Tag: health care

Caring for our seniors

Louis Brier Home and Hospital. (photo from cjnews.com)

“Louis Brier offers our residents variety in programming and services, as well as safe and quality care. Residents and families remain the primary decision-makers for the care received, as resident and family-centred care is at the core of our goals. All care is governed by our Jewish and professional values and standards of excellence,” Angela Millar told the Independent.

Millar is the director of quality and risk management, accreditation and resident experience for the Louis Brier Home and Hospital and Weinberg Residence. She was responding to questions from the Jewish Independent about the 2017 British Columbia Residential Care Facilities Quick Facts Directory, published by the Office of the Seniors Advocate (OSA). The directory “lists information for 292 publicly subsidized facilities in British Columbia that offer residential care services to seniors,” including Louis Brier.

The information was “gathered primarily from residential care facilities, health authorities, the Ministry of Health and the Canadian Institute for Health Information.” The data on licensing incidents and complaints is from the 2015-16 fiscal year, while the “inspection data was a snapshot taken on Dec. 7, 2016.” The 2017 OSA report can be found at seniorsadvocatebc.ca and the most recent inspection information from Vancouver Coastal Health at inspections.vcha.ca.

Millar explained, “Louis Brier is an affiliate of Vancouver Coastal Health, providing residential care for seniors. Vancouver Coastal Health provides an annual operating budget and Louis Brier Home and Hospital also receives donations from the Louis Brier Jewish Aged Foundation, which provides music and art therapy, Jewish culture and synagogue, kosher food and supplementation of medical equipment.”

The OSA directory mentions the Louis Brier Jewish Residence Society, as well as separate resident and family councils.

“The resident council represents the seniors who live at Louis Brier, ensuring they have a voice in how their home is run,” said Millar. “The council is supported by staff and meets monthly to discuss concerns, develop suggestions and plan activities. The executive director of resident care services and the chief executive officer attend meetings to provide updates, answer questions and develop plans to address concerns where needed.

“The family council is an independent group of family members and friends who meet monthly to support each other and advocate for the seniors residing at Louis Brier. A staff member liaises with the council and senior management team, who are often invited as guests. The family council acts as a forum to share experiences, learn and exchange information.”

In the 2017 OSA directory’s statistics on care services and quality, Louis Brier performed better than the B.C. average in percent of residents receiving physical therapy (34.3% versus 13.2%) and occupational therapy (10.3% versus 7.6%) but not in percent of patients receiving recreation therapy (1.1% versus 27.9%). With different percentages, Louis Brier fared similarly in the OSA’s 2016 report.

Noting that the data collected for the OSA report is “a snapshot at one time in a period,” Millar said, “I believe that the data is collected utilizing a seven-day observation tool throughout only one week in a quarter. Of course, my personal concerns are related to the validity and reliability of the data that is reported and thus the ability to generalize or glean valuable information from that data.

“My concerns aside, data collection is only looking at therapeutic interactions of the rehab team with residents – one PT/OT [physical or occupational therapist] per four residents and one rec therapist per eight residents – unfortunately rehab and rec resources [do] not abound, and our aim is to maximize the outcome and benefit to as many residents as possible given the resources that we have. As such, many of our programs and interventions are designed to accommodate larger groups of residents and most likely beyond the guidelines of the seniors advocate data collection parameters. It would help to understand how these parameters have been established and whether they have been evaluated for reliability in terms of producing valid data to help draw conclusions in relations to quality of care and residents’ outcomes.”

Millar emailed the home’s May recreation calendar, which can be found at louisbrier.com/events, “as an example of the plentiful and very rich programming that we are proud to provide our residents.”

In the 2017 directory, Louis Brier fares better than the provincial average in many areas: there were no substantiated licensing complaints and no reported incidents of disease outbreak or occurrence, abuse or neglect, food poisoning, medication errors or missing or wandering persons. With respect to falls with injury or adverse event, there were 5.1 per 100 beds, compared to a B.C. average of 11.9; and, in the category of other injury, 1.4 per 100 beds at Louis Brier compared to a provincial average of 1.6.

There is only one measure in which Louis Brier fared lower than the provincial average in the 2017 directory. In the year examined, there were nine reported incidents of aggression between persons in care at Louis Brier, or 4.2 per 100 beds, as compared to the provincial average of 1.5 per 100 beds; the 2016 OSA directory lists zero such incidents at the home.

With respect to four other quality measures, Louis Brier fared better or comparable to the provincial averages in three areas – percentages of residents diagnosed with depression, residents receiving depression medication and use of daily physical restraints. However, with respect to the percent taking antipsychotics without a diagnosis of psychosis, 40.8% of Louis Brier residents who were taking antipsychotic medications had not received a diagnosis of psychosis, compared with the B.C. average of 26.9% in the 2017 report, and 41% versus 31% in the 2016 report. As well, the OSA directory reports that, while 16.2% of Louis Brier residents had been diagnosed with depression, 48.1% of residents were receiving depression medication; in the 2016 directory, the respective figures were 21.1% diagnosed and 52.3% receiving depression medication.

“Your specific question with regards to prescription of specific treatments, medications and diagnoses is not something that can be responded to in a simple way…. While nursing staff are responsible to deliver care to the residents every day of the year, they, however, have limited control on what and how medications are prescribed and why,” said Millar. “Nurses advocate on behalf of the residents and may raise questions and awareness, however, changing physician practice or implementing best practices as it is related to the medical field and residential care are an entirely different area for discussion and attention. To understand and evaluate whether medications and treatment are prescribed appropriately requires a comprehensive approach by both the nursing and medical staff. We are certainly committed to ensure our residents receive safe, quality care and are continually monitoring medications and treatments as possible.”

Millar explained, “Louis Brier is regulated by the Community Care and Assisted Living Act, as well as the Hospital Act, which is enforced by Community Care Facilities Licensing.

“Currently the facility is showing its commitment to quality care by preparing for an Accreditation Canada Survey in May of 2018. Accreditation Canada will assess our organization against standards of excellence with regards to leadership, long-term care, medication management, infection control and governance.”

She described Accreditation Canada as “a significant wealth of information and resource for organizations in their quest to improve and achieve the highest level of care and quality possible within the industry” and invited the Independent and its readers to the Louis Brier Accreditation Fair on May 23 “to learn more and see how you can get involved.”

Millar noted that Louis Brier also has “just developed a quality and risk portfolio including a director of quality and risk management [QRM], manager of QRM, an infection control practitioner, as well as a QRM coordinator. Within this team, there are also individuals responsible for resident experience, including social work, volunteer coordinator and the manager of the companion program.”

As for staffing levels overall, Millar said, “I believe that there could never be enough staff and resources; however, we do have to work within our funding boundaries, given what we have. We can say with great confidence that Louis Brier has, most likely, more resources in terms of rehab and recreation staff than many other organizations (mainly because we are so greatly supported by the Louis Brier Foundation): we have over 300 volunteers and over 100 companions that help us deliver outstanding care to all of our residents. To that end, Louis Brier shares a common goal with the seniors advocate – of providing safe, quality care to our elders. Furthermore, Louis Brier certainly supports the efforts and intention of the seniors advocate in evaluating and advocating for additional resources to be allocated to the long-term care sector to help providers support and deliver excellent care to our seniors.”

Docs cover range of topics

The Jewish Seniors Alliance Spring Forum featured Dr. Saul Isserow, left, and Dr. Larry Goldenberg. (photos by Binny Goldman)

“If I had known I was going to live so long, I’d have taken better care of myself” – Eubie Blake

Approximately 120 people attended the Jewish Seniors Alliance Spring Forum on May 7 at the Peretz Centre for Secular Jewish Culture. Called Ask the Doctors, it featured Dr. Saul Isserow and Dr. Larry Goldenberg, who were ready to answer the audience’s many questions.

JSA president Ken Levitt welcomed the crowd, thanked them for giving up a sunny gardening day to attend the workshop and support the JSA, whose new motto is “Seniors, Stronger Together.” He explained that, in joining together and striving for common causes, we are stronger.

photo - Jewish Seniors Alliance first vice-president Gyda Chud, left, president Ken Levitt at the JSA’s Ask the Doctors forum on May 7
Jewish Seniors Alliance first vice-president Gyda Chud, left, president Ken Levitt at the JSA’s Ask the Doctors forum on May 7. (photo by Binny Goldman)

Gyda Chud, first vice-president of JSA, introduced Isserow, who is the director of cardiovascular health at Vancouver General Hospital and of cardiology services at the University of British Columbia Hospital, as well as the medical director of Vancouver Coastal Health’s Healthy Heart Program, among other things. She also introduced Goldenberg, whose many credentials include the founding of several programs, such as the Vancouver Prostate Centre, where he is director of development and supportive care, and the Canadian Men’s Health Foundation; he is also a professor in the department of urologic sciences at UBC. Goldenberg was inducted into the Order of British Columbia in 2006, awarded the Order of Canada in 2009 and received the Queen’s Diamond Jubilee Medal in 2012.

Isserow’s topic was How to Stay Away from the Chevra Kadisha (the Jewish Burial Society). He started his talk with humour – saying that the man who asks the best question will win a finger up his tuches (bum) by Goldenberg, referring to a prostate exam – and used humour throughout to make the sad facts of aging more palatable.

Using slides to illustrate his points, Isserow stated that hardening of the arteries starts when we are young. He likened the process to a bagel, which begins to harden on the perimeter. When the blockage reaches the centre of the “bagel,” that is when the heart attack occurs. To keep things in perspective, he described life as “a sexually transmitted disease with 100% mortality.”

He discussed many risk factors: age, obesity, genetics, hypertension and smoking. He strongly suggested that diet and exercise could halt or reverse immediate risks but, unfortunately, there are no reliable warnings and heart attacks come out of the blue.

Movement is strongly encouraged, said Isserow. Just walking 10 minutes a day is a start to reducing the risk of diabetes and obesity. Walking one hour a day can reduce the risk of heart disease by 35%, he said, and the Mediterranean diet of fresh vegetables and fruit, healthy fats and whole grains, can improve health by 27%.

Isserow presented studies showing that aspirin reduces heart disease significantly. Although statins may be necessary, there are possible side effects, such as aches and pains, he said. He ended his talk by saying that health is up to the individual: walk once a day, eat well and take medications as required, when the risk is high.

Goldenberg said that one reason men die 4.4 years younger than women is the “I will not, cannot, Sam I am” syndrome, paraphrasing lines from the children’s book Green Eggs and Ham by Dr. Seuss. Many men are unwilling to reduce their drinking, smoking and/or poor eating habits, he said.

The government is trying to develop expertise in communicating effectively with men about their health, connecting with them in a way that creates the space, freedom and encouragement for positive changes in their health awareness, attitude and behaviours, said Goldenberg.

Doctors are increasing awareness with the slogan of “precision, prevention and preemptive,” he said, recommending precision and personalized communication in telling men what you want them to hear. Get males to engage in their health discussions, he suggested.

In an effort to increase engagement, Goldenberg initiated the website dontchangemuch.ca. He gave a few examples of small changes that would help: ordering half a salad and half fries, parking the car further away from your destination and walking an extra block or two.

He also referred to the Canadian Men’s Health Foundation’s youcheck.ca, “a health awareness tool built specifically for men,” according to its homepage, and he spoke of “manopause” – aging and a lower level of testosterone lead to a lower libido, crankiness, fatigue and the onset of heart and bone disease. Low testosterone has an impact on the body but there is no consensus as to solutions, said Goldenberg. Doctors need to monitor any symptoms that seem worrying, he said, adding that men need women to guide them and to emphasize that their behaviour can be changed.

An active question period followed. In no particular order, some of the responses included the following.

Aspirin can reduce blood clotting, as can diet and exercise. If you are doing all things right but your CT scan shows calcified plaque, then focus on diet, exercise and statins. People should have a base line for everything – having a colonoscopy or, for men, a test for PSA (prostate-specific antigen) levels, for example – and be aware of family history.

Tiredness could be the result of sleep disturbance, low mood or loneliness, but heart health should be checked. Beta blockers can cause fatigue because of a reduction of blood flow.

Stress management is critically important and stress levels can be related to many things: mental and physical well-being and reduction of cholesterol. Sex is healthy for overall well-being.

After the session ended, Larry Shapiro, second vice-president of JSA, presented the doctors with tokens of appreciation. Continuing with the humour that had been present all afternoon, he said, “Vive la différence!” referring to the many differences between men and women and their approaches to health.

Chud said she had seen a sign in the Weinberg Residence saying, “Never live in a community where there are no doctors,” and she wanted to add “a community without Drs. Isserow and Goldenberg.”

Stan Shear videotaped the forum, and JSA staff and volunteers deserve kudos for putting it all together.

Binny Goldman is a member of the Jewish Seniors Alliance of Greater Vancouver board.

 

Books for people with dementia

Eliezer Sobel created L’Chaim: Pictures to Evoke Memories of Jewish Life with his parents in mind. (photo from Shutterstock)

Eliezer Sobel’s new book, L’Chaim: Pictures to Evoke Memories of Jewish Life, was born from personal experience.

Sobel is an artist at heart and has spent his life finding ways to interact with people – through writing, facilitating workshops and running retreats over the past three decades. Three years ago, on his parents’ 67th anniversary, things took a turn for the worse.

“My mother is in her 17th year of Alzheimer’s and is 93,” Sobel told the Independent. “My dad was fine and taking care of her at home until he was 90. On their 67th wedding anniversary, he fell down the stairs. He fell on his head and almost died. Overnight, there were two dementia patients in the house.

“Prior to that, he was driving, cooking and shopping, as well as hiring and handling the payroll for a team of seven aides. He was amazing with it. Suddenly, overnight, I had a brain-damaged dad at 90 years old.”

Sobel and his wife lived in Virginia at the time, which is seven to eight hours away from New Jersey, where his parents lived. After the accident, however, they moved into his parents’ home.

photo - Writer Eliezer Sobel’s parents, Manya and Max, in 2016. They were the inspiration for Sobel’s series of picture books for readers with dementia
Writer Eliezer Sobel’s parents, Manya and Max, in 2016. They were the inspiration for Sobel’s series of picture books for readers with dementia. (photo by Eliezer Sobel)

“We stayed in the house for 10 months, taking care of my parents and trying to get the right kind of help in the house that would enable us to eventually move out,” explained Sobel. “But we stayed nearby so we could monitor and manage the scene.”

His dad recovered a substantial amount of his cognitive and physical ability, but passed away this past November.

The work on the book goes back to 2011. “She didn’t speak English words anymore,” said Sobel of his mother at the time. “She would sometimes make up her own language and sounds. She stopped reading, as far as we knew.

“One day, I came upon her accidentally…. She was flipping through a magazine and I overheard her reading the big print headlines out loud, in English, correctly. I was totally floored. Mom can still read, even if it’s just a three-word phrase.”

Sobel wanted to run out and buy his mom a picture book, one designed for Alzheimer’s and dementia sufferers, but he couldn’t find one anywhere. His next thought was to use a children’s picture book, but he was unsure whether his mother could negotiate a book with a storyline. He wanted each page to stand on its own, so it would not require the reader to recall what had happened on a previous page.

“I called up the national Alzheimer’s association and spoke with their chief librarian for the whole U.S. and her response to me was to say that there were 20,000 books for caregivers of those with memory loss,” said Sobel. “I said, ‘I am not looking for [a book for] the caregiver, I’m looking for my mother, the patient. There was dead silence on the other end of the line. She couldn’t think of any such book. Eventually, she did mention one other author who has since become an acquaintance of mine who had a few books, but they weren’t really what I wanted, so I realized I had to do this myself.

“I first did a book that wasn’t just for Jews. It was for anyone with memory loss. It was called Blue Sky, White Clouds, and came out in 2012.”

Sobel – who has also written a novel and a memoir – received such a positive response to this first picture book that he decided to make it into a series.

“My mother got to enjoy the first book a lot,” said Sobel. “Her aides would use it with her almost daily. We would observe that she would zero in on particular photos, ignore certain pages, find a photo – particularly one of a married elderly couple – and contemplate it for 20 minutes and caress the faces.

“These books are for a particular stage of dementia,” he said. “They’re appropriate for someone who’s got enough memory loss and dementia that they won’t be offended or have awareness that this is kind of a simplistic picture book, they’ll just be interested. But they can’t be too far gone, like my mother now, who can’t even look at my face, let alone my book.”

Caregivers often struggle with how to engage people with Alzheimer’s.

photo - A page from L’Chaim: Pictures to Evoke Memories of Jewish Life
A page from L’Chaim: Pictures to Evoke Memories of Jewish Life. (photo by Olaf Herfurth)

“It’s very hard to find activities to do with someone in that condition,” said Sobel. “So, what I was trying to accomplish was to give caregivers something they could share with the patient … or give patients something they could use on their own…. It was an opportunity for sharing to occur, an activity of quality time. For certain pages, in the earlier stages [of dementia], it stimulates memories, conversations, reminiscences or free association.

“I’m from the creative right brain of things, so I could find things to do with my mother, like empty a box of coins on the table and we’d spend an hour playing with them – pennies over here, stacking the quarters, making a picture of a house with the dimes. Then, I’d say to my dad, ‘See, Dad! There are lots of things you can do with Mom. You could put these coins away and do the same thing tomorrow. She won’t remember.’

“He would call me the next day, and say, ‘Ah, it didn’t work. She didn’t know the difference between a penny and a nickel.’ That was the point. He’s a mathematician and very linear … [he] could not break into the play mode. If you’re someone who’s good with little kids, you can do that with someone like my mom.”

In some ways, Sobel often finds himself feeling grateful to Alzheimer’s, because it made it possible for him and his mother to grow closer – at least for the first 10 years of her disease.

At the beginning, Sobel saw her become more available. As a Holocaust refugee, she had always been very insulated, private and afraid of others. Sobel said he went to a psychic early on in her disease, worried that his mother was losing her memories, and the psychic thought she’d be happier without them.

“It was true,” Sobel reflected. “She transformed from that scared refugee into an open, childlike, loving, laughing angel. People would feel blessed to be around her. She was delightful – greeting strangers and striking up conversations that made no sense. She and I laughed about who knows what. She and my father would dance to music. A lot of things were happy about her Alzheimer’s experience.

“I’m not saying there weren’t nightmarish times. We had our share of those as well,” he added. “She went through a violent period where she was chasing people with steak knives. We had to put her into a psych ward for 10 days.”

That was the exception, though, and Sobel said, “I had an opportunity to finally heal my relationship with her.”

Rebeca Kuropatwa is a Winnipeg freelance writer.

Diamonds at Shalva opening

The new Shalva National Centre in Jerusalem officially opened on April 27. (photo from Shalva)

History was made on April 27, when hundreds of friends and donors traveled from around the world to gather in Jerusalem to celebrate the grand opening of the new Shalva National Centre. The day began with a rendition of “To Dream the Impossible Dream.”

photo - Leslie Diamond
Leslie Diamond (photo from Shalva)

“I fell in love with the concept that Shalva represents,” said Jerusalem Mayor Nir Barkat. “It is an icon and a role model for the world. Shalva has shown innovation in dealing with children with disabilities and I believe it will create ripple effects around the world.”

Leslie and Gordon Diamond, who dedicated the centre, flew in from Vancouver with family and friends. In addition, they dedicated the Steven Diamond Sports and Wellness Centre in memory of their son, Steven. With its semi-Olympic pool, large therapy pool, fitness centre and gymnasium, it is a significant gift of wellness to the Shalva children, their families and the broader community. Also dedicated was the Shalva Inclusive Parks in memory of Ambassador Ronald E. Arnall.

“Shalva epitomizes tikkun olam, making the world a better place and respect for family dignity. I am sure that Shalva will serve as the gold standard in its field for many years to come,” said Gordon Diamond. “For me and my family, it is an amazing honour to help this institution. Imperfection is inevitable in this world. We cannot make this a perfect world, but this is where society can shine. There is no more shining model than Shalva.”

“We have built a centre of excellence, full of colour, a magical place for the children of Shalva,” said Shalva chairman Avi Samuels. “We are humbled to open this state-of-the-art facility.”

photo - Gordon Diamond, reading into the microphone 
Gordon Diamond, left, with Shalva co-founder Kalman Samuels, who is holding the mezuzah. (photo from Shalva)

MK Chaim Katz said, “This is a huge day of giving. There’s so much heart and so much soul. I am bursting with pride to know that these world-class facilities are available right here in the state of Israel.”

The ribbon-breaking ceremony began with the sounding of 10 shofars. Barkat said, “When people come to the city of Jerusalem, they ask me what they should see. I tell them to go see the City of David so they see their roots. And then I tell them to go and see Shalva. People who enter this centre do not go out the same people. This place changes them.”

Kalman Samuels, who founded Shalva 27 years ago with his wife Malki when their infant son became blind and deaf following a faulty vaccination, thanked the audience of philanthropists, dignitaries and well-wishers. He said, “Your boundless love and your selfless care for your brothers and sisters with disabilities makes this earthly site heavenly.

I have gratitude to the Almighty and gratitude to each of you who continue to impact precious lives.”

Looking to Brier’s future

Louis Brier Jewish Aged Foundation’s new executive director, Stephen Shapiro. (photo by Lauren Kramer)

It’s been awhile since Louis Brier Jewish Aged Foundation had an executive director, but the fundraising branch of the organization is in good hands since Stephen Shapiro took the position in January.

A Calgarian who moved to Vancouver in 2000, Shapiro comes with impressive credentials. He served as president and chief executive officer of St. Paul’s Hospital Foundation for five years, fundraised at the University of British Columbia with former university president Martha Piper for six years and was deeply involved in cultural affairs and youth direction at the Calgary Jewish Community Centre prior to that.

“I feel I’m at a point in my career when I’ve accomplished a lot in the non-Jewish community and I want to give back to my own community,” Shapiro told the Independent. “I really believe in the mission, philosophy and work this particular institution does. I think our Jewish seniors are a very important part of our community and, with the history they represent, they should be treated with dignity and respect in their later years.”

Shapiro intends to grow the foundation from its current annual fundraising target of between $1 million and $1.2 million. He hopes to at least double that target in the coming years and sees lots of potential opportunities to fundraise in the non-Jewish community.

“Much of Louis Brier is publicly funded,” he said. “There are 215 beds this side of the organization that are contracted through Vancouver Coastal Health Authority, and 40% of our population is non-Jewish. But 99% of the donors to this organization are Jewish. So, part of my mandate is to bring my knowledge of fundraising in the non-Jewish community to apply here.”

Louis Brier is at a crossroads, he added, with much of the building at the end of its lifecycle. Still, a complete redevelopment plan is a number of years away, which means two distinct fundraising efforts are required. “We’re raising money for what we need in the next five to seven years, as well as planning longer term down the road for a potentially new campus,” he said. “Right now, our job is to look after today’s needs and today’s current residents, until such a time that we can build a new facility.”

Immediate needs include improved lounges, better furniture, new freezers in the kitchen and updated security and computer systems, he said.

“The practice of care has changed and evolved and we have to change with that,” Shapiro explained. “Certain things are no longer acceptable – for example, parking people in a hallway to look out the window all day because there’s not enough lounge space. That kind of thing is not considered OK anymore. With some physical improvements and relatively minor renovations, we can do things that improve our lounges and public spaces.”

Because Louis Brier is the largest contracted facility within the Vancouver Coastal Health Authority, now is a crucial time to make these upgrades, he added. “Given the size and demographics of the Jewish community, there’s a whole generation of people who are going to need our services quite soon. If anything, given the aging of our population, I think the Jewish needs at Louis Brier will rise, not diminish.”

Shapiro hopes to motivate non-Jews who have family members at Louis Brier to give back to the institution by finding projects in research and best practices that might be of interest to them. “Whether it’s in partnership with UBC or other institutions, promoting excellence in research and clinical care is the way to go here,” he stated. “Everybody could potentially have an interest in that.”

Lauren Kramer, an award-winning writer and editor, lives in Richmond. To read her work online, visit laurenkramer.net.

More bridges to build

The entire Jewish community was shocked to witness a spike in antisemitic vandalism in November, with incidents reported in Montreal and Toronto, and at three synagogues and a Jewish community centre, as well as at non-Jewish sites, in our nation’s capital.

The Centre for Israel and Jewish Affairs (CIJA) worked closely with targeted institutions and local police to ensure effective measures were taken to protect the community in Ottawa, and the police arrested a suspect who now faces serious criminal charges.

While these ugly crimes remind us that antisemitism – the world’s oldest hatred – still exists, solidarity demonstrated by many proves we are not alone in this battle. Countless leaders, including the prime minister, various members of Parliament, the mayor of Ottawa, police officials, the United Way, and leaders in the Christian, Sikh and Muslim communities, have denounced these incidents. In so doing, they have reminded us of the value of our efforts to build bridges with non-Jewish leaders and communities. Our voices are stronger when united in common cause. From the many communities whose interests, values, and concerns we share, I highlight just three recent examples of CIJA partnerships making an impact.

In October, CIJA was honored to meet with His Holiness Mirza Masroor Ahmad, caliph of the Ahmadiyya Muslim community. Numbering some 10 to 20 million globally, Ahmadis face persecution in much of the Muslim world. In Pakistan, they are denounced as “non-Muslim,” face systemic discrimination and are the target of harassment and terrorist attacks.

CIJA has built a relationship with the Ahmadiyya community of Canada, with whom we have established dialogue and joined in calling on the Canadian government to prioritize religious freedom abroad. The caliph (a non-political position) recently commented on the thriving Ahmadi community near Haifa and underscored his community’s belief in the need to respect all faiths. Canadian Ahmadiyya leaders have shared both their appreciation for Israel as the freest country in the Middle East and their opposition to boycotts targeting the Jewish state.

CIJA continues to enjoy warm friendships with several major Christian organizations, including the Canadian Conference of Catholic Bishops (CCCB), the Evangelical Fellowship of Canada and various mainstream Protestant denominations.

Last November, CIJA and the Canadian Rabbinic Caucus launched a partnership agreement with CCCB, including a shared commitment to join forces in countering antisemitism and hatred in all its forms. We’ve since worked with CCCB on issues as diverse as Holocaust commemoration, the persecution of Middle East Christians and – in a unique Jewish-Catholic-Evangelical-Muslim partnership – a campaign calling for a national, well-funded palliative care strategy. This latter issue is especially crucial given Canada’s aging population and evidence that far too many patients cannot access high-quality end-of-life care.

We have also mobilized the support of various Christian groups and others, including Sikhs and Muslims, in our effort to strengthen Canada’s hate crime laws. Currently, vandalism targeting places of worship is automatically treated as a hate crime with serious penalties, a designation not applied to incidents involving community centres and schools associated with an identifiable group. Working with our interfaith partners, we are urging MPs to support Bill C-305 to close this loophole in the Criminal Code.

And, while Canadian society has witnessed a generational shift regarding LGBTQ rights, many in this community continue to face bigotry. CIJA is proud to be part of the four-member executive committee overseeing Trans Equality Canada, a coalition leading the advocacy efforts for Bill C-16, which extends hate crime and anti-discrimination protections to the transgender community. This historic legislation passed the House of Commons in November and is now with the Senate.

CIJA’s role in this campaign is unique. We’re the only ethnic or religious community organization at the forefront of what is, arguably, the most important issue concerning the Canadian LGBTQ community today: the rights of transgender Canadians.

This work mirrors the efforts of local CIJA offices and grassroots Jewish groups across Canada building ties with their respective LGBTQ organizations and Pride festivals. For their work in Montreal, our team received an award from the LGBT Chamber of Commerce of Quebec.

These relationships don’t just advance human rights. They help ensure we have allies within the LGBTQ community when anti-Zionists attempt to import their bigoted agenda into Pride, just as, in October, Halifax Pride voted down a resolution to ban any mention of Israel from its events.

This is just a sample of the partnership work we’re doing to build a better society for the Jewish community and all Canadians. But it’s a work in progress, and there are countless communities with whom we will seek opportunities to strengthen ties through issues of common cause. If you have suggestions or would like to get involved, connect with us at info@cija.ca.

Shimon Koffler Fogel is chief executive officer of the Centre for Israel and Jewish Affairs.

Rare transplant

Prof. Eytan Mor, left, and Dr. Evyatar Nesher with a kidney transplant recipient at Petach Tikvah’s Beilinson Hospital, which is part of the Rabin Medical Centre. Mor is director of the transplant department and Nesher, the department’s deputy head. (photo from Ashernet)

About nine years ago, a 55-year-old woman with a congenital kidney disease underwent a kidney transplant in the Philippines. Last week, she died following a stroke and her brother, who suffered from the same congenital disease and needed a transplant, received his sister’s kidney, which was still viable, though she had died. This was the first time such a surgical procedure had been performed in Israel, and it is thought that this procedure has been performed only five times in the world. This is also the first time that such a transplant has been carried out between family members. It is hoped that this landmark operation will encourage more live donations of kidneys.

Caring for people at life’s end

Henry Fersko-Weiss, president of the International End of Life Doula Association. (photo from Henry Fersko-Weiss)

Doulas offer support to expectant mothers, guiding women and their partners through the childbirth process and into their first steps of parenthood. Now, a similar concept is gaining ground to fill a need at the end of our lives.

Fear, exhaustion and uncertainty often leave us unsure of how to best support a loved one during their last days, while we also try to deal with our own impending loss.

The idea for end-of-life doulas was conceived by licensed clinical social worker Henry Fersko-Weiss, who works in hospice care in New York and New Jersey.

“There seemed to be a gap in the services that were traditionally available to people,” Fersko-Weiss told the Independent. “As wonderful as hospice is in the U.S., where most people die in their own homes – which is the ideal, unless there’s a cultural reason not to – that’s when people really need help the most.

“They recognize that death is very close and now they can’t avoid thinking about it. They are exhausted and the care demands have increased. They need more help than they were able to access through normal programs. So, I started to think about how to figure this out … and, at the time, a friend of mine was learning how to become a birth doula.”

Fersko-Weiss had not heard about doulas before then. But, as his friend shared with him what she was learning in her training, he increasingly felt this would also be an ideal way to approach the end of life.

“There are a lot of tremendous similarities between birth and death, clear differences as well,” he said. “I became intrigued and started learning more about birth doulas. And, I took the training myself, so I would learn exactly what they were learning.”

By then, Fersko-Weiss was convinced that there were many tools, techniques and principles of care from the birthing world that could be transferred in a very positive way to the end-of-life sphere. So, he went to Carolyn Cassin, the chief executive officer of Continuum Hospice Care in New York City, where he was working at the time, and presented the idea to her. She encouraged him to follow it through.

By 2015, Fersko-Weiss had established a not-for-profit organization that trains and supports end-of-life doulas.

“Currently,” he said, “my work is focused on promoting the use of end-of-life doulas through organizations that care for people at end of life, as well as training people publicly and helping them to achieve certification through the organization that I head: the International End of Life Doula Association.”

To create the program, Fersko-Weiss incorporated some of the concepts from the birth doula training, such as visualization and guided imagery, techniques used by birth doulas to help ease pain.

“I started building on that and writing the training, looking for material that would support some of the things that were important and created a model of the different phases of care that this would offer,” he said. “At that first training, I had 17 people. Once we went through that first training, which was a weekend – which has become the standard for us, about 22 hours – we went on and kept training, and developing the program, and serving patients and their families.”

There are three phases to the model Fersko-Weiss has created, the first of which is summing up and planning. This occurs as early as possible, when the patient and the family are shifting their focus to end-of-life comfort care and away from a cure.

“But, even if they were still focused, to some degree, on a cure, parts of what we do would still make sense, probably even months before somebody would be at the point of dying,” said Fersko-Weiss. “We work on exploring the meaning of their life, as they look back over their life, and help them think about what they might want to leave behind as a legacy that reflects that meaning that they’ve uncovered or what they think is important for their loved ones and friends to remember them by or to carry into their lives.”

Psychologist Erik Erikson has examined the different developmental stages that we go through within our lifespan and refers to the last of these stages as “integrity versus despair.”

“When somebody is dying and facing death, they are automatically propelled into that final developmental stage, no matter what age,” said Fersko-Weiss. “In that stage, they have to contend with coming to the point of a positive completion of their life as they go through reviewing their life. Or else, they move towards despair, anguish and feeling that their life either didn’t matter or didn’t fulfil their dreams.”

The other aspect of the first phase of Fersko-Weiss’ program is planning what one’s last days of life will look like. This entails finding out what would be most helpful to them and their family to allow those last days to unfold in a way that honors who they are, carries deeper meaning for everyone involved and makes it easier for the person to approach death.

The second phase of the program is when the person is actively dying, which generally comprises the last two to four days of life.

“We stay with people as much as possible, around the clock,” said Fersko-Weiss. “We help them understand what is coming next. We support the family emotionally and spiritually, and we assist with physical care in a basic way.

“We will stay [with the family] through the death,” he continued. “We will wait hours afterwards to give them time to process it and have the death experience sink in a bit. We sometimes call the funeral home for them, or friends, if they are too emotional. We stay with them through the body being removed from the home and also up to the point where they feel more comfortable being on their own.”

Phase three of the program has the doula returning to the family three to six weeks following the death to review and tell the story of the dying process. This helps the family see some of the many beautiful and loving things they did together during that time, reminding them how things went, as they may have not have been thinking clearly during that time due to the pain of loss.

“This is done as a way to reframe some of the negative pieces that they are carrying that may be coming back to them over and over again in their mind, and help them to begin the very early stage of grief, understand what grief work is about,” said Fersko-Weiss. “We help them through some of the early grief work and then refer them to programs in the community or within the organization that were perhaps involved with the care as well. We may, at that point, do a final ritual to bring closure to our work with them.”

The end-of-life doula service is provided primarily by hospice and out-care programs, which may be part of a hospital. Fersko-Weiss is working to spur interest in this service at assisted living facilities and nursing homes. This type of care is also starting to be done by groups of people getting together to provide the service to a dying person and their family.

Fersko-Weiss has been teaching at the Institute of Traditional Medicine in Toronto, doing a compressed form of the doula training he offers in the United States. Students attend classes one weekend a month for six months, and graduate as certified contemplative end-of-life-care practitioners.

“My understanding of hospice in Canada is that many people are very underserved,” he said. “There are a lot of people who are dying without the ability to access hospice care in Canada.”

Fersko-Weiss has also been working with a Canadian organization called the Home Hospice Association.

“They are still in the process of forming, but their intention is to provide home hospice in Canada and to solve the problem of lack of access,” he said. “Their intention is to build into that program the utilization of end-of-life doulas.”

Rebeca Kuropatwa is a Winnipeg freelance writer.

Taking care of elders

Cindy Greenlay, therapeutic recreation manager at Winnipeg’s Simkin Centre, is one of the first to admit that no one plans to retire and move into a care home. But, she explained, “Circumstances happen and the support we’re able to provide here is something needed in the community.”

On Feb. 18, the women’s philanthropy of Combined Jewish Appeal (CJA) in Winnipeg hosted an educational evening at the Simkin Centre on the centre’s programming. Daniela Jacobson, co-chair of women’s philanthropy, began the event, noting that the Simkin Centre “is our newest agency to the Jewish Federation of Winnipeg.” She then gave the floor to Greenlay.

photo - Simkin Center’s therapeutic recreation manager, Cindy Greenlay
Simkin Center’s therapeutic recreation manager, Cindy Greenlay. (photo by Rebeca Kuropatwa)

According to Greenlay, people don’t come to the Simkin Centre at the end of their lives to die – they come to continue living. Something about which the centre staff feel strongly is the importance of getting to know each of the residents individually. “We don’t assume that everyone who is 75 likes to play Bingo,” said Greenlay by way of example.

The staff meet with each resident several times and gather as much information about what he/she likes to do, so they can build activities to match. One of the most important things to understand, said Greenlay, is that residents have a lot of free time on their hands and the centre needs to fill that time with relevant programming.

“We need to do that every single day – 13 hours a day,” she said. “As 80 percent of our population is cognitively impaired, so we have some people here who make those choices…. We’re all trained in specific areas to adapt to different disabilities…. We have one recreation staff for every 40 residents. That person works five days a week to fill up this big piece of the pie.”

The centre’s programming is funded by the local Jewish federation and private donors.

“To brag a little bit, our facility is chosen every year by Red River College to bring the recreation students to,” said Greenlay. “The students come here every fall to see what they want to be when they ‘grow up.’ They shadow our staff every fall to see what the programs are supposed to look like.”

Until a year ago, Simkin’s spiritual health care was led by Rabbi Neal Rose, and it was based on a chaplaincy model. “Once Rabbi Rose retired, the board met and did some rethinking,” said Barb Findlay, the centre’s spiritual health care practitioner. “They researched what spiritual health could look like going forward. I think that in the whole world – and the Jewish world is not different – generally, people today are less religious and more spiritual. People use yoga and meditation and different ways to access the Divine. It’s interesting, as I go around and meet new residents and introduce myself, I get one refrain that I hear all the time, ‘Wait a minute. I’m not too Jewish.’ And, you know, actually, they are very Jewish.”

photo - Barb Findlay, Simkin Centre’s spiritual health care practitioner
Barb Findlay, Simkin Centre’s spiritual health care practitioner. (photo by Rebeca Kuropatwa)

Spiritual health has been recognized by the Canadian Medical Association and the Winnipeg Regional Health Authority (WRHA) as an integral part of the health profile, which includes physical and emotional health.

“Spirituality is defined as that which gives meaning and purpose to life, besides the physical,” explained Findlay. “The purpose of spiritual health is to symbolically walk beside people and to occupy that liminal space between what’s known and what’s not known in life.”

Although the overwhelming majority of people at the Simkin Centre are Jewish, the centre operates as the Victoria Hospital emergency placement location. As such, the spiritual health personnel have to provide support for people from all religions, including Buddhists, Catholics, Evangelical Christians and First Nations.

“What is important is their belief system and helping them to boost that and work with that for whatever needs they have,” said Findlay. “Israel has embraced this new profession. They named it the ‘livui ruchani,’ which is Hebrew for ‘spiritual accompaniment.’

“The Simkin population is roughly 200, and about 15 percent aren’t Jewish,” she continued. “The average age is 90, and about 85 percent of our people have some element of dementia. Ninety-six percent of elders live out their lives in the community with or without some supports, so, what we have here is a very small percentage of our elderly population – about four or five percent.”

Dr. Harvey Chochinov, a geriatric psychiatrist in Winnipeg, has dedicated much of his work focus to end-of-life care, and has found that distress at the end of life is usually connected with people feeling as though they are a burden.

“He’s developed a whole process which involves questioning and reflection, so we can help people review and rebuild, and hopefully move away from feeling they’re a burden for their loved ones,” said Findlay.

The evening’s talk ended off on a lively and light note, with Cindy Bass, the centre’s music therapist demonstrating how she engages residents. “Music memory is one of the last remaining faculties for the elderly population with Alzheimer’s disease,” said Bass. “For example, if you take a song like ‘My Bonnie Lies Over the Ocean,’ everybody knows it. And it’s been shown that some people who can’t speak anymore can still sing, which is also why it works well as therapy for stroke victims, helping them relearn to speak.”

Music can increase attention span and be very useful for the cognitively impaired, she added, as it opens new brain pathways, evidence of which has been seen using MRIs.

Bass led the crowd in a few songs to illustrate the power of music and she explained the many benefits gained through music, including the building of community ties and increased socialization, as well as its use in prayer and to enhance self-expression.

“Music,” she said, “provides people of all ages, regardless of disability, with ample opportunity for meaningful responses to all aspects of our environment.”

Rebeca Kuropatwa is a Winnipeg freelance writer.