pain, and often worsen the quality and length of life.

The struggle around whether or not to place a feeding tube is even more challenging for second generation. They wonder whether their action may actually cause additional suffering to their survivor parent by triggering the painful memories of the starvation they had in the war. Since they are not allowed to eat after placement of the tube, it also takes away the basic physical pleasure of eating that is so important because it had been previously denied to them. Not allowing a survivor to eat also creates tremendous guilt in their children. One of my 2G friends told me when they declined having the feeding tube placed in their dad, it felt like they had put on the black uniform of a SS soldier.

I was thinking about the various challenges of caring for aging Holocaust survivors as I watched the small group gathered around a table in the Zuckerman Board Room at the Jewish Home. Thankfully, those thoughts quickly left and were amazingly replaced by the warmth, love, and friendship that were evident. I saw in their eyes and heard in their strong voices that this group was different than one seen in typical nursing homes. It was full of hope. I am looking forward to the next time I have a chance to sit down with them, listen, and hopefully help bring the generations together.

Noah Marco, M.D.
Chief Medical Officer
Los Angeles Jewish Home

When Death Approaches Again By Jane Gross October 23, 2014 4:27 pm

Support at the End of Life's Journey

Support at the End of Life's Journey
Each year, Skirball Hospice, a program of the Los Angeles Jewish Home, helps over 500 individuals and their families move through the final phase of life's journey. The following is based on one family's story. Sarah* came from a distinguished Jewish family, and, although she was raised with knowledge of Jewish rituals, she identified herself as more of a cultural Jew. What mattered to her was championing causes for people in need, making sure they were fed, housed and clothed. She studied anthropology and travelled all over the world, making friends with people from different cultures and religions. Her Judaism was more focused on the universal, rather than the particular. Having grown up during the Great Depression, Sarah had learned to be frugal and spent money on things that really mattered to her. She wasn't frivolous; she gave monetarily in ways that reflected her values and on causes she believed in. Her four children knew exactly how she felt about the importance of caring for others, both emotionally and financially.

At age 90, Sarah was dying from heart disease and was admitted to Skirball Hospice. Her devoted children cared for her around the clock with the help of the hospice team. Her oldest daughter was a great cook and prepared the foods her mother loved. She would sit with her for hours, holding her hand and kissing her cheek. The middle daughters both worked in the medical field and provided the physical care their mother needed. The youngest child, Sarah's son and a bit of an insomniac, stayed with her at night so she wouldn't be alone. Hospice made sure she had the right medications, oxygen when she needed it, and provided emotional support to the family. Their questions were answered and the hospice staff was always available when they needed reassurance. The partnership between the family and the team made a huge difference in the quality of Sarah's last few weeks, and made the prospect of losing her more bearable. Her family was very appreciative of the support they received.
When Sarah died, her children knew there wasn't going to be a funeral, memorial, or shiva service, in keeping with their mother's wishes and values. Still, for them, something was missing. There was no coming together to mourn and tell stories, no sense of closure, and no kaddish prayer. Sarah's children had reclaimed some of the Jewish rituals their mother had discarded, and wanted something more for themselves. How could they get that and still be true to what Sarah had wanted?
A few months later they received an invitation to attend the annual Skirball Hospice Memorial Service. It was truly an answer to a prayer. All four children attended this touching tribute. Candles were lit, a stone was placed to honor the deceased, and family members were given the opportunity to say a few words in memory of their loved one. Prayers were said, the names of the dead were recited, and the kaddish was read. For Sarah's children, they finally received the solace and comfort they had been looking for. Surrounded by others who had also lost someone dear, they felt embraced and held by the atmosphere of love and acceptance. The staff who had cared for their mom were there to reconnect. With both tears and laughter, Sarah, and all the other former hospice patients, were remembered as only ones who have been through this experience can truly understand.
Skirball Hospice will be holding its annual Memorial Service on Sunday, February 22, 2015 at the Skirball Cultural Center. Family members and service providers of people who were on hospice in the past year are invited to attend. For more information, please call Skirball Hospice at 818-774-3040.
*fictitious name

The "Pneumonia" Shot

The Pneumonia ShotFor years it's been recommended that everyone 65 and over get the one-time "pneumonia" shot (Pneumovax, or PPSV23). Pneumovax helps to prevent invasive, and deadly, complications of pneumococcal pneumonia, the most common kind of pneumonia. Unfortunately, it didn't have much benefit in preventing pneumococcal pneumonia itself. However, a new vaccine called Prevnar 13 (PCV13) does significantly prevent pneumococcal pneumonia. This should greatly reduce pneumonia in the senior population.
The current recommendation is that everyone over 65 receive two pneumococcal vaccinations. First, at 65 or older, Prevnar 13, followed in 6-12 months by Pneumovax. If the person has already had Pneumovax after the age of 65, they should just get Prevnar 13 (at least a year after the Pneumovax). If the person had Pneumovax before 65, they should wait several years, then get Prevnar 13 followed by a second Pneumovax (but making sure the second Pneumovax is at least five years after the first Pneumovax and one year after the Prevnar 13).

This means that everyone over 65-70 should have at least two pneumococcal vaccinations and maybe three, depending on their age when they received the first Pneumovax. This is complicated but should result in a substantial health benefit. Seniors should expect their primary care doctor to be order these vaccinations for them. If you have any questions, do not hesitate to ask your doctor.

The other vaccinations everyone should have are Zostavax (shingles shot) one-time (but not if you have problems with your immune system), and tetanus every 10 years, with one of these being Tdap — tetanus, diphtheria, pertussis. And, of course, influenza vaccinations every year are a must.

Remember, an ounce of prevention is worth a pound of cure, and vaccinations are one of the best forms of prevention.