Services Guide for Aged and Disabled in Israel

TLC

2008-12-11T22:32:00.000-08:00

I was recently asked to speak to a local Caregivers' Support Group and many people asked if I would make my speech available to them. So here is the content of the speech for all those caring caregivers and their support systems.

A friend recently sent me a joke list called Sayings of the Jewish Buddha, and, being Jewish, I could particularly identify with them, especially the one that goes: “Accept misfortune as a blessing. Do not wish for perfect health or a life without problems. What would you talk about?”

Here I am to talk about it, so I guess I have accepted misfortune as a blessing. I guess it also proves that I’ve managed to cope with it. Caregiving is no easy road to walk. I’m here to tell you that the road is not impossible or impassable. From my own experience I have found that the key to traveling it with a minimum of frustration and stress lies in our attitude and approach to the challenge.

Caretaking takes up every waking and sleeping moment. You’re tired, angry, stressed out and harbor feelings that make you feel guilty. To top it all off you never have any time for yourself.

Let me assure you that these feelings are normal and valid. We have been placed in an unenviable position and are asking ourselves “Why me?” and “Why does my loved one have to suffer?”

I’d like to read you part of an article by Dr. Bernie Kastner entitled “Why did God put us Here?” which may put things into perspective. He writes: “It is easy to go through the motions of our days, weeks, months and years and not ask ourselves, “What is it that God wants from me? Some of us tend to think it is our right to choose and become anything we want to be without checking in with Him. We enjoy the pleasures this world has to offer…and if our plans go haywire, we get angry at God for having the audacity to intervene.” He goes on to explain how special souls actually request to be sent back to earth for another incarnation in order to complete some tasks they did not complete in a previous one, and now they are here in their “seemingly limited capacities. Why?...in order to give … others around them the opportunity to do [kind deeds]. Here, take care of me so that you can grow in your deeds. I am here so that I could be an object of your love. Nothing more, nothing less….” Then he goes on to talk about us other people: “We ask for courage and humility before our journey into another life. As we grow in awareness, so will the quality of our existences. This is how we are tested. Passing this test is our destiny.”

I have regarded this challenge as an opportunity for self-improvement. I sorely was in need of more patience, tolerance, respect for the elderly, and love of every precious moment of life. My answer to the challenge has been to make the best of the situation and use it as a means of personal growth.

“Easy for her to say,” you say. No, it is not easy for me to say. I have gone through hell to get to this point—the same hell you’re going through—but once I changed my attitude, I felt calmer, less guilty and better able to cope.Let me briefly tell you what I’ve gone through over the past 18 years:

My husband and I cared for his mother who had Alzheimer’s for 10 years. After she died, my mother developed signs of dementia. In 2004 we moved from Jerusalem to Netanya to keep an eye on things, and three months later my father, who had been handling all the household chores and finances suffered a severe stroke. But wait—it gets better. Right after getting my parents resettled in their apartment after my father’s stroke, my mother developed a urinary problem. OK, off to the urologist to take care of her. When we got home I was ready to sit down and cry. My mother’s condition required that I catheterize her five times each day, or her kidneys were going to fail.

So that sets the stage for the emotional upheaval I went through and the drastic change in my lifestyle. Although I have a sister living in Israel, all the care for my parents was falling on my shoulders. For a long time I resented my sibling’s not helping me. I resented my predicament, I was angry at the world, I was depressed, getting less and less sleep, spending more and more time worrying about how I was going to keep track of everything and keep things under control, and I got to the point where I literally could not function. I took my frustrations out on the most convenient target and that was my husband, who, God bless him, has been my strongest support through this entire episode. I knew things couldn’t keep going on this way, because what good would I be to anyone if I couldn’t function? Here’s what I’ve learned from the experience:

First of all we have to understand the new reality, and come to terms with it. We have this picture that life is supposed to be perfect, this ideal that everything should go according to our plans. And then God steps in and says, “Wait a minute. Who’s running the show here?” And we suddenly find ourselves in an existence other than what we perceived as the “ideal” life we had until now.

So we have to reassess the situation and our expectations. We can either moan about our plight or we can set new goals and expectations. Change your vocabulary. Say: This is not a punishment, it’s just a new stage of life, and I am going to meet this challenge.

To meet this challenge one of the most important items on your agenda should be finding ways to lessen the tension and create more free time for yourself. If you’re wrung out, you won’t feel up to the task, and your patient will suffer.

Here are some of the changes I made:

A. I identified what things in my life I could control and what not. And I tried to stop getting upset about those things which I could not change.

B. I learned to say “no”. Just as I have learned to cope, so can others.

C. I arranged a clear filing system to keep track of documents.

D. I bought a Palm Pilot to record dates and appointments, and set alarms for reminders.

E. I listened to music and sang along with it. It really does pick up your spirits.

F. I had reflexology treatments and occasionally even splurged on a massage or took a leisurely walk on the beach.

G. I consented, after procrastinating for over a year, to my doctor’s recommendation that I take an anti-depressant. I also agreed to take sleeping pills.

H. At bedtime I’ll give myself a relaxing foot or neck massage.

I. When I felt I was about to crash, I announced to my sister that I was taking a break, and after preparing detailed emergency information lists, I went on a 12-day cruise with my husband.

J. I developed what I consider my therapeutic Method of TLC, my acronym for the activities of Talking, Laughing, Writing and Crying (I left out the W because somehow TLWC just doesn’t seem to strike the right note).

K. I took up my watercolors again. I started exercising at the gym and playing tennis. I feel better for it and my attitude has improved proportionally.

In my opinion attitude is everything. Instead of looking at the difficulty of the situation, find ways to enjoy it. Laughter is the best medicine and is documented to increase those endorphins in your brain that make you feel good. Even the action of smiling has this effect. This goes for the patient also. Find reasons to laugh. Share jokes, old memories of funny incidents or watch something funny on TV. Spend time with the grandchildren.

What did you used to do that brought you pleasure? Find creative ways to keep doing these things together. Perhaps you’ll have to take a shorter stroll or vacation, or something nearer to home. Or you’ll have to order special transportation and take some emergency equipment with you. So what? This is the new situation? Adapt to it and make it work for you.

Another attitude that is important to foster is that of the patient. Instill a feeling of worth in him. There’s nothing quite as demoralizing as the feeling that one is no longer of any value to society. Keep the patient active. Include him in decision making and give him a voice in his own care. Ask him to share his feelings. Because the patient’s life has already changed so much, he will tend to be resistant to further change, so try to keep to a routine. Treat him with the same respect you did when he was younger and “whole”.

I made a serious mistake in overprotecting my father after his stroke. I think it made him feel less of a man, and if I had it to do over again I would do it differently. But I try not to dwell on regrets, because this can only lead to feelings of guilt.

Ahhh, guilt. There’s a dirty word if ever I heard one. We feel guilty for not providing well enough for our patient, for neglecting other family members and friends, for harboring feelings of anger at the patient or at God, for taking time off, for making wrong decisions. And then we are hit with guilt feelings for being so insensitive to what our loved ones are going through: "I shouldn’t be feeling this anger, resentment and self-pity when the patient is really the one who is suffering so much more than I."

Well, I don’t know about you, but last time I checked I wasn’t wearing a blue stretchy under my clothes with a big yellow “S” on the chest. I’m not Superman! We’re all human and fallible, yet we think we must be everything to everyone whenever they want us, and then we feel guilty when we don’t live up to our expectations.

So lower those expectations. What we once viewed as the ideal “me” has to be redefined to fit the real me. Don’t expect to achieve everything, and you won’t be disappointed. You’re doing the best you can under trying circumstances. Don’t feel guilty for not doing it perfectly. Instead of allowing guilt to drag you down, use it to propel you take action against whatever is causing those feelings.

While I’m on the subject of feelings, let me point out that it is not uncommon to feel depressed and sad. Don’t be ashamed of it. Our situation has brought us face to face with our own mortality, and feelings of sadness are legitimate. I personally have had so many episodes of crying that I wondered where in heaven’s name all those tears were stored. It doesn’t solve any problems, but it does relieve stress and is a good way to reduce the tension that often builds up from our daily responsibilities. So go ahead and cry, but then wipe your eyes. Wallowing in self-pity is a waste of energy better spent in positive directions. Likewise anger, particularly misguided anger, is an exercise in futility. And each of these emotions feeds on the next, resulting in a vicious circle of wasted energy, wasted negative emotions and precious time lost. Let me give you an example:

Let’s say your patient is uncooperative: you can get upset, nag and shout and work the patient and yourself up into a real frenzy, or you can try a different approach, experiment with non-confrontational techniques. I remember once trying unsuccessfully to convince my mother to go for a certain test. No matter how much I tried to tell her how important it was, I made absolutely no headway. Finally I tried a different tactic: I asked her how she would feel if the situation were reversed, and I needed a test to help diagnose my condition? How would she feel if I refused to comply? Would she want me to go on being sick and untreated? This is what did the trick. Now there’s an example of using guilt to work for you in a positive manner.

There are times when frustration just gets the better of us. When you are feeling especially frustrated ask yourself “Is this situation working for me?” You know the saying ”if it ain’t broke don’t fix it?” Here’s the corollary: “If it ain’t workin, you better fix it.” And here are some proactive steps you can take:

1. If what you are doing is not working, change what you’re doing. Become inventive. Believe in yourself and trust your instincts. No one knows better than you exactly what the situation is, and how best to deal with it.

2. When you have a legitimate complaint, do not be afraid to stand up for your rights. If you don’t, who will? Do it courteously, but do it. Take emotion out of the picture and stick with the facts to make your point. I’ve encountered people in public offices that are extremely caring and anxious to help. But they are limited by regulations. Getting angry with them is like killing the messenger. Instead make them your allies. They really aren’t your enemy, but if you treat them as such, they will retaliate in kind.

3. Stay aware of what is happening in the moment. Don’t agonize about tomorrow or punish yourself over what you should or shouldn’t have done in the past. Now is what’s important. If you can get through now, you can turn your attention to other problems when things are calmer.
And finally I’d like to address adjusting to a whole new lifestyle:

You’ll find you need more sleep and are getting less. Not only that, you probably have a very disturbed sleep if you manage to sleep at all. Some imagery and breathing techniques work to ease the troubled state of mind that often prevents sleep. Don’t be ashamed if you need medication to relax you or to relieve depression. Whenever possible, try to sleep when the patient does.

Simplify your life. This may entail giving up sumptuous meals and relying on fare such as “Meals on Wheels”. Use disposable dishes and cutlery. You can place grocery orders by computer for home delivery, and some pharmacies provide a messenger service to pick up your prescription and then deliver the medication to your home.

Social activities may have come to a standstill. Hire a caretaker for a few hours a week and space the hours so that you can get a change of scenery and do whatever you feel will enhance your life. Invite friends over for short visits. They actually want to help you, believe it or not, so take advantage of their visits to treat yourself to a relaxing shower or manicure or whatever.

It also helps to keep a diary for venting your frustrations and emotions. Getting those thoughts off your chest and onto paper is therapeutic in itself. Writing my blog for Yad Sarah helped me get better in touch with myself and the situation and find humor in what could otherwise be a very depressing predicament.

Find joy in the simple things. There is much beauty around us if we take the time to notice. If you are the spouse of the patient, do what you can to make the patient feel loved and wanted. Sit together, reminisce, listen to music and verbalize your feelings. The idea is to go with the flow, change your pace to meet the new demands on you, support the patient and maintain as much quality of life as you can.

I have a friend who lost her husband to a neurological disease that causes progressive total paralysis. She told me that the final two years of his life were the best years they spent together. They had all the time in the world to pour out what was in their hearts, talk about the beautiful family they had raised and be thankful for the good times.

Before I close I just wanted to point out what a treasure trove you are. Do you know that the average price of nursing homes now runs at about NIS 10,000 per month? Pat yourself on the back. You deserve it. And you also deserve time off from your job, so be sure to take vacation to recharge your batteries. If it means finding a nursing home to house your patient in for a few days, then do it, without regrets. I’ll repeat it like a mantra and so should you: You are of no use as a caregiver if you yourself cannot keep going.

So this has been the story of my life and how I cope. I will leave you with one last bit of advice that I got from a friend who has been battling Multiple Sclerosis most of her life and also has had to undergo a liver transplant. If ever anyone had reason to feel sorry for herself and curse the gods, she is that person. But I have never known her to say an unkind word or complain about her fate. She taught me an important lesson in how to deal with life’s ups and downs. Whenever I would complain about something or someone that had gotten under my skin, she told me to put it on my “list of things not to worry about.” My advice to you is to go home and develop a list of things not to worry about. Go and enjoy your life whatever it may be. Your attitude will determine your state of mind. With a little TLC (and W) you’ll be better able to cope with giving yourself and your patient real TLC, tender loving care.

P.S. Yad Sarah has opened a website for caregivers to share their experiences. It's filled with inspirational, humorous and heartwarming stories and advice. Visit http://www.care2tell.com/ and share your experiences with us, or vote and comment on stories that others have shared. Looking forward to meeting you there!

Guide to Services for the Aged and Disabled in Israel
© Copyright-2008
This work is protected by copyright law. Use of this work or any portion thereof, including photocopying, publication, public production, distribution, translation, broadcast, allowing public access to it, and utilizing portions derived from it for other purposes, without prior written permission from the author is prohibited.

Part 10: Practical Tips to Ease the Way (Section 2 of 2)

2008-06-23T03:48:00.000-07:00

by
Shari (Zissie) Gitel
zissieg@walla.com

Now it’s time to discuss tips for keeping the patient well-dressed, fed, comfortable and occupied. Sounds easy, right? Well, with a little ingenuity and a lot of determination it isn’t all that hard. Let’s get started.

Fashion Design and Physical Education 101
If the patient is able to dress him/herself there are some nifty contraptions to aid the process. There is a device to help patients put on their socks without having to bend down to do it. Long shoehorns help with getting shoes to slide onto the feet. Avoid shoes with laces or buckles. Slip-ons or shoes with Velcro closures are the easiest to handle. Shirts, trousers and skirts without buttons or zippers speed up the dressing process. Simplicity is the name of the game, not haute couture.

In the event the patient is wheelchair-bound and sedentary or supine most of the day, you’ll need to protect the patient from pressure sores. Special pillows for chairs and air mattresses, which require electric pumps to keep them inflated, for beds help prevent these sores. There are many types of wheelchairs, some with reclining padded high backs and legs that can be raised to elevate the patient’s legs. Trays can be acquired to attach to the wheelchair. The patient should be encouraged to change positions several times during the day to prevent the same area of the body from receiving the bulk of his/her weight continuously. In hospitals, they place a folded flat sheet under the trunk of the patient’s body to help pull the patient up in bed or turn him/her over. This is a two-person job.

PREVENTING PRESSURE SORES IS A MUST!

Doorways in many homes do not accommodate the width of a wheelchair, walker or commode chair. Many homes do not have elevator access, or ramps. If your home falls under one of these categories, check with Lishkat HaBriyut to see how to qualify for altering your home to meet the patient’s needs. If you must carry a wheelchair-bound patient up or down stairs, it is easier to transfer him/her to a sturdy arm chair first. This greatly reduces the weight you will have to lift, as the wheelchair alone can weigh as much as 40 pounds or more. Again, this is not a one-person job.

Home Alone
If the patient is on his/her own for any portion of the day he/she may benefit from a long-handled reaching device—either to reach something on a high shelf or to pick something up off the floor. It is also worthwhile to bring in a professional to advise you on how to redesign rooms to make them patient-friendly. Cabinets, drawers, height of furniture—just about everything imaginable—come under this category. Eating and food preparation utensils can be purchased that make life easier for patients with manual dexterity problems. For patients who have difficulty swallowing thin liquids, there is a food thickener on the market that can be added to the liquids. For people who have difficulty getting food and drinks into their mouths spillage on clothes is a common occurrence. You may want to invest in disposable bibs for adults. If food preparation is a problem, many organizations and companies provide meal deliveries to the home, some of them subsidized according to the patient’s ability to pay.

Some other items you may want to have on hand, depending upon the patient’s condition are a blood pressure machine and inhalation machine. And let’s not forget one of the most important items: an alarm system for the patient to call for emergency help.

Patients with dementia should be taught to always put things back in their proper place: keys on a table by the door, glasses next to the bed, money in his/her wallet, etc. It takes a lot less time to spend an extra minute or two replacing the items in their proper location than spending several minutes or sometimes even hours trying to locate them. Carefully label items that the patient may have trouble identifying. Monitor the patient’s medications. There are medicine boxes of all types on the market for this purpose. Depending on the degree of the patient’s dementia, you may not want to give him/her access to medications at all.

WORDS TO LIVE BY: A PLACE FOR EVERYTHING AND EVERYTHING IN ITS PLACE!

Leisure activities should be encouraged to keep the mind and body sound. I have found that a discman/tape player with headphones (my daughter says I’ve dated myself and should really recommend an iPod) is a handy entertainment center. Whether it’s music, audio books, or lectures, the patient is bound to find something that will hold his/her interest. Large print books are available for the visually impaired. There are also many assistive devices to help the visually impaired enjoy the use of TVs and computers. Playing cards come with large numbers on them. If the patient can handle them, give him/her games to exercise the mind, such as Jumble puzzles, Sudoku, crosswords. These are readily available on the internet and can be printed in large type or enlarged on a copy machine to facilitate use by the patient.

Make sure the patient regularly exercises his/her body to the best of his/her ability. Keep those extremities limber and strong. Muscle atrophy is something you really want to avoid. You can purchase an elastic sash from your kupat cholim’s physical therapy department (at least that’s where we got ours). When the ends are tied together the sash, looped around the ankle and held in the patient’s hands, acts as an aid to the patient to raise his/her legs while sitting, thereby exercising the muscles. It can also be used in arm exercises, providing resistance as the patient stretches against it. Again, this is something you will want to discuss with the patient’s physical therapist.
Tricks of the Trade
For us, the caregivers, I also have some tips. Continue to breathe in and breathe out. This will keep us going for the short term. I found a little trick which works wonders for me, and I’m considering patenting it. Previously I mentioned how much benefit I received from reflexology. For those who are not familiar with reflexology, it involves the therapist pressing and massaging different areas of the foot which correspond to different areas on the body. After every session I felt extremely relaxed. One day I said to myself if my feet being relaxed makes my body relax, let me try an experiment. I am about to share my discovery with you. It’s something you can do any time day or night, and no one need even know you’re doing it. For me it provides instant relaxation. All it involves is wiggling your toes. Try it. When I wiggle my toes, my forehead relaxes and my back and shoulders are less tense. I hope it works for you, too. Another technique I have employed when I find myself clenching my jaws or grinding my teeth is repeating the letter “N” over and over. This relaxes the jaw and facial muscles. You may, however, want to practice some discretion in where you perform this particular exercise. Otherwise, people around you may decide you’re a good candidate for institutionalization! And do find time for yourself to get out and exercise to keep those endorphins flowing. Laugh as much as you can, because laughter is truly the best medicine.

This whole adventure in writing my blog itself has been therapeutic for me. I don’t know how helpful it has been for you (I sincerely hope it has been), but for me it just felt great to get a lot of things off my chest and transferred to paper. Perhaps writing down your frustrations and feelings can do the same for you.

Finally, I would like to thank the Yad Sarah organization for giving me this opportunity to enlighten the public on services for the disabled and elderly. Most of the assistive items and services I have mentioned in my articles are available through Yad Sarah. I strongly recommend you visit the Yad Sarah website (http://www.yadsarah.org/). If you live in Israel, I hope you take advantage of the many services Yad Sarah provides, visit the Guidance and Exhibition Center, volunteer for the organization or support it in any way you can. If you are among my readers from abroad, perhaps Yad Sarah can act as a model for a similar organization in your own community. Contact Yad Sarah to find out how their representatives can help you. Visit the headquarters in Jerusalem. You’ll enjoy a tour like no other you have ever experienced.

I hope you’ve enjoyed reading my blog as much as I have enjoyed writing it.

Shalom for now.

Guide to Services for the Aged and Disabled in Israel
© Copyright-2008
This work is protected by copyright law. Use of this work or any portion thereof, including photocopying, publication, public production, distribution, translation, broadcast, allowing public access to it, and utilizing portions derived from it for other purposes, without prior written permission from the author is prohibited.

Part 10: Practical Tips to Ease the Way (Section 1 of 2)

2008-06-17T00:46:00.000-07:00

by Shari (Zissie) Gitel
zissieg@walla.com

Introduction to Interior Decorating 101
My pediatrician had a good sense of humor, and his tip regarding how to care for teething babies was unique. In fact, this tip was useful under a variety of circumstances. He told me that if the baby cries for a long period of time due to pain from teething, this is what I should do: fill a shot-glass full of bourbon or rye or scotch and dip my finger into the liquor; then rub the liquor on the baby’s sore gums. The alcohol will almost always relieve the pain. If the baby continues to cry after this procedure, however, I should then proceed to drink the remainder of the liquor in the shot-glass. I told you he had a good sense of humor. Well, as we all know, this is not a very practical tip for handling that problem or any other problem. But I have learned a lot of tips both from my experience and the experience of others that can make the home and environs more user-friendly for people with mobility problems. I’d like to share some of these tips with you.

THERE IS NO SUBSTITUTE FOR A PROFESSIONAL THERAPIST’S ASSESSMENT AND INSTRUCTION BASED ON THE NEEDS OF EACH INDIVIDUAL PATIENT

Before I share these tips, I should caution you that in any event you should have a qualified occupational or physical therapist from the patient’s kupat cholim evaluate the situation and recommend the necessary equipment and environmental alterations needed for the patient’s particular case. This is no substitute for professional medical advice. Any links to specific sites for sale of such equipment are for demonstration purposes only, not an endorsement of any particular company.

How to Achieve a Standing Ovation
Probably the most important item we introduced into the home was a sturdy office-chair with arms. Some patients may be able to push themselves up by simply placing the palms of their hands on their thighs and pressing on their thighs to gain the strength to stand. Post-stroke patients who have lost use of one side of their body have great difficulty in standing up. Placing their hands on the chair arms helps them boost themselves to an upright position. Likewise, raising the height of the chair seat, either by placing a firm cushion on it, or by purchasing specially made cones that fit under the chair legs, makes it easier for the patient to rise to an upright position.

The same holds true for the height of the patient’s bed. Getting in and out of bed can be very difficult with no support on the sides to hold onto. A raised mattress somewhat alleviates the situation. There are also bars (similar to but smaller than the types of bars used to keep children from falling out of bed) that can be inserted under the mattress and act as a support for pushing up from a sitting position at the edge of the mattress.

While we’re on the topic of the edge of the mattress, it is important that the patient learn how to scoot forward to the edge of the chair or bed before attempting to stand up. An occupational therapist can instruct the patient in all the steps necessary to properly stand up from a sitting position. If the patient still has difficulty achieving this on his/her own, you can assist the patient by placing your hand on the small of the patient’s back and applying gentle pressure to give him/her that extra nudge forward to be able to rise. Unless you really enjoy the experience of back pain, try to refrain from pulling the patient up by yourself.

Cars present a special challenge. The car seat’s proximity to the ground coupled with the need to maneuver the body until the feet are in the proper position for either sitting or standing pose difficulties for the patient. Bars are available for installation into cars to enable the patient to grasp onto something while either attempting to sit in or rise from a car seat. I personally have never used these bars, so cannot vouch for their effectiveness. There are also swivel discs (like a turntable) that can be placed on the car seat to help the patient maneuver in the seat and position his/her feet correctly.

Then there are toilet seats to deal with—can’t do without them, can we? Booster seats are available for toilets. Some have a hole and plug in the plastic where you can fill the seat with water, the weight of which helps stabilize the seat on the toilet. I came up with a Velcro solution to keep the seat I bought stabilized, gluing a piece of Velcro to the toilet bowl in several strategic spots, and matching strips of Velcro on the booster seat. I then cut a third piece of Velcro for each of these strategic spots and joined the booster seat to the toilet bowl that way. This kept it from sliding around. Necessity is the mother of invention, they say. Another important item near the toilet is a bar attached to the wall. Utilizing the bar the patient can more easily pull him/herself up from the toilet seat. There are also other bathroom solutions available, such as a U-shaped bar that can be placed surrounding the back and sides of the toilet to act as arms for the patient to use to help him/herself stand up, or a commode on wheels (similar to a wheelchair) that can be pushed to the toilet without the patient even having to stand up. These commodes also come with removable bed-pans. OK, that’s enough about the toilets. I think I’m going to lose my audience if I dwell on this subject any longer.

As long as we’re in the bathroom mode, let’s talk about showers. Many patients will need to be seated during a shower. The commode mentioned above can double as a shower chair, or you can use a regular plastic garden arm chair with holes drilled into the seat to prevent a buildup of water while showering the patient. Next to the area where the patient is seated or standing there should be a bar on the wall. A slip-free floor surface is also recommended. It is difficult to shower the patient with a stationary shower-head, so if your bath is not already equipped with a hose type shower-head that can be directed to different areas of the patient’s body, you’ll want to invest in one of these.

TOSS THOSE CARPETS!

Just a-Walkin’ Through the House
Now that we have the patient clean and standing, let’s discuss how he/she is going to walk around. First of all, carpets and throw-rugs are a “no-no”. Not only is it harder to push a walker on a carpeted surface, it’s just too easy for a patient to stumble over the edge of one. So roll them up and get rid of them. Some patients may need no assistance in walking. Others may manage with the assistance of a simple cane (make sure to purchase a cane that is the correct height for the patient). A cute device that can be added to the tip of the cane is a rubber contraption that allows the cane to remain upright. It’s called a tripod. A cane equipped with this makes life easier for the patient: he/she no longer has to find a wall against which to lean the cane, or a chair on which to hang it, and, should the cane topple over, the patient need only press on the side of the rubber tripod with his/her toe to bring the cane back up to a vertical standing position. Brings back memories of those bop-bags we used to punch down and watch pop right back up.

If the patient requires a walker, be sure to adjust the height of the walker to suit the patient’s needs. There are both folding and non-folding walkers, the latter being more sturdy, the former more easily transported in cars. Tennis balls placed on the back legs of the walker (you have to work hard at slitting and prying them open to fit them onto the tips of the walker) make for a smoother glide across the floor. Replace the tennis balls periodically, as they get worn. You can purchase accessorized walkers that come with seats, and baskets are available for the patient to tote things along with the walker. The patient will tend to want to use the walker as support for standing up from being seated. Some physical therapists will say this is the proper way to stand with one hand on the walker and the other pushing up from the seat, and others will discourage it. Follow the advice you receive from your own physical therapist.

I think now would be a good time to take a break from discussing all this equipment. It’s time for a breather. Look for my post next week with the remainder of the tips I have accumulated from my experience—I know the suspense is mounting, but hang in there: there will be more help and advice on the way.

Guide to Services for the Aged and Disabled in Israel
© Copyright-2008
This work is protected by copyright law. Use of this work or any portion thereof, including photocopying, publication, public production, distribution, translation, broadcast, allowing public access to it, and utilizing portions derived from it for other purposes, without prior written permission from the author is prohibited.

Part 9: The Gamut of Emotions—Lessons in Living

2008-06-05T01:37:00.000-07:00

by
Shari (Zissie) Gitel
zissieg@walla.com

Why Me?
One of the greatest lessons I have learned from this whole experience is that there are many aspects of life over which we have no control, and when faced with any of them, if we don’t put things into perspective we waste a tremendous amount of energy on misguided anger. How much anger I expended at the beginning of this experience! I was wallowing in self-pity and angry at everyone and everything. Woe unto anyone who got in my path. Just ask my husband! My tongue developed a mind of its own and lashed out at family and friends. No one could do or say anything right.

It didn’t happen overnight, but slowly, very slowly, I learned how to put things in perspective and accept the situation for what it was. Initial anger is certainly understandable. The natural question “Why me?” is the first one to pop up, both for the patient and the caregiver. When you think about the question, though, in an objective sense, the corollary is “Why not?” Do bad things only happen to other people? What is so special about me that I should merit exemption from diseases, accidents, or any other traumatic event? Isn’t it rather self-centered and childish to think that if I’ve behaved well I shouldn’t be punished in this manner? The trick is to reassess the situation and not consider it a punishment—turn it into a challenge and a means of bettering yourself.

Consider the situation a challenge—not a punishment

Sensitivity Training
I do not in any way mean to trivialize the difficulties patients and their caregivers have to endure or the hardships visited upon anyone. The vagaries of life seem to conspire to produce an endurance test and a challenge where sometimes the hurdles seem insurmountable. Attitude, however, can make all the difference. Acceptance of the circumstances, I believe, is the first step to development of a constructive attitude to aid in coping with daily challenges. Once I resigned myself to the fact that this is what life has in store for me, I decided there must be a reason for what had been visited upon me and asked myself what I could learn and gain from the experience?

Sensitivity to the feelings and obligations of others has been a by-product of this whole experience for me. Though it took me a while to attain this level of understanding, I feel more attuned to the moods and needs of my parents and better appreciate the time and geographical constraints that prevent many family members from visiting more often. I enjoy the luxury of being retired. As small as the world has become, it is still no mean feat to find the money, time and energy required to travel long distances when one has to contend with work and children.

UNSOLICITED ADVICE?JUST SAY “YES”.

At the other end of the spectrum there are those who feel they must insert themselves into the picture and know better than I what is best for my parents. They will not hesitate to make suggestions and offer criticism. Annoyance with these people and their intrusion into my personal affairs was my gut reaction. It takes a great deal of self-control to refrain from telling them to mind their own business. I was raised to be courteous, and I courteously let them know how much I appreciate their concern. Then I just go on doing what I consider is in my parents’ best interests. The advice I received long ago from my pediatrician right after our first child was born has served me well over the years. He warned me that everyone was going to tell me what I was doing wrong in caring for my baby and how it would be better if I did things their way. His advice to nod my head ‘yes’ as though I was agreeing to all their suggestions and then proceed to follow my own motherly instincts was one of the best recommendations I ever received. So, here I am utilizing that same advice in a reversal of roles—what served me well then, continues to serve me well now.

Role Reversal and its Toll on Emotions
This issue of role reversal is laden with emotions in and of itself. Whereas once I relied on the sage advice and care of my parents (other than in my teen years, of course), now I am obliged to take responsibility for their needs and make decisions affecting their lives. I am changing them and feeding them and lifting them in and out of a car. It is an awkward position to be in to say the least. Often the obligation of respecting their dignity and wishes clashes with the ethics of assuring their physical well-being. Their understandable desire to want to die already and not have to endure the indignities of not being able to handle their own affairs and physical needs hurts me to the core. I don’t want them to suffer, yet I don’t want them to leave me either. As a defense mechanism I have developed a rather hardened façade so they don’t see how much they are hurting me. I do not make light of their wishes, but I do try to get them to know how much I understand how they feel and encourage them to make the best of the situation.

Often this requires putting on a face of cheer and demonstrating an attitude of hope that in reality are totally false. We are cautioned not to rely on miracles, and there is no medical reason to believe that my parents will recover from their illnesses or see any improvement in their condition. Reality dictates otherwise. In the early stages of these trials I went through a phase of denial. I pushed and pushed to get my father to put more effort into his rehabilitation. I did whatever I could to exercise and medicate my mother’s mind to ensure that whatever faculties she still had would remain intact. It became easier to cope, however, once I accepted the situation and resigned myself to the fact that my parents just weren’t going to get better.

ACCEPTING REALITY AIDS IN COPING

Have you ever been to Venice? One of the tourist attractions there is the “Bridge of Sighs”. It is a bridge over one of the canals that leads to the jail cells from which there was no return for the criminals sentenced to imprisonment. Well, I have my own Bridge of Sighs. After every visit with my parents in the nursing home I leave with a sigh of frustration and helplessness. I am already experiencing the feelings of grief at having lost them. Their personalities have changed as have their actions. They simply are not the parents I remember. Sigh....

To family members who speak to me after visiting my parents and express how upset they are with the rapid deterioration in my parents’ condition, I must seem very uncaring. They, however, see the situation on a very infrequent basis, whereas I see the situation regularly and have become somewhat inured to it. What they don’t understand is that I am already beyond the sorrow and the grief stage of losing my parents. Their decline is something I take for a given now, and what may appear as nonchalance on my part regarding their condition is simply my way of demonstrating that I have already cried myself out and worn myself out in caring for them. I will put on a happy face for my parents and continue to boost their spirits, but I know in my heart of hearts that I have lost them already. If that’s hard for others to fathom, so be it. I have accepted the situation. This is my way of coping.

Faith and future
Fear is another emotion I have begun to experience. It has nothing to do with the caregiving that has played havoc with my state of mind; rather it is a result of thinking of all the genetic probabilities that point in the direction of my one day being in the same condition as my parents. My chances for developing cancer and/or dementia are looking pretty good. The thought of being on the receiving end of the caregiver process is not tantalizing to say the least. I only hope that if and when that time comes I will be able to accept the help graciously. My children are aware of my wish that I not be a source of their having to put their lives on hold to take care of me. If I reach the stage of needing such demanding care, they have their instructions to get on with their lives and hire others to care for me.

Issues of faith often come to the fore when life deals you a severe blow. It’s easy to become agnostic when one feels he/she is not deserving of what appears to be God’s punishment. It is so much more dignified, though, to utilize the experience as a means of building character, demonstrating to the world courage in the face of disaster and perseverance in the face of adversity. Despite all the setbacks and sometimes humiliating circumstances my parents have had to confront, they have managed to maintain a sense of humor and keep on going, albeit somewhat reluctantly. They find pleasure in the little things in life—a violin concert, listening to anecdotes about their great-grandchildren, and visits from family and friends.

As for myself, the experience has taught me important lessons that I believe have improved my character. I have gained a greater respect for the elderly. I have learned to exercise a patience that I never before knew I had. I have overcome severe depression and learned to prioritize and put things in perspective. I have learned to be grateful for all the precious moments granted to me. Rather than losing faith, I have learned to pray harder than ever that God continue to grant me and my loved ones His many favors and have learned to look around and recognize just how many favors He has indeed granted us.

My advice to you is to be grateful for every single day and utilize it to its fullest. Who knows what tomorrow may bring? Carpe diem—and don’t look back.

Sites for suggestions on how to cope with emotional turmoil:

http://www.nia.nih.gov/Alzheimers/Publications/coping.htm
http://www.webmd.com/alzheimers/features/caregiver-grief-triggers-mixed-emotions
http://www.ec-online.net/knowledge/Articles/emotions.html
http://www.dshs.state.tx.us/alzheimers/hints.shtm
http://familydoctor.org/online/famdocen/home/articles/589.html
http://www.bbc.co.uk/health/conditions/mental_health/emotion_index.shtml

Guide to Services for the Aged and Disabled in Israel
© Copyright-2008
This work is protected by copyright law. Use of this work or any portion thereof, including photocopying, publication, public production, distribution, translation, broadcast, allowing public access to it, and utilizing portions derived from it for other purposes, without prior written permission from the author is prohibited.

Part 8 Legal Guardianship and Financing Revisited--Third Time's a Charm

2008-05-28T23:20:00.001-07:00

by
Shari (Zissie) Gitel
zissieg@walla.com

I think I’m finally starting to get the hang of things now. Our third application for legal guardianship (apotroposut) went fairly smoothly. The most involved portion of the process was getting all the paperwork we needed from my sisters who live abroad. It was not complicated, only time-consuming. Once we had all the paperwork in hand, my sister who lives in Israel and I met at court to submit the application.

In my previous experiences in the Jerusalem and Bnei Brak family courts, we had to make several trips to different desks within the building for each portion of the application. In one case we even had to leave the building to make a payment at the local post office and then return to the courthouse to complete the processing. For the most recent application, which we handled in Rishon LeZion, the procedure was far less complicated:

THE EARLY BIRD CATCHES THE WORM

We got there early and were able to get one of the first numbers to be served (from the machine outside the office where you open a file). As soon as the court offices opened for business I was directed to one of the desks for opening a file. I should point out that there were not very many people there, so in any case, it would not have been a long wait, but you cannot count on that all the time. We were advised to get there early, and that is always good advice to follow.

Of course, we were missing some paperwork. We thought we had it all, but, despite what the social worker at the nursing home had told us, there was one form missing. Fortunately, it was a form we could fill out on the spot. The registrar gave us the paperwork and suggested we visit the desk where volunteer law students help customers in completing the forms correctly. Once we finished that, the only remaining item was to have our signatures verified by an attorney who was located directly opposite the desk of the volunteer students. There was a NIS 40 fee for verification of our signatures. Make sure to have your identity card with you for this transaction.

THERE IS A FEE FOR
SIGNATURE
AUTHORIZATION

Then back we went to the original registrar with our verified signatures and the requisite form. The registrar was quite pleasant and accommodating, even gave us a blank copy of the missing form to present to the nursing home so the social worker would not omit it the next time someone needed to apply for guardianship. She accepted our payment (NIS 470) for the application by credit card and started to send us on our way. That’s when I noticed that my last name was spelled incorrectly on the application she had typed—never a good sign when dealing with computers. We straightened out that little glitch and were done.

Now we are awaiting the court’s decision, which will take approximately two months. When you make your payment you are given a document with the court case number on it for follow-up. Presumably you can make periodic inquiries as to the status of the case. This also enables you to petition the court to act immediately upon your request in the event an emergency situation arises. The social worker at the nursing home has assured us that she will do the follow-up to make sure that things progress at a decent speed.

In the end we only applied for physical guardianship. It is possible to apply for both physical and financial guardianship, but we chose not to after learning of the problems a friend has had in meeting the court’s requirements for such guardianship. Among other things the court requires opening of a separate guardianship bank account, as well as detailed itemization of income and expenses. Also details of assets for the past seven years have to be itemized. Our friend has no idea how to go about itemizing everything, and doesn’t even know what her parent owned or did not own seven years ago, let alone the value of it. Since I am an authorized signatory on my parents’ checks, we are postponing this aspect of the guardianship, at least for the time being. It just seems like too much additional aggravation if we can get by without it.

KEEPING TRACK OF ALL THE PROCEDURES SOMETIMES FELT LIKE A JUGGLING ACT

Simultaneously we had reapplied to Lishkat Habriut for help in financing payments for the nursing home. For better or for worse, the value of the dollar had dropped dramatically, making it impossible for my parents’ social security income to cover their nursing home care costs. The whole process had to be restarted from scratch—same forms (with a few additional thrown in for good measure), same committee review. It took a little longer than originally promised, but eventually we received the answer we had long awaited: the Ministry of Health would finally assist us in payments. My sister in Israel was assessed a monthly fee based on her income, and my parents would have to pay their social security income to the Ministry of Health. This would cover part of the nursing home fee, while the Ministry of Health would pay the balance, including any medications approved for the “basket of medications.” According to the manager of the nursing home, the Ministry of Health also pays for the patient’s ambulance costs and diapers.

I believe that pretty much brings this tale up to date in my adventures with the various branches of bureaucracy I’ve had to deal with while parenting my parents. There may be more surprises waiting down the road, and you can rest assured that if there are, you will hear about them. It’s been quite a learning experience for me, and I hope you’ve also learned something from my trials and errors. Good luck in your own personal journey down this never boring road. I hope you encounter no bumps or detours, but if you do, and I can be of any help, please don’t hesitate to contact me.

Stay tuned for my next post, where I hope to deal with the range of emotions associated with the trauma of caring for a loved one with a deteriorating condition.

And now, I think I’ll work on a project that has been weighing on my mind since I began this journey—getting my own house in order, both literally and figuratively.

TIME TO GET MY OWN HOUSE IN ORDERI sorely need to learn more about handling family finances, a realm that until now my husband has single-handedly controlled. I’m going to make sure my will is up to date (why else did I send my daughter to law school?). And I’m going to do a clean sweep of all those things I just had to hang onto that in truth I no longer need and just add to the clutter of my home. Last, but not least, I’m going to work off a lot of tension that has built up in my system and find a healthy outlet for all that energy—after all, why else did God create tennis courts?
Guide to Services for the Aged and Disabled in Israel
© Copyright-2008
This work is protected by copyright law. Use of this work or any portion thereof, including photocopying, publication, public production, distribution, translation, broadcast, allowing public access to it, and utilizing portions derived from it for other purposes, without prior written permission from the author is prohibited.

Part 7: When Push Comes to Shove—a Journey of Epic Proportions

2008-05-15T08:36:00.000-07:00

By Shari (Zissie) Gitel
zissieg@walla.com
Caught between a rock and a hard place
It was bound to happen eventually, and indeed it did. One foreign worker was no longer enough help to care for my parents. For a while we were able to manage with a foreign worker plus occasional help from a local caregiver. As time wore on, however, we began weighing the option of either hiring an additional full time foreign worker or admitting my parents to a nursing home. Neither one of the options was attractive: the conflicts that might arise between two foreign workers living together under one roof (one male and one female), although it would be affordable, appeared formidable (and I am not even certain whether by law it would be permitted); the impersonal atmosphere of a nursing home and the indignities it probably afforded were no more palatable. We were caught between Scylla and Charybdis. The cost of the nursing home, itself, was way out of my parents’ reach. Even if we located one that met our needs, how would we be able to afford it? To make matters worse, the foreign worker we had in our employ was seeking to move to Canada. We were faced with retraining someone new, if not two new people. The scales started to tip in favor of care in a protected environment.

What do you call a Jewish Odyssey?
Thus began the Odyssey of searching for an appropriate nursing home and the means to pay for my parents care. In our ongoing epic we became familiar with the Ministry of Health as well as the Ministry of Welfare, who vie against each other in funding of nursing home care—neither one of them wanting to assume responsibility for it. Patients in need of care in a protected facility are categorized in a number of ways. For our purposes the two categorizations that applied to my parents were either tshushi (frail) or siyudi (requiring more extensive nursing care). The Ministry of Welfare funds tshushi care, whereas the Ministry of Health funds siyudi care. Bituach Leumi funds nothing towards nursing home care. And here’s how the process goes:

One must apply to the Ministry of Health through Lishkat HaBriut to see whether the patient qualifies for nursing home care, and whether the patient is considered tshushi or siyudi. The initial forms comprise medical reports completed by the patient’s physician and nurse detailing the patient’s degree of functioning (ADL’s again), as well as additional medical documentation of specific diagnoses by specialists when dementia is present (from my experience). In addition there are forms for the social worker to complete. This information is submitted to the Social Worker at Lishkat HaBriut, who reviews the forms in a meeting with you to ascertain that all the necessary information is available for submission to their medical committee for review. The review committee meets every couple of weeks to render decisions.

NOT ALL NURSING HOMES ARE RECOGNIZED BY MISRAD HABRIYUT FOR FUNDING—IF FINANCIAL AID IS REQUIRED, MAKE SURE THE FACILITY OF YOUR CHOICE IS RECOGNIZED AND HAS A “CODE”.

When we first submitted our forms for the review committee, we were contacted and told that some committee members would have to examine my parents at their home. Apparently it was not clear whether they were siyudi or tshushi. A nurse and social worker from Lishkat HaBriut arrived for the examination and were of the opinion that one of my parents was siyudi while the other was tshushi. I explained how we wanted to keep them together in the same room in a nursing home, and if they were categorized differently that would be impossible. (Not only that, we would have to deal with two different government entities for financial support, if indeed they did qualify.) The crew informed us that they would make their recommendations to the committee and we would be hearing from them. Then we again played the waiting game.

PARDON ME FOR CHANGING
MY GENRE, BUT HERE'S WHERE WE HIT "CATCH 22"

Nursing Home Sweet Nursing Home
While we waited we toured several nursing home facilities in the area, while my sister did the same where she lives. We were in for a rude awakening when the nursing home administrators looked at my parents’ medical records and forms listing their functioning capabilities. They predicted that my parents would fall between the cracks—they actually required siyudi care, but would, from past experience, most probably be classified as tshushim by the Ministry of Health. In that case my parents would fall under the responsibility of the Ministry of Welfare. If the nursing home maintained they required siyudi placement, no government funding would be available. Both bodies—the nursing home and the Ministry of Health—must be in agreement in the categorization for the patient to qualify for financial coverage—be it the Ministry of Health for siyudi patients or the Ministry of Welfare for tshushim. Nevertheless, we plodded on in search of a place suitable to deal with their needs and with a religious atmosphere appropriate to their background and observance. English-speaking staff was also important to us. Proximity to either my home or that of my sister was a priority, and the cost played a major role in our decision making. No one place met all our conditions. Time was running out. We decided to waive some of our preconditions and opted for what we believed was the best choice at the time. We will never know if the choice we made was the right one, but given the time constraints and the condition of my parents we could not be too choosy.

I STRONGLY RECOMMEND STARTING THE NURSING HOME SEARCH
BEFORE YOU ARE UNDER PRESSURE TO MAKE A HASTY DECISION

The committee proved to be compassionate and categorized both my parents as siyudi, effectively guaranteeing they could be housed in the same department, and most probably (depending on the availability) in the same room of the facility they chose. Not only did this relieve our anxiety about their transfer to a new place, it also made my parents more receptive to the idea of this drastic change. No matter what difficulties they might have in adjusting to the new situation, at least they would be able to face them together, as they had throughout their lives. Plus we had a definitive answer as to which government body would be in charge of the financial aspects and were able to avert the hassle of a power struggle between two government offices.

I hope you haven’t forgotten about all those forms you always have to fill out. We had only just begun. Now that the medical portion of the application had reached its close, we were faced with the financial reporting. Application forms are available online. There are forms to be filled out regarding the patient and his/her spouse’s finances and property, as well as forms regarding the finances of each of the patient’s children residing in Israel. Monthly salary printouts of children working in Israel must be supplied for the three months preceding the application. When we first applied (and were rejected, because my parents’ finances were just borderline enough to allow them to “get by”), there were fewer forms than what are required now. Recently Lishkat HaBriut has added more forms to those previously requested. The patient and his/her children also have to provide a listing of assets such as property and automobile, bank account information and documentation of property holdings. How do I know this? I have just re-applied for financial support and am still awaiting an answer.

As an aside, what put my parents over the limit financially was the fact that they each had a nursing care insurance policy that we had activated when they started paying for in-home care. This additional monthly income just put them over the edge. If you are considering purchasing nursing home insurance (bituach siyudi), carefully weigh the pros and cons. You may be paying more in monthly premiums than is worth your while. This, of course, depends on your financial situation. For someone who has a limited fixed income and who will require government help for nursing home care, it may not be cost-effective to invest in additional nursing home insurance. Do your own calculations and research to see where you fall in this area. There is an excellent article which appeared in Ha’Aretz describing the pros and cons of investing in this type of insurance.

Epics don’t necessarily have happy endings
To make a long story short, we resettled my parents in a nursing home near my sister. Having been assured by the marketing manager that the staff spoke English and the religious atmosphere coincided with my parents’ traditions, we toured the facility and were favorably impressed with the care and accommodations. It wasn’t the Waldorf-Astoria, and the synagogue didn’t boast any famous cantors, but it was clean, well-staffed and met the physical demands of my parents’ condition.

Soon it became apparent, however, that not all the staff spoke English—in fact very few of them did—and this has been the source of much aggravation. I can speak Hebrew. My sister can speak Hebrew. My father understands Hebrew reasonably well and can make himself understood in the language. My mother neither speaks nor understands Hebrew—no matter how many times you repeat the question or statement or how loudly you say it, she still will not understand it. Regardless of how many times she tries to express what she needs or wants, the staff is totally baffled by the foreign language she speaks. She is an ulpan (Hebrew classes for new immigrants) dropout and now sorely regrets it. The alternate languages that may have helped her communicate in her current environment are Amharic and Russian, and perhaps some Yiddish. She struck out in all three. So, when I say it is important to learn Hebrew, I mean it. You cannot afford to be reliant on a translator when you have to fend for yourself. If you haven’t learned Hebrew yet, now would be an excellent time to start.

BE KIND TO YOUR CHILDREN… THEY’RE THE ONES WHO WILL CHOOSE YOUR NURSING HOME.
If you find yourself in need of approaching the Ministry of Health/Lishkat HaBriut for the purposes of financial aid, be aware that the hours of service are quite limited. In my area they receive the public one morning and one afternoon per week, and are available for phone queries three mornings a week for about two hours each morning. See the link for the various offices and their contact information to ascertain the hours applicable to your area. Our experiences with the personnel have been quite positive. They have been caring, informative and helpful. Regretfully, even their willing personalities do not get the bills paid if the patient does not meet the standards dictated by the system. We fell short and for several months have had to bear the burden on our own. Nevertheless, I know that we made the right decision to place my parents under constant medical supervision. As painful and expensive a decision as it was, I can see now that there is no way we could have continued catering to their growing needs in a home environment. It was not fair to them, and it was not fair to us.

Guide to Services for the Aged and Disabled in Israel
© Copyright-2008
This work is protected by copyright law. Use of this work or any portion thereof, including photocopying, publication, public production, distribution, translation, broadcast, allowing public access to it, and utilizing portions derived from it for other purposes, without prior written permission from the author is prohibited.

Part 6: The People You Meet Along the Way

2008-05-01T09:25:00.001-07:00

by Shari (Zissie) Gitel
zissieg@walla.com

Preface
Some of my closest friends and relatives are doctors and nurses. I wonder how they'll feel after reading this post.

Introduction
I debated long and hard whether or not to include this column, because it really does not provide any guide to services available. Rather it reflects my feelings of frustration with the system. So, I won’t be insulted if you choose not to read this post. If, however, you do choose to read it, and your feelings resemble mine, maybe you can add your voice to mine in trying to improve how we are treated by members of the health professions.

I’d like to talk about the people I’ve met along the way on this challenging road. As you can imagine they come in all kinds. Somehow those that manage to get under your skin are the most memorable, unfortunately, and we tend to forget the many wonderful people out there who really care. I believe in giving credit where credit is due, and I also believe that inexcusable behavior should be brought to the attention of those in authority. In the process I have become an expert letter-writer. Some of my more successful letter-writing experiences will remain secret, as part of the legal agreement we reached restrains me from implicating the institution at fault. My apologies in advance to every person in the health field whose performance characterizes how people in the medical profession should act.

A Trip Down Memory Lane
So let’s take a trip down memory lane and review some of the highlights, instances that provoked some of my letters of commendation and condemnation. There is no excuse for rudeness, particularly when dealing with those who are ill and the family members who are frazzled enough by coping with the illness that the last thing they need is the apathy or outright nastiness of the very people who control the fate of the patient. To me it seems that anyone who has chosen medicine as a profession would actually strive to be courteous and helpful to patients and their caregivers. Why then is it that when I have to go to kupat cholim I start to break out in a cold sweat, my blood pressure rises and my stomach starts turning somersaults? Could it be because I know what’s in store for me there? Before I even start dealing with solving the dilemma of the day, the mood is set by the patients around me. Does this prelude to dealing with the receptionists sound familiar?

"I have to (insert your favorite excuse), but I’m after you in line if anyone else comes.”
“I don’t care what time your appointment is scheduled for, my number is before yours, so I’m going in first.”
“I was here earlier and just have to ask one more question that I forgot.”
“I’m only here for a prescription—it will take just two seconds.”

WHY DO I BREAK OUT IN A COLD SWEAT JUST THINKING ABOUT GOING TO KUPAT CHOLIM?

And the list goes on. Then, when at long last it's your turn to sit down and discuss your matters you get “the attitude” from the clerks. They seem to indicate that you are nothing but an inconvenience that has shown up to bother them with your petty problems when it’s time for a coffee break. Often you get the feeling that they are trying do everything within their power to throw as many obstacles as possible in the way of your achieving your goal. I do not believe that “the customer is always right.” Of course, there are times when the customer is wrong, but the preconceived attitude that the customer is a nuisance non-deserving of a helping hand is a far cry from providing a service, especially a medical service, adequately.

The Customer is Not Always Right

I will be the first one to admit that many times I have been in the wrong. One of those times I not only messed up which date my father was supposed to arrive for his test, but also showed up there without the Tofess 17-Hitchayvut (the form stating the kupat cholim’s agreement to cover the cost of the service) and the orders for the test. It’s a long story. I’m not usually so absentminded. The test had been set up a month before by the hospital where my father had at the time been hospitalized. A few days after his discharge, the nurse from the hospital phoned me and told me they had set up an appointment for an outpatient test for him on such and such a date. I asked if he needed any paperwork to take with him or any hitchayvut, and she said that it was unnecessary because the hospital had taken care of providing all the details to the testing facility. I admit I should have done my homework, but I accepted what the nurse said to be accurate, recorded the date and time in my Palm Pilot, and we dutifully showed up for the appointment on the date the nurse had told me. Well—you can imagine my surprise when we arrived and the receptionist informed me that my father was not scheduled for a test that day. The test was actually scheduled for the same date but the following month!! I looked at the receptionist pleadingly and pointed out my father. I explained his frail condition and how difficult it was to transport him. With a sympathetic look she told me she would see if they could fit him in anyway that day. Then she asked for the requisite paperwork. I told her that the appointment had been set up by the hospital while he was an inpatient, and they had assured me that no paperwork was needed. You should have seen the look of incredulity on her face. She explained that without the orders and the hitchayvut they could not perform the test. But, she told me, she would try to contact the family doctor’s office to get them to fax the necessary paperwork on the spot. And that’s exactly what she did. In the twenty years or so that I had been living in Israel this was the first time I was presented with a real live caring individual who, although she would have been perfectly within her rights to send us packing, went out of her way to help the patient. After I recovered from the shock and thanked her a million times, I left my father sitting supervised in the waiting room while I went and bought pastries for the whole staff.

Then there is the kupat cholim receptionist who, when I asked her for advice on how to go about getting a hitchayvut that would cover monthly hospital treatments for a whole year, saving me the time of having to request and pick up the hitchayvut each month, told me that to her “the patient is king,” and she will run the paperwork through to the highest levels of administration to make sure it gets done properly, saving the family the aggravation of having to deal with all the red tape. After all, she said, if you’re going to do a mitzvah you should see it through from start to finish.

There Really are Some Angels of Mercy out there in the Medical Field

How about the doctors who, when they see how hard it is for the patient to come into their hospital examining room, actually go out to see the patient and speak to him/her in a more spacious area, saving the patient and the family the difficulty of navigating small spaces and getting up and sitting down numerous times? Or those who unsolicited phone the patient’s home to check on the patient’s recovery? There are even some who cheerfully make house calls without any reference to how much they have to go out of their way to do this and how pressed they are for time. Rare breeds, these doctors.

If you are in the medical profession and don’t recognize these dispositions as part of your makeup, you should ask yourself, “why not?” What has made me so callous that I act in a way that belittles the importance of the patient and his/her family as human beings and turns them into “cases” referred to by their diagnoses rather than their names who, to me, only represent added paperwork? Why should a patient be forced to feel that his/her respect and dignity are being violated by the sometimes flippant attitude directed towards him/her—anything from ignoring his requests to outright disrespect of his privacy, acting in an unprofessional manner often bordering on total negligence?

How would you like a dose of your own medicine?
Now I’m about to do some serious receptionist/nurse/doctor bashing, so, if you don’t want to hang around for it, stop reading now.

Before coming on Aliyah I worked as a medical assistant, first for an oncologist for 10 years, and then for a group of neurologists for about 10 years. I’ve seen pretty much the worst of what can befall humans when illness or accident strikes, and I’ve worked with some wonderful, caring medical practitioners who have gone beyond the call of duty to reassure family members, to work extra hours, to treat patients with the dignity and respect and compassion that is their due. My husband also worked in the medical field in hospitals both in the USA and Israel, and we both are privy to what goes on in that world. We have sat at both sides of the desk, so to speak, and have come to know some very considerate, polite, and compassionate professionals in the field of medicine.

It is the others that give medicine its bad name. What happened to the work ethic of performing your job to the best of your abilities? Not slacking? Not looking for every reason to avoid having to put in a little extra effort to bring a result that will be agreeable to both the service provider and the recipient? The motto of many of these workers seems to be “Work slowly and carry a big lip” (with apologies to Theodore Roosevelt).

The Hierarchy of Power and its Abuse
The receptionist, who is first in the line of hurdles to overcome, wields an enormous amount of power in his/her small corner of the world. And in many cases he/she will try to demonstrate to you just exactly how much control he/she has over the outcome of your request. These workers are no doubt underpaid and unappreciated, and the quality of their work usually reflects the grudge they bear on these accounts. This, however, does not excuse rudeness and unwillingness to do the job properly. You can accomplish much more by doing something right and thoroughly the first time than by cutting corners and trying to see how much work you can save yourself. If you’re sitting there already, you may as well smile and be user-friendly.
If You Aren’t Doing What You Love, At Least Love What You Are Doing

Let’s move on from pkidim/ot (clerks/receptionists) to the next human in the medical hierarchy—nurses. There are many species. For instance, the nurses who will do nothing more than the minimum to care for you, and act like they’re doing you a favor to boot. One of my favorites was the nurse at the specialist’s office who started yelling at me for not following her instructions properly in exposing enough of the patient’s body for the test she was going to perform. (God forbid that she should overextend herself and pull the clothing down another two inches on her own. Maybe that wasn’t part of her job description.) I lost my temper and yelled back at her, because her outburst was so uncalled for. It was amazing how, when I asked what her name was and started writing it down, she became the absolute picture of courtesy and developed a sweet personality.

Her nastiness pales, though, in comparison with that of the impudent nurse who told me she could tell I was “the daughter-in-law and not the daughter of the patient,” because, had I been the daughter of the patient I would have shown more concern and would have brought an undershirt to put on her for going home. There I was—all alone with a demented wheelchair-bound woman, taking care of releasing her from the hospital, arranging for an ambulance, dealing with discharge reports and all the other bureaucracy involved in getting my mother-in-law from the hospital to her nursing home, and I was greeted with the audacity of that nurse. I thought perhaps I had misheard what she said because it was so outrageous, so I asked her to repeat it, and sure enough that’s what she had said. It totally unglued me. I could hardly describe to the head nurse what had happened to upset me so much because I was crying and trembling so hard. That nurse was immediately called into a room for a good bawling out by the head nurse in charge, and, when I calmed down sufficiently a few days later, I wrote a scathing letter describing the incident to the hospital director. I have more stories about less than exemplary nurses but if I told them all, this article could go on forever.

Contrast this with the visiting nurses who are usually models of kindness and patience. They take the time to listen to the patient and to teach different techniques to family members unfamiliar with procedures necessary to care for the patient. I don’t envy any nurses, with the complicated and often unpleasant tasks demanded of their job. I hold in high esteem those nurses who are truly dedicated and proficient. Without them the patient and family would be at a total loss. If only there were more of them around...

Ahhh, now we come to doctors. There is some question whether they come below or above the nurses in this hierarchy, but for our purposes we will put them at the top. It is beyond my understanding why there are so many doctors (I’m referring primarily to doctors on staff in the hospitals) who treat patients and their families like some kind of dust they have to brush off their clothing. I enclose links to several oaths recognized by the medical profession, namely the Hippocratic Oath (for doctors), Maimonides Physician’s Oath (apparently a prayer he said before he started working each day), and The Nightingale Pledge (used by many nursing schools when nurses achieve their R.N. degree). Nowhere do I see a reference in any of these oaths that family and patients should be treated by doctors and staff like they are not deserving of courtesy and compassion. I’m reminded of one of my favorite stories:

A Jewish man dies after having lived a long observant life. When he enters the Gates of Heaven, he is warmly greeted by the welcoming angel and escorted on a tour of the grounds. They start walking along, and the angel points to a bearded gentleman sitting outside a tent, “That’s our forefather Abraham,” he says to the newcomer. Jacob stares in awe and can’t believe he is actually in the presence of such a renowned person. They walk on a little and come across a man with a glowing face polishing two tablets. “You probably realize that that is Moses,” the angel says. “And over there you can see King David and King Solomon.”

“Wow,” Jacob says to himself. As they continue their tour he notices someone walking along in a white coat with a stethoscope slung around his neck. Everywhere this guy goes people bow their head to him. He turns to the angel and says, “Who is that? He really must be somebody important the way everyone is treating him.” And the angel says, “Oh, Him, that’s God—He thinks He’s a doctor.”

WHAT EVER HAPPENED TO THE HIPPOCRATIC OATH?

Shall I start with emergency room doctors or ward doctors? They are pretty much the same in their behavior patterns. ‘Don’t bother me now’ is the general attitude. Well, in the emergency room, if I wait for later, it may be too late. I personally know someone who suffered this fate, and the litigation is still in progress. And, in the ward, if I wait to talk to you during your posted hours, the chances are 50/50 you will actually show up there, and why should I once again lose a whole day’s work waiting for someone who may or may not show up to speak to me? And, if I accidentally ask you a question that is beneath the dignity you ascribe to your level of expertise and not part of your job description to deign to answer, do not contemptuously say “I’m a doctor, not a receptionist.” A polite “I’m afraid I don’t know the answer to your question but I think …. can help you,” would be received with much more understanding.

Finding a Cure
Is there a solution to this attitude problem? Probably not. I think all medical professionals should see the film The Doctor, starring William Hurt, based on a true story described in the book written by Dr. Ed Rosenbaum (and subtitled “A Taste of My Own Medicine”), and read the book Tuesdays with Morrie by Mitch Albom, just for starters. Frequently I will make a comment to a service employee such as “If you smiled you would look so much more pleasant.” To those employees who indeed go the extra mile I shower praise and comment on how wonderful it is to be treated so graciously. I write letters not only about those who disappoint me but also about those who are outstanding in their approach. Whenever I can, I tell them that I am going to write a letter in their praise and try to ascertain exactly to whom the letter should be directed to have the most impact. I don’t know that my letters help, but I would like to think that maybe, little by little, we can make inroads into improving how we as recipients of treatment during critical times of our lives can at least feel that those who are out there to help us through those times really do care.

You, too, can state your opinion when you see an injustice or some extraordinary behavior worthy of comment. Perhaps together we can make a change.

*********
Originally I was going to end this column right here. I decided, however, that in all fairness something should be said about us as consumers and our attitudes. It is incumbent upon us to be as courteous to the person serving us as we would expect them to be to us. Coming in with a fighting attitude and aggressive behavior does not serve our purposes. It immediately puts the other person on the defensive and sets up a barricade before we even get started with our negotiations. So let’s all try to set an example, and we just may be able to work out our problems to everyone’s satisfaction in an atmosphere devoid of animosity and dedicated to achieving what is in everyone’s best interests.

For your reading pleasure I enclose a link to the Patient’s Bill of Rights and some tips for writing effective letters.

Letter Writing Tips:
1) Organize your thoughts on paper omitting any emotional references
2) Ascertain the title, name and address of the person in authority to whom the correspondence should be mailed
3) Compose the letter sticking to the facts with as much detail as possible

Date
Time
Location
Patient Name
Employee Name
Unemotional description of the incident
Request for action, whether disciplinary, monetary or to draw attention to behavior worthy of emulation
Signature and contact information

Guide to Services for the Aged and Disabled in Israel
© Copyright-2008
This work is protected by copyright law. Use of this work or any portion thereof, including photocopying, publication, public production, distribution, translation, broadcast, allowing public access to it, and utilizing portions derived from it for other purposes, without prior written permission from the author is prohibited.

Part 5: Be Careful What You Wish For

2008-03-22T11:17:00.000-07:00

by Shari (Zissie) Gitel
zissieg@walla.com

Those dreams for more help were realized, but at what a price! Now both my parents were awarded hours by Bituach Leumi—each at 9.75 hours per week. As time progressed so did their disabilities, and about two years ago, after several appeals for more caregiver hours, they both eventually reached the maximum number of hours that Bituach Leumi allowed (at that time 15.5 hours per week apiece). I finally had a lot more help. The flip side of the coin was the degree of how incapacitated my parents had become. If they were in bad condition before, now they were defined as totally house-bound (merutakei bayit) and requiring care for almost all their ADL’s.

This did come with several “perks”, though. It is indicative of my new perspective on what was important in life that I reached the point where I considered free house calls by the doctor and blood tests performed in the home by visiting nurses “perks”. My chauffeur services were somewhat reduced—though I was still making frequent trips to the kupat cholim to arrange for tests and get the proper paperwork done, not to mention regular visits where I met with the doctor and reviewed the medical situation with her to get medical advice, referrals and prescriptions. At least, I didn’t have to “schlep” my parents to the clinic—an ordeal neither they nor I enjoyed.

And now I would like to express a personal thank you to whoever invented the fax machine. This modern day device has been a Godsend. Many transactions with the kupat cholim (as well as other entities) can be conducted by this method, saving time both in travel and waiting in line. It is music to my ears when I hear the clerk tell me over the phone to fax the information to them for processing.

USE THE FAX TO SAVE PRECIOUS TIME

But what did this mean when you get down to brass tacks? Before my parents had been awarded the maximum allotment of hours, the caregivers (now we had a man coming several hours a week for my father, as well as a woman coming several hours a week for my mother) had been arriving early in the morning to take care of getting my parents breakfast and lunch, and getting them into bed for a nap. Then help arrived in the evening for bedtime. I set up a complicated schedule to make sure the hours did not overlap and to provide the best daytime coverage I could arrange for my parents during their waking hours. Once they received the maximum allotment of hours they were in no condition to be left alone. Great! Now what?

Advantages of staying at home
When we moved to Netanya to be closer to my parents (after having cared for my mother-in-law in Jerusalem for 10 years) we took into consideration the needs of my aging parents (and our own as well—we aren’t getting any younger, either). We purchased a home suited to the needs of the handicapped and elderly, i.e. there were no steps leading to the entrance of the house from our driveway; there was a bedroom on the entrance level as well as a bathroom across the hall from the bedroom. We installed a shower in the laundry room (off the bathroom) as soon as possible after my father had his stroke. For all intents and purposes we were physically set up to have them at our home. Indeed, during the holidays and on Shabbat my sister and I would take turns hosting them. So we got a taste of having them live with us for prolonged periods. Out of concern for their welfare we decided that staying in a home situation was better for them (we felt that individualized care and familiar surroundings were preferable to the more impersonal atmosphere and care afforded by a nursing home), as long as we could manage to continue providing the needed services for them. But the home where they would stay was not going to be ours.

WHAT EFFECT WILL A MOVE HAVE ON THE PATIENT? ON YOU?
Having your parents move into your home ideally should allow for the best supervision of their daily needs. Each person has to consider the risk/benefit factors of such a move. There are many considerations to take into account: invasion of privacy, clashes of temperaments, effect on your marriage, extra chores and meals, to name but a few. After much deliberation and despite the fact that I felt extremely guilty about not moving them in with us, we decided that for everyone’s sake it would be better to hire permanent full-time sleep-in help and keep my parents in their own apartment for as long as feasible.

Enter Foreign Worker Stage Left
Oh, if it were only so easy!! Applying for a foreign worker is a long, involved process and can be initiated only after the applicant has reached a certain number of points on the Bituach Leumi scale of requirements for extended nursing care. My father finally qualified. There are several stages in the application, first of which is acquiring the license for employing a foreign worker through the Ministry of Industry, Trade and Labor, Yechidat HaSemech L’Ovdim Zarim. To do this you have to contact a reputable employment agency that has experience in these matters. These agencies have all the forms necessary and can guide you through the process. Along the way there are many bureaucratic fees to pay, crowned by the fee that is paid to the employment agency itself for its services as intermediary. Until you have the license in hand, you cannot officially apply for the foreign worker.

Needless to say, this takes time. Once you have the license, if you are willing to hire a foreign worker that is already in the country (which generally means paying a higher salary than for a worker who has not yet entered the country), you may be able to find a suitable candidate in a relatively short time. If, however, you wish to hire a worker who has yet to arrive in the country, you could wait several months before this materializes. The contract for foreign workers from the Philippines may vary from company to company, but most of the terms as far as holidays and days off are basically the same. I am not familiar with contracts for workers from other countries.

In addition to the monthly salary for the foreign worker there are other benefits the patient (employer) must provide. These include health insurance, Bituach Leumi payments, overtime, accommodation and food, a weekly allowance, vacation/holiday pay, sick pay, rest and relaxation pay (d’mei havra’ah), severance pay under certain circumstances, and fees for repatriation of the foreign worker for a variety of conditions.

I never promised you a rose garden.

SALARY IS ONLY A SMALL PART OF THE COST FOR A FOREIGN WORKER

While you’re anxiously awaiting the arrival of the mystery foreign worker, you might consider some shortcuts to shopping for medications and groceries—although I myself never took advantage of them. Internet shopping for groceries is an option with delivery to the door of the patient (here is the Supersol link, and I am sure there are other major chains that provide the same service). Some pharmacies and kupot cholim also advertise that they will send a courier to the home to pick up prescriptions and send the medications back to the home of the patient. No doubt there is a fee involved, but it may be worth your while to look into this option.

Don’t believe everything you hear
Well, we filled out the inevitable forms to process the arrival of a foreign worker, and paid the inevitable fees involved. Of course, as luck would have it, our scheduled worker’s flight kept getting postponed for one reason or another. Our original application for a license was made at the beginning of November. We received the license at the end of November and were told that within three weeks or so the worker would arrive. The worker actually arrived in mid-January. According to the employment agency all their workers attend a course in basic spoken Hebrew and are taught the laws of keeping kosher. We found this to be an exaggeration in the extreme. But we did receive a very capable, bright and energetic worker and managed to continue with home care for close to two years.

Be prepared, if you do decide to go this route, that there are many days off (besides the weekly day off) that the worker is allowed, and if the worker agrees to work on those days off you will have to pay a hefty overtime rate for this service. If the worker takes vacation days (highly recommended for the worker’s sanity and well-being), you are left on your own to care for the patient/s or to find alternate help. The website for the Philippine Embassy has a list of the national and religious holidays to which their citizens are entitled. The hours that Bituach Leumi has awarded the patient/s can be used towards the salary of the foreign worker. (Note: Bituach Leumi does not pay the caregiver of a patient during days that the patient is hospitalized. This applies whether the caregiver is a local worker or a foreign worker. Many times, however, it is possible to reassign the hours to a different date in the case of a patient who is cared for by a full-time foreign worker. If all parties agree and there are enough hours left in the month for a part-time caretaker to make up the lost salary, the caregiver may choose to work extended hours to recover the money lost due to the patient’s hospitalization.)

MAKE SURE TO HAVE THE PATIENT'S VITAL INFORMATION READILY AVAILABLE

I must have been doing something right
To ensure proper dosage of medications and performance of medical procedures accurately I prepared many lists. All the medical information relating to my parents was stored in my head, and if I were unavailable for whatever reason, without these lists everyone else would be at a loss for how to deal with them. Among the lists I prepared for each of my parents individually were:
Each of their medications including the strength of the medication, how many times a day and at which hours to take them, as well as whether they were to be taken with a meal or not.
All their diagnoses, lists of their hospitalizations, and answers to frequently asked questions when being admitted to the hospital, e.g. date of birth, date of aliyah, country of birth, Holocaust survivor?, allergies, next of kin and contact information for close family members both in Israel and abroad.
Information on how to reach their family doctor, dentist, barber, pharmacy, supermarket, etc.
Sample menus for their meals.

Can you tell I’m a Type A personality? Born under the sign of Virgo? But knowledge is power, and you never know when the information might come in handy. I’m a little neurotic, so what? When out of the blue my parents’ family doctor sent the district geriatric specialist team to pay a home visit to my parents, they took one look at the organized listing of medications and the set-up in the home and said we had everything under proper control. If only my head felt that way, too, I’d have been in good shape.

So, one more milestone was reached, and another sigh of relief was heaved. But not to worry—the saga continues.

Part 4 The Energizer Bunny Syndrome

2008-03-07T01:27:00.000-08:00

by Shari (Zissie) Gitel

email: zissieg@walla.com

Remember the TV commercials for Energizer batteries? That one bunny rabbit just kept on going and going and going. Well, it may work with bunnies, but it sure doesn’t work with humans. This column is devoted to pitfalls I encountered when I thought I could be Superwoman and various resources available to help both the patient and caregiver get through difficult times.

Progress and the conservation of energy
About four weeks after my father’s stroke, my daughter, son-in-law and their three children moved in with us during the period between vacating their rental apartment and waiting for their apartment under construction to be inhabitable—including my parents that made nine, but who’s counting? Right about then I came down with the flu (flu-shot notwithstanding) and I came to the realization that this old machine just can’t keep going at its present pace.

If you’ve read my previous postings you know that I try to maintain a lively sense of humor to get myself through the day and advocate the same for everyone else having to endure a crisis such as this. But make no mistake. I do not take this situation lightly. We had a rocky road ahead of us, and my batteries were running down. How could I provide the maximum amount of care for my parents, if I myself could barely function?

Things had improved somewhat with my father to the point that he had “graduated” to having physical and occupational therapy at the kupat cholim, rather than at my home. He also started speech therapy, and as much as possible we tried to coordinate the appointments to minimize the number of times we would have to travel to the clinic.

Coordinate appointments to minimize hardships on patient.

Although this was a milestone, it further complicated my schedule—now I could add chauffeur to my long list of occupations. It actually was a two-person job to transport him anywhere, as he had to be dropped off near the entrance to the building with one person accompanying him and another parking the car afterwards. In addition, it took two people to get him into and out of the car. This situation can be circumvented by ordering special transport services in vans equipped to handle wheelchair-bound patients. Besides the YadSaraVan service, there are other places that provide similar transportation options. One that I know of is Ezer MiZion. Though these services are certainly helpful in getting the patient into and out of the vehicle, they do have at least one drawback—they are not always available to suit your schedule, unless you don’t mind going to the appointment a couple of hours early and being picked up a couple of hours late. For some people this may not be a problem, but my schedule was so tight already, and my father was in no condition to be hanging around sick people for hours on end, that we rarely availed ourselves of these services.

Another option is for the patient to apply for handicapped parking privileges. I myself never did this, however, and have no experience with the procedure. I would venture a guess that pretty much the same type of medical information that is requested for Bituach Leumi would be requested here. There may also be restrictions as to who bears ownership of the vehicle.

Could things possibly get any worse?
I’m sure it will come as no surprise to you that things can always get worse--especially when dealing with chronic illnesses and conditions. We would like to hope and pray for full and speedy recoveries for our loved ones, but often, barring some miracle or medical breakthrough, the reverse is often the case.

For awhile we were making good progress with my father’s recovery. He dutifully went to all his therapy sessions for several months, during the course of which time my mother’s condition deteriorated. By this time they had returned to their apartment, and my father was receiving additional hours from Bituach Leumi. We divided up the allocated hours between a woman who came a few hours a week to deal with household chores and a man who came to deal with my father’s personal hygiene issues. My husband and I dealt with everything else—shopping, doctors, medications, therapy, finances, all types of medical tests, apartment repairs—we were on call 24/7. If only someone would lend a hand, I kept saying to myself, maybe I could get through the week in a better state of mind.

During his hospitalization for the stroke and for the first few weeks afterwards, friends and family came to visit my father regularly. As time wore on, however, the number of people that came to visit dwindled. There simply was not much for my parents to look forward to at home, and leaving the house was such a difficult project that they preferred to just stay put. This dreary existence further complicated by deterioration in my mother’s condition started them down the slippery slope to depression. There are organizations (Yad Sarah and Ezer Mizion come to mind) that have outreach programs with volunteers that make home-visits to shut-ins. It has just come to my knowledge that even Bituach Leumi has volunteers for this purpose through their Department of Counseling Service for the Elderly (in a recent advertisement in the Jerusalem Post Lifestyle Magazine they advertise the service with a National Hotline number to call: 02-646-3404). In our situation we made an attempt to recruit visitors, but did not succeed in finding English-speaking volunteers.

Outreach programs are available to boost the patient’s spirits.

As my mother worsened, my father’s spirits declined, and he started displaying signs of depression. The fighting attitude he had at the beginning of the ordeal was being eroded by having to cope with the painful deterioration in my mother’s mental and physical condition coupled with additional hospitalizations for pneumonia that he had suffered. He no longer had the will to work at improving himself physically and gave up hope of ever getting better. Things were looking pretty bleak.

How to deal with Hachmarat Matzav
When my mother was initially assessed by Bituach Leumi, her claim was denied. My father, on the other hand, was awarded 9.75 hours per week of care. We were ready to appeal to Bituach Leumi for a re-evaluation on both of them (a process we went through at least twice, as the situation warranted it). In order to apply for re-evaluation one must complete a form claiming hachmarat matzav (worsening of the situation/condition). There is a portion for the family doctor to complete indicating the nature of the deterioration, and there is a portion for the patient or caregiver to complete with basic information (since the initial application had already supplied detailed information).

Appeal to Bituach Leumi for more

hours if the situation warrants.

In researching this column I learned that the forms can be ordered online. Again these forms can be submitted directly into the Bituach Leumi mailbox outside their offices to avoid waiting in line. Place them in the envelope provided by Bituach Leumi and complete the necessary information on the outside of the envelope to identify the patient, the liaison for making appointments, and the office to which the form is intended (in this case siyud). Bituach Leumi will contact you to set up a date for the re-evaluation. As before, there is a waiting period of a few weeks until the committee’s decision is available. It is highly recommended to phone Bituach Leumi periodically to see if a decision has been reached. Call your local branch (this response line is usually available only for about two hours in the morning) to check on progress with your claim. With verbal notification over the phone you can begin utilizing the added hours, without having to wait for the written verification, which is often delayed in the mail.

Each time there is a significant change in the patient’s condition you can go through this procedure. Conversely, Bituach Leumi can decide to send someone to re-evaluate the situation on their own to determine whether the patient is still eligible for the number of hours they have been awarded. If the situation has improved, they can decide to reduce the number of hours previously granted.

The importance of being earnest

Let me say at the outset that I am not a medical practitioner, and cannot nor will I recommend any particular medical treatment. I am just reporting on my experiences. Should you feel you need medical intervention you should see a competent licensed medical practitioner to assess your individual case.

Needless to say, the worsening of the situation was taking a toll on my health. I was in a state of denial about requiring the anti-depressants that my doctor recommended—no one was going to fool around with my head, if I could help it. So I began trying alternative treatments to reduce the tension, sleep disturbances, aches and pains and depression I was experiencing.

Reflexology helped with many of my symptoms (and it was during the evaluation by the doctor at the alternative medicine department of my kupat cholim that I was diagnosed with fibromyalgia—a disease I apparently had had for many years, based on my symptoms, but which had been exacerbated by the traumatic and tense situation I was dealing with currently). I also tried the Bach remedies, with no significant results. I tried meditation and conscious relaxation techniques. I had so many conversations with God (one-sided—don’t worry, I don’t hear voices! yet!) that I was starting to bear a close resemblance to Tevye from Fiddler on the Roof. In short, I tried just about anything I could to postpone the inevitable. When I finally reached rock bottom, I realized that in order to get through this period of my life I was going to need some pharmaceutical help. I made an appointment with my family doctor and walked out with a prescription for an anti-depressant. It took a few weeks before it began to take effect, but my coping mechanism has certainly improved. I also rely on sleeping pills now.

Take immediate action upon signs of depression and suicidal thoughts.

I’m starting to sound like a member of Drug-Takers Anonymous, but there are two points I am trying to make:
1) For anyone out there who thinks they are SuperCareGiver—you cannot do it all by yourself and expect to maintain your health. If you need help, do not hesitate to seek it. There are support groups (see end of article for partial list of links) for family members of patients with all types of diseases. Don’t be ashamed to admit that you might need to take medications to help you get through the crisis.
2) If you think you, as a caregiver, are depressed, can you imagine what effect the illness or condition is having on the patient him/herself? He/she has lost his independence and control of his/her environment and is now totally reliant on others for his/her every need. This is a drastic life-change to say the least. Be on the lookout for signs of depression or suicidal indications in the patient. Run, don’t walk, to the patient’s doctor to notify him of these signs and to get prescriptions for the appropriate medications and/or referrals for psychiatric care. It goes without saying that if the patient expresses suicidal thoughts you must get him/her to the hospital immediately. I am not personally familiar with the Israel Mental Health Association, but you can certainly check out their site for useful information if needed.

Without going into details, suffice it to say that I speak from experience. Professional intervention in cases of severe depression is not a luxury, it is an absolute necessity.

“If I am not for myself, who is for me?
And being only for my own self, what am I?
And if not now, when?”
Hillel, Ethics of the Fathers

Looking out for Numero Uno
I hope that I have managed to sufficiently scare you into being alert to both your health needs as well as those of the patient. I must reiterate how important it is to take a break from the routine. What they say about taking care of frail parents all falling on the shoulders of one child is no exaggeration. For whatever reason, this is usually just how it is. So don’t forget to treat yourself regularly to time-out—at one point my husband and I went on a two-week cruise where we were unavailable by phone or email, forcing other family members to bear the responsibility. That may sound pretty drastic. But a gal’s gotta do what a gal’s gotta do to recharge her batteries.

I welcome your comments.

Related Links:
Eran for emotional first aid
Mental Health Services of Ministry of Health
Guide for the Disabled in Israel
Support Groups for Neurological Diseases
Israel Society for Fighting Pain
Israel Cancer Society
Israel Lupus Association
Bookmarks of Ministry of Foreign Affairs for a comprehensive listing of useful sites

Guide to Services for the Aged and Disabled in Israel
© Copyright-2008
This work is protected by copyright law. Use of this work or any portion thereof, including photocopying, publication, public production, distribution, translation, broadcast, allowing public access to it, and utilizing portions derived from it for other purposes, without prior written permission from the author is prohibited.

Part 3: Money: Can’t live with it, can’t live without it.

2008-02-29T03:28:00.000-08:00

by Shari (Zissie) Gitel
zissieg@walla.com

Well, on second thought, maybe you can live with it.

Money—it seems to be slipping through your fingers with all the added expenses you now face. If your incapacitated loved-one is able to handle his/her finances and sign checks, you’re still ahead of the game. The problems arise when you yourself need to gain access to his/her money to cover costs of care. I am now about to begin round three of applying for apotroposut (legal guardianship), and each time the circumstances have differed slightly. The process, however, remains more or less the same.

When Do You Need Apotroposut?

The following is based solely on my own experience and research and in no way represents legal advice or a professional legal overview. In any case you should contact a competent attorney regarding your specific situation.

If your loved-one is incapable of handling his/her own affairs and making lucid decisions regarding his/her physical or financial issues, due to physical and/or mental dysfunction, you may need to have a guardian appointed by a court to handle these matters. In my experience it seems that in most cases guardianship is awarded to one or more of the next of kin of the patient, but not without substantial proof that indeed the patient has reached this stage of incompetence. Note: to the best of my knowledge, this application is made through the Family Court—Beit Mishpat l’Inyanei Mishpachah—and not every city has a Family Court. Check for the Family Court closest to you on the list supplied by the Ministry of Justice (or your social worker should be able to provide this information). There are two types of applications: physical (for medical decisions) and financial (for monetary transactions). In many cases, you will want to apply for both at the same time.

LOCATE THE APPROPRIATE COURT FOR YOUR CASE!

Encounters of the Legal Kind
My first encounter with making the application involved emergency surgery that my mother-in-law, of blessed memory, had to undergo to allow for tube-feeding. Without the court-awarded guardianship the hospital would not do the procedure. My husband, actually, was the applicant, and I was his representative at Family Court. With very little notice we had to assemble all the relevant paperwork substantiating our claim. This paperwork included: a) the attending physician’s declaration that the patient was mentally incompetent and in need of an urgent procedure, b) a letter from a social worker familiar with the patient’s condition and family situation attesting to the applicant’s suitability to obtain guardianship, c) signed and legally witnessed written agreement from all siblings of my husband that he be awarded the guardianship, d) the application itself which delineates the request and specifies particulars of the other living first-degree relatives of the patient. Fortunately we have a close family member who is an attorney. The cover letter she composed outlining the situation in Hebrew legalese certainly did not hurt the cause.

The court procedure was pretty straightforward and we were able to manage on our own, but if you have any doubt as to how to proceed, hire an attorney to help you. Many organizations provide legal counseling services (Yad Sarah and AACI to name two with which I am familiar). The Ministry of Justice also provides free legal counseling for those who cannot afford it, subject to the completion of the necessary form outlining the nature of the request and financial status of the applicant and their approval of your request.

Persistence is the key to

overcoming legal hurdles.

Although the courts post specific hours for when they conduct business, in emergency circumstances, we learned that there is a judge on call at all hours to help with processing the legal work. The trick is getting past the guard at the door—don’t be shy, insist on the urgency of your request. The guard carries a walkie-talkie and can get approval to allow you into the building to proceed with your mission.

My second encounter involved surgery for my mother. She was scheduled for elective surgery, but due to her diminished mental capacity, when she was interviewed by the anesthesiologist, there was some question as to her ability to handle her medical affairs. This time the urgency was not so great but the process was more complicated. Whereas the previous time we were ushered into the court building after-hours, and our case was handled immediately with a minimum of hassle and waiting (we never even saw the judge, rather dealt with a registrar), this time we entered into the scary world of the court system at its busiest. Attorneys were running all over the place with papers flying and briefcases swinging. There were a myriad of desks and clerks for every kind of legal situation, laymen (none of them looking too ecstatic) were stumbling around in a daze, and we had no idea where to go. Naturally, for starters, the guard pointed us in the wrong direction when we explained what we were there to accomplish.

Finding your way through the system can be confusing.

First rule at court: You have to open a file before you can go through any other part of the process, so your first stop is to the clerk that takes your paperwork, places it into a folder and pastes all kinds of stickers on it, gives it a number and tells you where to go next. If memory serves correctly, our next stop was the desk in charge of apotroposut, where the clerk looked over the paperwork and determined which judge would hear our case. She sent us to wait outside the judge's courtroom for our turn. A sign on the door warned in no uncertain terms not to enter when court was in session or until called in by the judge or his clerk. By this time, I was ready for the bathroom, so I asked one of the clerks in the area if I had enough time to take care of my needs. When assured that there was plenty of time, I rushed off. By the time I returned five minutes later, my husband was nowhere in sight. I peeked into the courtroom, and sure enough there he was. Remember the aforementioned sign? “To enter or not to enter?” that was the question! Taking a deep breath and expecting a jail sentence at the very least for my intrusion, I opened the door and went in without being summoned (memories of Queen Esther swirling around my head). I guess that sign wasn't all it was cracked up to be, because I didn't even receive a reprimand.

Make sure to have all your documents

to avoid unpleasant surprises.

All our paperwork was in order with two minor exceptions—the social worker at the hospital had told us we would not have to get permission from my siblings in the USA as the court was only concerned about siblings living in Israel. Wrong!!! At 10:30 a.m. Israel time, the judge insisted I phone my sisters in the USA to get their verbal agreement. They did not appreciate the wake-up call at 3:30 a.m. All's well that ends well, though. The judge agreed to the guardianship, but for only 30 days—enough time to implement the surgery. We were sent to pay the fee for the service and after some arguing about how we needed the paperwork on the spot (not mailed to us) because of the pending surgery, we were able to walk out of the courthouse with the legal work in hand.

Don't be intimidated. Perseverance Prevails.

Note: Don't be intimidated by the clerks and somber atmosphere (couldn't they have chosen pink instead of black for those robes and attorneys' suits?). Stand up for your rights. There is a desk marked "Mesaye’ah" (pronounced almost like Messiah—and a true savior if ever there was one), where there is a clerk whose sole purpose is to help confused citizens through the tangles of the legal system. Do not hesitate to avail yourself of this service. As with any other bureaucratic system, perseverance is the name of the game.

My sister and I are about to go round three to obtain permanent joint physical and financial guardianship for our mother. We have to arrange for a psychiatric evaluation (for the patient not for us), get a social worker’s letter of recommendation, get written consent from our father, and consent from our two sisters living in the USA (signed at an Israel consulate), and photocopies of the first page of everyone’s identity card or passport. I will keep you posted if things change this time around, but I am hoping that the third time will be a charm.

Temporary Money Solutions
In the meantime, there are some stop-gap ways to get access to the patient’s account, with the patient’s approval, of course. Policies vary from bank to bank, but you can inquire at the patient’s bank whether it is possible to get authorization to become a signatory on his/her checking account and/or acquire use of his/her credit/debit card. Become money savvy as to all the patient’s assets. You are going to need this information both for the patient’s benefit and for filling out various applications that require financial status reporting.

Happy treasure hunting!

I welcome any comments you may have.

Parts 1 and 2: My Loved One has Become Incapacitated, What do I do Now?

2008-01-20T03:33:00.001-08:00

by Shari (Zissie) Gitel
email: zissieg@walla.com

PART 1
ADJUSTING TO THE INITIAL SHOCK
No matter how hard we try to deny it, with every day that passes we and our loved ones get older, and with the blessings of old age come the not so welcome aches, pains, and limitations that make us dependent on help, whether it be in the form of equipment, transportation, food, financial aid or personal caregivers.

The elderly are not the only ones subject to these needs. In the blink of an eye any one of us can be transformed from a vibrant, active, independent member of society into one totally in need of outside help. We cannot predict if and when, G-d forbid, tragedy will strike, but when faced with adversity, if we are armed with the necessary information of where to go for help and how to navigate the bureaucratic maze, we can more easily deal with crisis.

I hope in this series of articles chronicling my experiences with coping with the nitty-gritty of bureaucracy, the court system, the medical system and the emotional upheaval brought about by the seemingly overwhelming demands placed on me as a primary caregiver, I will be able to help you in some small measure. Bear with me as I describe my frustrations, cheer along with me as I claim my victories, and most of all keep your chin up and maintain your sense of humor. We can get through this together. So let’s get started.

MISSION POSSIBLE:

CUTTING THROUGH THE MAZE OF RED TAPE

Israel society is a particularly caring one. Many government agencies cater to the needs of the disabled, ill and elderly—ranging from the municipal to the national level. Likewise, non-profit organizations abound with services such as transportation, meals-on-wheels, equipment loans, legal counseling, therapy services and day-care centers. But where do you start? If you are "lucky" your situation will slowly deteriorate and enable you to gradually wend your way through the system. Those of us who have been forced into the situation through a sudden unexpected illness or accident, have had to learn the system in a crash course.

In my case, one moment I was planning an 80th birthday party for my parents to take place in three days time, and the next moment I was in the emergency room with my father who had suffered a sudden stroke, paralyzing him on his right side and affecting his speech. As if that weren't enough, shortly after my father was released to my care from rehabilitation, I found that my mother would herself require medical procedures to be performed by me every few hours of every day at their home.

I felt like the proverbial carpet had been pulled out from under my feet, I'd been run over by a bulldozer and my whole world had crashed down on me, to put it mildly. None of the platitudes offered to help me cope were useful, and, believe me, I've heard them all. I knew that I just had to put one foot in front of the other and step by step take care of all my parents' needs. And that's how I learned the system. I am by no means an expert, but I hope my experience will serve to help others who have to go through similar circumstances.

I CAN HANDLE THIS...

PREPARATIONS FOR HOMECOMING
My first piece of advice is not to delay. As soon as you can, begin making preparations for the patient’s return home. My father spent about 10 days in the hospital, during which time several employment agencies approached us to describe their home-care services. My initial reaction was that these companies were in competition with each other to attract my business, and I would wait until things quieted down before making a rational decision on which company to choose. With 20-20 hindsight I now realize that that was when I should have already begun the process of hiring a caregiver.

When the time came to transfer my father to a rehabilitation center, most of the facilities in the area of his home were either full to capacity or undergoing renovation, and we were not given a choice of facility. Through my volunteering at Yad Sarah I had learned of the YadSaraVan service, and promptly ascertained that the minimal charge for the service was well below that of an ambulance. With my husband (without whom I could never have gotten through this continuing ordeal) trailing behind the van in our car, and me in the van with my father safely buckled into his wheelchair (also borrowed from Yad Sarah), we made our way to the rehab center. Only when we got my father to the correct building for admission to a bed did the driver leave. Although it was nearing evening, he acted as though he had all the time in the world to help us. We waited a little longer than we would have for ambulance transport, but the friendliness of the driver and his readiness to help us get my father to his destination with a minimum of hassle was well worth the wait.

Although I was of the opinion that he required more time for rehabilitation, the powers that be determined that after two weeks of physical and occupational therapy at the rehab center, my father was ready to return home. So, armed with the discharge summary from the hospital, the discharge summary from the rehab center, and forms detailing his disabilities and need for 24-hour care and continuing physical, occupational and speech therapy, we piled into our car to head home.

HOME SWEET HOME? GET READY FOR ALTERATIONS!

But his home was not ready for him. He now required a variety of assistive items. In addition, issues we had never before needed to consider—such as the width of the doorways in his apartment, the height of chairs (for ease in sitting and standing), and the tripping hazard posed by carpets—had to be addressed, and we desperately needed to find some outside help to assist us in remodeling our lives to this new challenging situation.

Help was not far away. First of all I turned to (Surprise!) Yad Sarah. At the lending center we were able to borrow many of the necessary assistive items. At a local medical supply store we were able to purchase the remainder of the items we needed to install. Again I must emphasize that time is of the essence. These items should be installed before the patient is released home. The consultant at the Yad Sarah Guidance and Exhibition Center was able to make several suggestions to help us get started. These solved our immediate problems. But there was much more involved before we could heave the first of many well-deserved sighs of relief.

APPLYING FOR CARE SERVICE IN THE HOME
The hospital or rehabilitation center can supply you with a list of local agencies that deal with providing home-care. Check out several from the list to ascertain if they have workers that meet your needs. In our case we needed a male who spoke English. The day following my father’s arrival home (to my cottage which had wider doorways and where I could supervise the initial care) the agency sent out a social worker to evaluate the situation. She helped us fill out the necessary forms to apply for “Chok Bituach Siyud” (the law that determines qualification for nursing care) through Bituach Leumi, and showed us which portion of the application needed to be filled out by the family doctor. Until a definitive answer was received from Bituach Leumi as to how many hours a week they would allot, the agency would provide, free of charge, a caregiver for the minimum amount of time (six hours a week). Once we got the response from Bituach Leumi, the caregiver’s hours would be paid retroactively by Bituach Leumi and we could then set up a schedule based on the actual number of hours they would allot. If Bituach Leumi denied the claim, we still were not required to pay for the services utilized for this interim period.

Bituach Leumi has a committee that meets periodically and determines the degree of home care needed by applicants based on a point system defined by the lack of ability of the patient to perform certain daily activities (known as ADLs), namely: being able to stand up and sit down unassisted, dressing oneself, feeding oneself, getting in and out bed unassisted, bathing oneself, ability to control excretions and utilize toilet facilities. The fewer activities the patient can perform, the higher his score. If the patient is a holocaust survivor, he/she is awarded additional points. The higher the score, the more hours of care allotted by Bituach Leumi, anywhere from 6 hours to 15 hours per week (from my experience).

PHOTOCOPY EVERYTHING!!!

And now it’s time for another word of advice. I cannot overemphasize the importance of photocopying everything before you submit the originals to the service provider with whom you are dealing. Numerous times representatives from various agencies arrived to examine my parents and were grateful that I had photocopies of relevant documents—every doctor’s letter, recommendation, hospital discharge summary, documentation of diagnoses, physical limitations etc. You can never be too careful in this respect.

AVOID LONG LINES:

USE THE MAIL!!

Bituach Leumi offices are not open to the public every day, but they do have a mailbox outside their offices where you can deposit your completed application. There is a special envelope for this purpose near the mailbox outside the Bituach Leumi offices. Put your completed original application, with all the documentation required attached to it, into this envelope and seal it. On the outside of the envelope fill out the required information identifying the patient and whom to contact by phone, check off the appropriate box to direct the envelope to the proper department for processing (in this case: “siyud”), and place the sealed envelope into the Bituach Leumi mailbox. In my experience, this was the most efficient way of handling the situation. Within a day or two, Bituach Leumi contacted me to set up an appointment for sending a nurse to come evaluate the situation. The nurse’s report would then be sent to committee for consideration (this can take several weeks).

THE IMPORTANCE OF KNOWING HEBREW
Now another word of advice: It is wonderful to speak English as a mother-tongue. It gives you advantages in the marketplace, in educational venues and international forums, but when it comes to dealing with government forms and clerks in Israel, nothing compares to being able to speak, write and understand Hebrew. I know your Aliyah representative told you you'd have no problem getting along in English when you move to Israel. What he left out is that you can get along in English only until you need to know Hebrew. Although my father understands the language in a biblical sort of way, my mother neither speaks nor understands Hebrew. With all the good will and intentions of the Israel government in attempting to help all its citizens, the misunderstandings that can derive from insufficient knowledge of English on the side of the clerks and insufficient knowledge of Hebrew on the side of Anglo-Saxons can mean the difference between getting your problem processed efficiently and expeditiously or not at all. Get a handle on the language. If you cannot understand and communicate in Hebrew, you will not be able to fill out all the necessary forms or find your way to the right clerks to take care of your specific problem, unless you have an interpreter at your beck and call. Precious time is lost and frustration only mounts. Should the time ever come when you yourself have to be institutionalized—you should live so long—you will not be able to communicate with your caregivers.

But more on that later.

I welcome your input, comments and suggestions and look forward to our next chat.

Guide to Services for the Aged and Disabled in Israel
©Copyright-2008
This work is protected by copyright law. Use of this work or any portion thereof, including photocopying, publication, public production, distribution, translation, broadcast, allowing public access to it, and utilizing portions derived from it for composing other written works, without prior written permission from the author is prohibited.

Part 2
I Think I Need a Secretary

Arranging for Home Care Through Kupat Cholim
Just when I thought things would start to calm down, the fun really began. Our arrival home from the rehabilitation center heralded an unending chain of phone calls and appointments to continue the process of physical and occupational therapy. I have had personal experience with only two of the kupot cholim, but I would venture to say that all of them have a division devoted to what in Hebrew is called hemshech tipul—“continuing care” in English. If the patient is housebound, arrangements can be made to have a physical therapist and occupational therapist come to the home.

TAKE ADVANTAGE OF HOME SERVICES.

Keep the patient’s personal physician and staff apprised of the situation. Ideally, they should be able to provide you with information on how to arrange for home therapy. As I am not familiar with all the kupot cholim, I am attaching links to the site of each kupah with the closest information I could locate on either how to contact a social worker or find out how to arrange for home care in your area: Clalit, Leumit, Maccabi (you will have to search for the yechida l’tipulei bayit to open a list of phone numbers to contact for home care according to region), Meuhedet (open the menu under sheirutim refuiim and choose ovdim socialiim to find a social worker in your area).

HELP! I CAN’T KEEP TRACK OF EVERYTHING!

My calendar was starting to look like I was running a major industry. Social workers from everywhere (the municipality, the kupat cholim, the caregiver agency, Bituach Leumi) were coming and going. Physical and occupational therapists were scheduled at varying times of the day, the caregivers were arriving at different hours (one for my mother, one for my father), and I had my own personal schedule to worry about. Those little boxes on the calendar that used to be large enough to write down an appointment here and there began to look like a nightmarish maze with scribbles on the side and arrows pointing in all directions to indicate where I had to squeeze yet another appointment into an already bulging schedule.

I needed a secretary. Since that was out of the question, my husband presented me with the next best thing: a Palm Pilot. Now I was ready to take on the world. I have finally gotten used to hearing the alarm go off every couple of hours to remind me of either an imminent appointment, or a looming deadline that has to be met—like my colonoscopy or dinner (not necessarily in order of preference). If you can’t afford a Palm Pilot or some similar electronic gadget, get yourself an office-type diary with plenty of room to keep track of appointments and space to set reminders for things you need to take care of before time runs out.

ORGANIZATION IS THE KEY TO EFFICIENCY.

Another useful item is an accordion type folder for filing doctors’ letters by specialty, test results, hospital summaries, insurance information, etc. It goes without saying the more orderly you are, the quicker you can locate needed documents when the time comes.

LEARNING ABOUT BENEFITS AND SERVICES
Although each situation differs, there are some basic facts that are valuable for everyone to know. The patient’s municipality (iriya) should have a social worker available through its welfare department (agaf harevachah). Actually, in our case, the social worker contacted us, as she had already been informed by the kupat cholim of my father’s condition upon discharge and knew that the family required guidance. She also happened to be the liaison with Bituach Leumi (the National Insurance Institute) and was extremely helpful in providing information on services available though the municipality, such as discounted meals on wheels (for those who qualify financially), reduction on arnona (property tax) costs for the disabled, and general information on services for the disabled. Check your local phone book under the iriya listing for agaf harevachah or call your local moked for the correct phone number, if a social worker from the municipality has not contacted you.

YOU MAY BE ELIGIBLE FOR MANY BENEFITS.

To mention a few items that may be available at reduced cost (often there are financial forms and statements that must be provided to determine eligibility): meals on wheels, disposable diapers, wheelchairs, emergency alarms, nutrition supplies for patients being tube-fed. The Ministry of Health will subsidize certain items of equipment for eligible patients and may even assist in altering the home to accommodate qualified patients. Your kupat cholim will often reduce the cost of certain medications for chronic illnesses, and may forego payment of the deductible for certain tests and doctors’ visits. Some of the items listed above can be acquired through Bituach Leumi in lieu of caregiver hours. In other words, you may choose to utilize only a portion of the hours allotted by Bituach Leumi towards a personal caregiver and the remaining portion towards purchasing diapers at a reduced cost or installation of an emergency alarm system. Weigh the pros and cons. This obviously will cut down on the amount of time the caregiver will be spending in the home, on the one hand, but, on the other hand, will reduce your out of pocket costs for a potentially expensive item. Your are not required to limit yourself to the number of hours allotted by BituachLeumi, but keep in mind that you will have to bear the cost for any hours over and above those paid by Bituach Leumi.

ASSURANCE AND INSURANCE ISSUES
Are you familiar with the patient’s insurance coverage? If not, now is the time to do some investigation. Many patients, in addition to the basic health package provided by their kupat cholim, have supplemental insurance available through the kupah. They may also have a disability insurance policy and/or a policy to cover extended nursing care.

Did you know that you can purchase “falling” insurance? I found out about this the hard way.

LIFTING CAN BE DANGEROUS TO YOUR HEALTH.

My father, G-d bless him, is a big man. When he falls it is not easy to get him up from the floor (and in some cases is even contra-indicated). We tried to lift him ourselves on several occasions. This was causing damage to our backs and also possibly my eyes (my doctor really scared me when he told me I had possibly torn my retina from straining to lift my father). That’s when we started phoning Magen David Adom (101) for an ambulance crew to examine him and lift him up. The bills started piling up. After we had an emergency alarm installed in parents’ bedroom (through the Yad Sarah Emergency Alarm Center), we summoned Magen David Adom via the alarm center. From Yad Sarah we learned of relatively inexpensive insurance we could purchase in order to have someone come to the home and physically lift my father for us in the event he fell. The insurance also provided for home doctor visits at a token fee at all hours of the day and night. Unfortunately we had to utilize this service more often than we anticipated and under circumstances that were literally life-threatening. I have only praise for the speed and efficiency of the alarm center and the insurance company in coming to our aid.

WEIGH THE PROS AND CONS OF WHEN TO CASH IN ON YOUR INSURANCE.

When it comes time to consider utilizing extended-care nursing insurance, you have to make some tough decisions. How do you time it for maximum effectiveness to meet your financial and physical needs? Although policies differ, extended care nursing insurance will at least partially cover home-care costs (or costs at a nursing home facility), if the patient meets the criteria set by the insurance company (again ADLs come into the picture and more visits from nurses to make evaluations, forms to be completed and documentation sent to support the claim). My parents’ policy has a four-month waiting period between the time the patient applies for the insurance benefits and the time the payments actually arrive to his/her bank account. We were astounded to find out that although my parents did qualify for the insurance coverage (which we did not activate until the situation deteriorated both physically and financially), they would still have to continue paying the monthly premium on the policy. And the coverage is good for a limited time only. After that, you’re on your own again. So consider your options and the consequences of postponing activation of such insurance policies. Is it better to take the benefits now, or put them off until things really get worse, at which time you may have to wait a few months before seeing any financial assistance?

FINDING TIME FOR YOURSELF
I’ve touched on only a few of the issues that will come up when you first get home from the hospital with your loved one, and I’m feeling exhausted just from re-reading it all, let alone having to do it—so you most probably are feeling that the task is daunting, too. As you can tell, I am here to write about it, testimony to the fact that I survived the experience, and so can you. Don’t despair. And above all, make time for yourself.

As I wrote that last sentence I am reminded of the saying, “Do as I say, not as I do.” For the longest time I kept pushing myself to the extreme to make sure that everything was taken care of properly. It took a toll on my physical and mental health—not to mention family relations. At the end of the day (as well as during the day) I was a basket case, frustrated by setbacks, worn out from dealing with pressing problems, and concerned that I was not doing enough to care properly for my parents. But, you know? We are only human and can only do so much, and life is too short to spend it in a constant state of depression. So, do what you can to give yourself a break—it could be something as simple as stepping outside for awhile and breathing the fresh air, clearing your mind and smoothing out your wrinkled forehead. Go for a massage—I particularly fell in love with reflexology as a means of relaxation. Pick up the phone and talk to a friend. Watch a hilarious comedy and have yourself a hearty laugh. And, when all else fails, I have found that a good cry releases a lot of tension and gives you the strength to keep on going.

Guide to Services for the Aged and Disabled in Israel
© Copyright-2008
This work is protected by copyright law. Use of this work or any portion thereof, including photocopying, publication, public production, distribution, translation, broadcast, allowing public access to it, and utilizing portions derived from it for other purposes, without prior written permission from the author is prohibited.