Laura’s Smile

Laura Benichou was born on June 9, 1998, with a hole in her heart. This hole probably saved her life, because she was also born without her main pulmonary artery.

The blood had to go somewhere, so it went through the hole. Her condition would take too long to explain, but one result was the lowering of the oxygen level in her blood to 75 percent and below (normal is 99 percent to 100 percent), which meant that her body had to compensate by producing more red blood cells. This in turn thickened her blood and caused other complications, like periodic brain seizures.

The first major seizure happened before she was a year old. To save her life, the top cardiac team at a major hospital in Los Angeles performed an 11-hour operation that implanted small “pipes and faucets” to help normalize the blood flow between her heart and lungs. This didn’t get the results they wanted, so a few weeks later they went back in to implant larger devices. Laura was not responding well to post-surgery care, which created more complications and led to another operation. After six months and three major operations, Laura was a year and a half old when she returned home.

Laura has never spoken a word, but she can coo, laugh, sigh and cry. At her best, she has taken steps with the help of a walker. She has a thin body with a smallish, sweet face framed by dark-brown hair. She gets 24-hour home care, with three rotating nurses monitoring her breathing and other vital signs.

One of those nurses says that Laura expresses a wide range of “appropriate” emotions, from happiness to surprise to crying for attention. Her favorite movie is “Mary Poppins,” and her favorite TV show is “Hannah Montana.” She likes toys that move, and she has a fondness for anything slapstick.

Oh yeah, and she loves to smile.

It’s that spontaneous smile, which I saw firsthand on a recent visit to her family’s handsome high-ceilinged apartment in West Hollywood, that her mother says “hypnotizes everyone who meets her.”

I think the smile has also helped her family fight to keep her alive. While she was in the hospital for six months, her parents took turns to be with her at all times. Her brother, a very cool-looking 16-year-old who’s a starter on his high school basketball team, is very protective of her and seems to have a knack for making her laugh.

Her mother, Veronique, a thin and perfectly put-together French Moroccan Jew in her early 40s, has become a walking medical handbook. During my late-afternoon visit, while she was serving mint tea in elegant china, she took several hours to calmly answer all my questions regarding their ordeal, and Laura’s medical history, even drawing a diagram to explain one of the surgeries.

Veronique says she “stopped living” when the doctors told her the news about Laura. At the time, she had a thriving international trading business. Her husband Richard, an intense, darkly handsome, French Algerian Jew who is a member of the Pinto shul on Pico Boulevard, ran a successful garment business. They were also going through a major renovation of their home near the Sunset Strip, which they were preparing for the new baby.

It didn’t take long for the house (which they have since sold) and their businesses to take a back seat to Laura. Veronique herself was in a “coma of denial” for the first few months, but once she got out of it, she became quietly unstoppable — whether fighting in court against insurance companies (so far, she has prevailed at the key hearings) or doing constant research on the Internet to make sure that everything medically possible is being done for her daughter.

And God knows she’s done it all, medically and otherwise. She recalls now, with a tinge of disappointment, how vulnerable she was to faith healers of all kinds. She especially remembers the woman mystic from Israel, who spent three days rubbing different oils on her daughter while chanting special prayers. Veronique knew then that because they were people of means, there would be no shortage of miracle workers knocking on their door. But she was too vulnerable to turn them away.

Meanwhile, she was knocking on the doors of emergency rooms at all times of the day and night, whenever Laura had a seizure or some other complication. After a few years, she got so frustrated with the service and long waits that she started a company called SOS Medlink, which coordinates a network of doctors who make house calls (I’ve used the service myself, and if I had a say on the Messiah, I’d nominate a doctor who makes house calls). She is currently looking for partners to expand the business nationally, in the hope that it will help provide for Laura’s future care. Her husband has also gone back to work.

Right now, they’re both hoping for a medical success. They don’t like the option of doing nothing, because Laura’s condition hasn’t gotten any better, which leaves her at risk of another seizure (Veronique won’t elaborate). At the same time, though, an “out of the box” operation to repair Laura’s heart is also delicate. So they’re torn between two risky options.

Veronique and her husband will soon make a decision. In the last few days, they have met with a prominent surgeon, and they are exploring a “middle of the road” option that will hopefully do a little repair of the heart and buy them some more time.

In the meantime, they will continue to care for Laura around the clock, take her to parties and to visit family around town, and enjoy one thing that can always fill the hole in their own hearts.

Her smile.

Israeli Government Gets on With It

Israel is resigning itself to politics without Ariel Sharon.

Shock gripped the Jewish state last week when Sharon was hospitalized with a massive stroke, turning to fears for the worst when he underwent repeated surgery.

Doctors said it could take time to ascertain whether Sharon had suffered cognitive damage or permanent paralysis on the left side of his body from the Jan. 4 stroke. At press time, it also was not certain that Sharon would recuperate at all — his condition was such that it could deteriorate at any moment.

Still, a prognosis took shape whereby Sharon could survive but in a form of forced retirement. Sharon’s chief surgeon, Dr. Jose Cohen, said this week that Sharon had a “very high” chance of surviving.

“He is a very strong man, and he is getting the best care,” the Jerusalem Post quoted Cohen as saying. “He will not continue to be prime minister, but maybe he will be able to understand and to speak.”

As the prime minister lay in a post-operative coma Sunday, his temporary replacement, acting Prime Minister Ehud Olmert, chaired the weekly Cabinet meeting.

“We hope that the prime minister will recover, gain strength and with God’s help will return to run the government of Israel and lead the State of Israel,” Olmert said.

While noting that doctors’ reports from Jerusalem’s Hadassah-Hebrew University Medical Center at Ein Kerem had given a “glimmer of hope” as to Sharon’s chances of recuperating, Olmert said matters of state were as robust as ever.

“We will continue to fulfill Arik’s will and to run things as he wished,” he said, using Sharon’s nickname. “Israeli democracy is strong, and all of the systems are working in a stable, serious and responsible manner. This is just as it should be and how it shall continue.”

With general elections looming on March 28, the 60-year-old Olmert has his hands full. But he received an early show of support with a weekend phone call from U.S. Secretary of State Condoleezza Rice.

There was also an internal reprieve from the Likud Party, which decided against resigning from the government, reversing a decision made before Sharon suffered his stroke last week.

“Now is not the time for such moves,” Foreign Minister Silvan Shalom, one of four Cabinet members from the Likud, told Army Radio.

A Channel 10 television survey issued after Sharon was stricken predicted that his new centrist party, Kadima, would take 40 of the Knesset’s 120 seats in the election if it is led by Olmert. But analysts suggested the showing reflected short-term public sympathy.

The political correspondent for the newspaper Ha’aretz, Aluf Benn, recalled the aftermath of Prime Minister Yitzhak Rabin’s assassination in 1995, when opinion polls showed his successor, Shimon Peres, as a clear favorite for re-election. In the end, Benjamin Netanyahu defeated Peres by the slimmest of margins.

“Instead of presenting himself as pressing ahead with Rabin’s path, Peres made the mistake of insisting that he was an autonomous candidate,” Benn said, suggesting Olmert, the former mayor of Jerusalem, was wise to portray himself as a reluctant stand-in for Sharon.

Yet the Channel 10 survey found that Peres, should he lead Kadima, would perform better than Olmert, taking 42 Knesset seats.

Though Peres quit the Labor Party last year to back Sharon, he has yet to formally join Kadima. But he voiced support for Olmert, who advanced the idea of a unilateral Israeli pullout from occupied Gaza prior to Sharon’s public embrace of the strategy.

“He supported the policies of Mr. Sharon and even occasionally was ahead of him,” Peres told Britain’s Sky Television. “The policies for peace, the continuation of the policies of Sharon, will have my full support.”


Community Braces for Flu Shot Scarcity


Michael Gabai is on a quest.

The owner and administrator of Ayres Residential Care Home has spent the last two weeks calling physicians, senior centers, grocery stores and pharmacies in search of flu shots for about half of the 18 residents in his facilities who have been unable to get one. Gabai was finally able to secure a reservation for his oldest resident, a 96-year-old, to get vaccinated at a grocery store about 10 miles away.

“We’re scrambling to get it done, Gabai said. “We know how easily [flu] can turn into pneumonia for our elderly clients.”

With the flu vaccine shortage becoming a national — and political — crisis, people working with seniors, like Gabai, are the most troubled.

“Flu is always a concern,” said Molly Forrest, director of the Los Angeles Jewish Home for the Aging (JHA). Vaccinations are normally given to all of JHA’s residents and frontline caregivers willing to be inoculated, she said. However, JHA has not yet received its supply of vaccines from the Los Angeles County Department of Health Services, which has promised to deliver them late this month or early in November. Flu season generally spans from November to March, and affects between 10 percent to 20 percent of Americans.

During the 2003-2004 flu season, there were 1,600 deaths from influenza and pneumonia in Los Angeles County, according to the Center for Disease Control. Also, over the last five years, nearly 90 percent of all deaths from flu andpneumonia were among those 65 or older.

Forrest believes they will get adequate amounts of vaccine to cover the residents, but thinks they might need to seek additional doses for frontline staff.

During her nine-year tenure, Forrest said that JHA had not experienced any serious flu outbreaks. When cases have arisen, they have isolated individual buildings or patients in order to contain the spread of the disease.

Jewish Family Service’s (JFS) Valley Storefront and West Hollywood Senior Center had to cancel scheduled flu shot clinics when the Red Cross failed to deliver vaccines as promised, said Lisa Brooks, one of the agency’s directors.

“We’re waiting to see if more supplies become available,” she said. Directors of JFS’s senior centers are in close contact with sources of the vaccine to find out when that might be.

Additional flu shots might soon be forthcoming from drug manufacturer Aventis Pasteur. The majority of its 22.4 million doses, which were promised but not yet shipped to customers, will be routed to entities designated by the Centers for Disease Control and Prevention (CDC) as priorities. In addition to seniors, those considered most at-risk of developing potentially life-threatening complications from the flu include children under 2 years old (the vaccine is not recommended for babies younger than 6 months old), individuals with chronic medical conditions and pregnant women. According to United Press International, CDC Director Dr. Julie Gerberding said the agency is mapping areas where the vaccine has been sent and those where it is needed and also tracking flu cases by county to quickly identify flu hot spots.

The flu shot shortage does not seem to trouble early childhood educators.

“I don’t think at this time anyone is particularly panicking,” said Betty Zeisl, director of public relations and communications for the Bureau of Jewish Education (BJE), who noted that at a meeting of early childhood center directors last week “the subject didn’t come up.” (While BJE facilities must conform to federal, state and local guidelines, protocols for dealing with illness are determined by each individual center.)

“I don’t think [the shortage] is going to affect us,” said Angie Bass, director of the early childhood center at Temple Beth Am, who believes that sensationalized media reports are needlessly scaring parents. Bass said that the school maintains routine health precautions such as undergoing regular cleaning, a hand-washing policy for staff and students and a practice of sending children home if they need to wipe their noses more than three times in a 15-minute period.

Bass said that “if it really looked like a real epidemic and not just media hype,” she would send home a letter informing parents and include advice from pediatricians. Thus far, however, none of the pediatricians she has consulted have expressed concern.

“As soon as the pediatricians are worried, then I’ll worry,” she said.

“I think it is a potential problem,” said Dr. Carol Berkowitz, professor of clinical pediatrics at Harbor-UCLA Medical Center in Torrance and president of the American Academy of Pediatrics. “We never know how serious a flu season we will have.”

At the same time, she said that last year was the first year that vaccination was suggested for healthy children between 6 and 24 months.

“Flu vaccine has never been recommended for healthy children over the age of 2 years,” she added.

Berkowitz and others emphasize the importance of following CDC recommendations to help prevent flu. These include avoiding close contact with people who are sick, staying home from work or school if you are sick, covering your mouth and nose with a tissue when coughing or sneezing, avoiding touching your eyes, nose or mouth and washing your hands frequently. Certain prescription antiviral medications (oseltamivir, rimantadine and amantadine) can either prevent the flu or lessen its symptoms if taken promptly after exposure to the virus — or soon after symptoms begin. Symptoms may include fever, headache, chills, body aches, dry cough, stuffy nose and sore throat.

Unfortunately, even if individuals take precautions, they cannot control the habits of others. As the JHA’s Forrest notes, this is especially true for the most vulnerable populations.

“The very young and very old, who get help from other people, are incredibly at risk because they depend on someone else’s hygiene,” she said.


Russian Community Fundraises for Israel

When obstetrician-gynecologist Ludmila Bess and her husband, a civil engineer, immigrated to the United States from Russia in 1977, they came with only $600 in their pockets. Like many others who arrived from the former Soviet Union with few or no financial resources “our goal was to survive,” Bess said.
Now established with a successful Los Angeles medical practice, Bess’ goals — like those of many of her contemporaries — have turned outward. She is chairing the Saving Lives gala on Oct. 17 to raise funds for the pediatric trauma unit of Tel Aviv’s Sourasky Medical Center.
The event is a collaboration among the Russian-speaking community, the American Russian Medical and Dental Association, the business community and The Jewish Federation of Greater Los Angeles. Taking place at the Hilton at Universal City, the gala will feature singer and actor Theodore Bikel, opera star Susana Poretsky and singer and cantor Svetlana Portnyansky.
While the event boasts the trappings of long-established philanthropic groups (hors d’oeuvres have been donated by Wolfgang Puck and his associate Bella Lantzman, for example), these efforts mark a relatively new direction for the Russian Jewish community.
“Originally, Russian immigrants, when they came to the United States, were mostly takers, not givers,” said event co-chair Eugene Levin, founder of the Russian-language Panorama Media Group. “There was no such tradition of giving in the former Soviet Union. Mostly, people depended on the state.”
While numerous agencies such as the Hebrew Immigrant Aid Society (HIAS) and Jewish Family Service of Los Angeles continue to help newly arrived Russian immigrants with resettlement, many in the community have lived in the United States close to two decades or longer. They have overcome cultural and language barriers, and attained professional and financial security. So their attention has turned to fundraising and outreach efforts for their community. Such entities include the Association of Soviet Jewish Immigrants, a Federation affiliate and the umbrella organization for agencies serving the Russian Jewish community, and the West Hollywood Russian Community Center, which aids new immigrants with practical necessities, information, referral and advocacy.
Now, efforts reach beyond their own community to others in need. It started slowly, with participation in the United Jewish Fund’s Super Sunday and two parlor meetings that generated funds for causes in Israel.
In 2002, Bess and her colleague, Dr. Yelena Vaynerov, decided that, as physicians, they wanted to generate support for medical care in Israel. Bess and others met with Federation President John Fishel about their idea. Initially, he suggested more parlor meetings. “We told him, ‘We want to have a big gala. We want people to feel together,'” Bess recalled. “And he told us, ‘I will do my best to make this event happen and be an A-plus.'”
With Federation support, the group held its first gala in January of last year, raising more than $250,000 toward the purchase of equipment for the trauma unit of Sourasky Medical Center. The hospital has provided front-line care for victims of terror attacks, including the 2001 Dolphinarium bombing that claimed the lives of more than a dozen Soviet-born teens outside a Tel Aviv disco.
Bess says that raising funds for a worthy cause was only one of her goals. She also wanted to increase community cohesiveness and change attitudes about giving.
“We wanted to show our community that it’s [a greater] pleasure to donate than to be a recipient,” she said.
Last year’s gala seemed to accomplish those goals. Besides attracting more than 650 attendees, the event generated support from across the community, with donations as small as $5 and as large as $10,000. Bess remembered being touched when a 75-year-old patient, living on government pension, presented her with a $300 check despite the patient’s limited income.
This year, organizers hope to accommodate more attendees and raise $300,000. The event honors Sourasky Medical Center’s Director General, Dr. Gabriel I. Barbash; Dr. Leonid and Natalie Glosman, one of the first couples to mobilize the Los Angeles Russian Jewish community in support of Israeli and American causes; Anita Hirsh, former co-chair of the Commission on Soviet Jewry and, with her late husband, Stanley, a supporter of major projects in the United States and abroad; Dr. Gabriel Rubanenko, supporter of numerous Israeli philanthropies; and Barbara Yaroslavsky, who along with her husband, L.A. County Supervisor Zev Yaroslavsky, has been an advocate of Soviet Jewry for more than 30 years.
Event co-chair Helen Levin, wife of Eugene, and director of the West Hollywood Russian Community Center, notes that the community at large — and, indeed, the nation — has begun to reap the benefits of supporting Soviet Jewry.
“You haven’t been fighting for us for nothing,” she said. “Now we are paying back to the United States.”
She added, “I always say to my clients [at the West Hollywood Russian Community Center], ‘Yes, there are problems here, as everywhere. But there is no better place…. So we better do something useful and positive for this country.'”
The Saving Lives gala begins at 5:30 p.m. on Oct. 17 at the Hilton Universal in Universal City. For more information, call (323) 761-8345 or visit n

Plan Seeks to Cure High Cost of Drugs

In this presidential campaign year, the figure is ubiquitous: One out of four Americans, about 70 million people, do not have health insurance. At the same time, Americans are spending about $100 billion on prescription drugs annually, more than double what was spent in 1990.

For the uninsured, that money comes from either government assistance programs or their own pockets. Los Angeles residents, however, may soon be the beneficiaries of a plan to help close the gap.

Councilman Antonio Villaraigosa has unveiled a proposal called, LA-Rx, that would enable the city to make medications cheaper for residents. The plan calls for a city contractor to purchase drugs at bulk rates from pharmaceutical companies and, in turn, sell them to residents at below retail cost.

Although estimates vary about the exact rate of rise in drug costs, anecdotal evidence suggests that there is a serious problem.

"There is no question that prescription drug costs which consumers are paying are escalating and continue to escalate," said Rabbi Hershy Ten, president of Bikur Cholim, a nonprofit organization dedicated to expanding access to health care for the residents of greater Los Angeles.

Concerned with the implications of prescription drug costs for both the Jewish community and the city at large, Ten met with Villaraigosa and his staff to discuss LA-Rx.

The root causes of the issue are economic. Pharmaceutical manufacturers, who have fought court battles with several state governments over health-care costs, claim that they are simply seeking equitable compensation for their risks: Only a very small percentage of drug research ever culminates in a product reaching the market.

The Pharmaceutical Research and Manufacturers of America (PhRMA), an organization that represents more than 100 major U.S. drug companies, also claims that the vast majority of the increase in public spending on prescription drugs is due to the increasing popularity and effectiveness of those drugs, rather than rising costs.

"Some look at the increasing use of medicines and the shift to newer medicines as problems to be solved, not solutions for patients and contributions to affordable health care," said Alan F. Holmer, PhRMA president, in a speech to his colleagues last year.

However, many local governments, health-care providers and ordinary citizens are contesting PhRMA’s position, especially since drug manufacturers expend large sums to advertise their medications.

"In health-care literature, there’s speculation about the dollars spent on marketing vs. true research and development," said Rita Shane, director of pharmacy services at Cedars-Sinai Medical Center. "I monitor [in-patient expenses] on an ongoing basis and deal with the exceedingly high cost of new breakthrough therapies for treatment of patients with severe chronic diseases."

It’s also widely recognized that the pharmaceutical industry enjoys large profit margins, recorded as five and a half times the median of all the industries represented in the Fortune 500 in 2002.

Villaraigosa’s proposal could possibly be the next step in the ongoing battle to reduce drug costs. Several states, including California, Maine and Oregon have already taken advantage of their existing buying power in a variety of ways to coax lower prices from drug makers.

"Many states are responsible for actual delivery of health care to their employees, retirees and Medicaid recipients, [and] they have been pooling their buying power together to negotiate better prices," said Joe Ramallo, Villaraigosa’s communications director.

"No one has yet taken it to the next level, which is what Councilmember Villaraigosa is proposing to do, and use that ability to bulk purchase on behalf of residents as a whole," Ramallo said. "This has been a growing issue of concern to seniors and those who are uninsured."

LA-Rx emerged from a series of town hall meetings on health-care policy sponsored by the Foundation for Consumer and Taxpayer Rights.

The system would work by first enrolling interested Los Angeles residents and establishing the size of the medication buyers pool. Next, the city would contract with an organization called a pharmacy benefit manager (PBM), which would do the negotiating with drug manufacturers.

An open enrollment period would give residents an opportunity to join LA-Rx annually. LA-Rx members would pay an annual fee for administration of the program.

Drug companies, however, would not be forced or coerced to negotiate with the city’s PBM.

"It’s just using market forces, and our understanding is that there are no legal barriers to doing this," Ramallo said. "Drug manufacturers would be foolish not to negotiate if [there is] a pool of 100,000 purchasers, 200,000 purchasers or more. Those are business decisions, and if you don’t do it, your competitor will."

The Jewish community, especially the often-ignored segment of poor, near-poor and elderly Jews in Los Angeles, would stand to benefit from a proposal to cut their drug costs.

The Freda Mohr Center, part of Jewish Family Service, is a nonprofit organization dedicated to aiding a mostly elderly population with health-care issues.

"We see people who [are taking] upwards of 15 to 20 medications," said Nikki Cavalier, center director. "We get a lot of requests for various types of financial assistance … and some of it we can help them with and some of it we can’t."

Cavalier estimated that approximately 80 percent of the center’s clients are Jewish.

Speaking of the prevalence of individuals who cannot afford their medications, Elaine Kau, a center case manager, reported, "I see it on a day-to-day basis. Especially with certain HMOs raising their co-payments and not covering brand-name medications and only covering generics."

"When someone does not take medication that is prescribed by the physician, they are compromising their health," said Ten of Bikur Cholim. "Part of the fiber of the Jewish community is that every life is worth living. That is paramount."

Raising the issue of possible LA-Rx problems, Shane of Cedars-Sinai said, "My concern [is whether] the people administering this benefit [would] end up profiting. Yes, maybe there would be some savings, but it would be hard to know how much of the savings will actually be passed on to the patients."

She added that a local organization might find its work exceedingly difficult "because on a national basis, it is challenging to get [wholesale] pricing on brand-name drugs."

Without accurate nonretail pricing, it would be impossible to know how much money a PBM is saving consumers.

"So my question is," Shane said, "how much additional dollars would be left to the third-party administrator? The purchasing structure of LA-Rx would have to be transparent."

Villaraigosa’s office, however, focused on LA-Rx’s propriety.

"There have been suggestions to regulate PBMs to ensure that they are negotiating on behalf of the pool that they are representing, rather than keeping an unacceptably high level of profit" Ramallo said. "We would go to great lengths to ensure that [PBMs are held accountable]."

One way to do that, according to Ramallo, is to form a nonprofit PBM. "That way there’s no advantage whatsoever for the PBM not to negotiate the best rates for its clients," he said. Under Villaraigosa’s plan, a PBM would be selected through a competitive process that would weigh the benefits of for-profit vs. nonprofit administration.

And although it could conceivably help Los Angeles residents, LA-Rx would inevitably face comparison with the Medicare prescription drug benefit approved by Congress for elderly Americans. Beginning in June, Medicare beneficiaries will have access to Medicare-endorsed drug discount cards and in 2006 full benefits become available.

On the surface, LA-Rx appears simpler and more straightforward than the Medicare drug benefit plan.

"There is a doughnut hole in terms of what people are going to get…. People who are on multiple medications are going to exhaust the benefit very easily, and there is a deductible and monthly premium," Shane said of the Medicare drug plan.

She also pointed out the difficulty seniors will have in understanding their complicated, tiered system of benefits under Medicare.

Cavalier echoed Shane’s concerns about both the Medicare plan and LA-Rx when it comes to the elderly.

"I’d be concerned about the complexity, how people are going to find out about it, how people are going to apply for it … [consumers] already seem to be somewhat confused and uncertain, and they come to us and ask us to help," Cavalier said. "We spend a lot time interpreting and helping them apply for the programs that are out there."

To increase awareness and understanding of the LA-Rx plan, it is currently being circulated within various communities. It may soon be put before the City Council.

"[Consumers of medication] right now have no one to speak for them," Ramallo said. "In this program, they will by pooling together and having a single entity negotiate on their behalf."

"This [proposal] will directly impact the Jewish community, as well as every resident in the city of Los Angeles, [and it] is a process that we want to participate in," Ten said. "This is an issue that crosses all boundaries and borders. If there’s any single unifying factor, it’s the health care of our families."

Bill Seeks to Cure Health-Care Plague

“Whoever enlarges on the telling of the deliverance from Egypt, that person is praiseworthy.” These words, included in the Passover seder, which will soon be read by Jews all over the world, remind us that the story of Exodus is meant to be applied to our lives today.

The Bible tells us that Moses and Aaron went to Pharaoh again and again, telling him that God said to let the people go. But Pharaoh’s heart was hardened. He refused to free the Israelites, and God afflicted Egypt with plagues.

After each plague, every one worse than the one before, Pharaoh’s counselors begged him to change his mind. But Pharaoh’s hardened heart interfered with his reason. Even though he brought nothing but calamity on his country, he would not accept the changes that were needed to make the suffering stop.

Today we are beset with a series of health-care plagues, each seeming worse than the one before. The number of Californians without health-care insurance coverage hovers between 6 million and 7 million people — that’s about one in five of us. About 85 percent of those people are working in jobs where health care is not provided. Nationwide, health-care costs are the second largest cause of personal bankruptcy.

For those people who do have health-care coverage, premiums, co-pays and out-pocket-expenses due to lack of adequate coverage are out of control. There is an over-reliance on emergency-room care by the uninsured, as well as the underinsured, who often wait so long to seek care, their once-treatable chronic condition has worsened.

Treatable high blood pressure leads to strokes; diabetics discover their condition only after a coma. This results in pain for the patients and their families, and, since emergency-room treatment is much more expensive than preventive care, there is an increased burden on California’s health-care budget.

Hospitals, doctors and clinics are passing on the costs of treating patients who cannot pay their bills to those patients who are insured. Insurance companies drive up the costs of premiums for hospitals and cut back on reimbursements. In some cases, hospitals are seriously considering shutting down.

Jewish tradition is clear about the importance of health care as a shared social concern. Maimonides put health care first on his list of the 10 most important communal services that a city had to offer to its residents.

As Conservative Rabbi Elliot Dorff reminds us in his teachings, Jewish tradition says that it is a positive commandment to save the life of a person in danger from illness, as it falls under the general obligation of saving life: “Thou shalt not stand idly by the blood of your fellow,” (Leviticus 19:16).

So great is the mitzvah of saving life that Jews are directed to violate the Sabbath to fulfill it. The Shulchan Arucha calls for communities to take financial responsibility for those unable to pay for health care themselves.

In 1976, the Reform movement’s Central Congress of American Rabbis adopted a resolution, affirmed in 1991, in favor of “universal access to health care benefits, including access to primary and acute health care, immunization services, early diagnostic and treatment programs, provider and consumer education, programs of extended care and rehabilitation, mental health and health and wellness promotion. Such a program should provide for education, training and retraining of health-care workers, as well as just compensation and affirmative action in hiring. An effective plan will provide for cost containment, equitable financing and assure quality of services.”

That resolution could have served as a model for Senate Bill 921, a comprehensive health-care reform bill that I introduced last year, and which, after having passed the state Senate, is now up for consideration by the Assembly.

Senate Bill 921 will put no new burden on the state’s General Fund. In fact, it will save billions of dollars in health-care costs by reducing the 25-27 percent of every California health-care dollar that is now spent on administration to between 3-5 percent.

Senate Bill 921 will save that money by creating a single, streamlined claims and reimbursement system in place of the fractured, hodgepodge of public and private systems we have now. It will replace all of our current inflated premiums, deductibles and co-pays with a single means-based premium that each of us can afford, while covering everyone under the same generous and flexible plan, which includes medical, dental, vision, mental health service and prescription drug coverage. Senate Bill 921 will also provide every Californian with the freedom to choose his or her own health-care providers.

Senate Bill 921 also relieves employers of the exclusive responsibility for their employees’ health coverage. Like individuals, businesses will be assessed a means-based premium as their only contribution to this plan. Like individuals, businesses will pay what they can afford, and they will find themselves on a level playing field with regard to health-coverage expenses.

They will also find their expenses for workers’ compensation dropping dramatically, because this bill folds the medical portion of workers’ comp into the state insurance plan. This deep reform will save money for employers, while improving actual care for people who are injured.

Senate Bill 921 will provide every Californian with prescription drug coverage, because it mandates the state to buy pharmaceutical drugs and durable medical equipment directly from the companies, in bulk.

In this season, as we approach our time to celebrate the Exodus of the people of Israel from their confinement in Mitzrayim, we have an opportunity to reflect on the tight spots we find ourselves in today and how we can free ourselves. One of the saddest things about Pharaoh’s hardened heart is that it would not let him see that the compassionate option really was the most sensible option as well.

State Sen. Sheila Kuehl (D-Los Angeles) represents the 23rd Senate District. She and other experts will take part in Zey Gezunt, a panel on health care, SB 921, on March 18 at 7 p.m. at Temple Beth Am, 1039 S. La Cienega Blvd. Los Angeles. The forum is free. For more information, call (310) 441 9084.

Promoting Medical Care in Israel

Even when Jews packed medical school classrooms, there were few organizations dedicated to their special concerns. Today, most schools lack active associations for Jewish students. As Carol Ghatan puts it, "The Jewish medical student gets lost sometimes."

Ghatan, both the daughter and the mother of a doctor, is also associate director of the American Physicians Fellowship for Medicine in Israel (APF). This organization, founded by three Jewish doctors in 1950, is now belatedly reaching out to Jewish medical students.

APF is sometimes called "Israel’s best-kept medical secret." Committed to advancing medical education, research and care in Israel, it gives fellowships to Israeli doctors for advanced study in North America, and sends American experts to lecture and teach in Israel. Board member Peter Glazier, son of an APF founder, estimates that over time the group has dispersed $6 million in grants, helping to ensure that Israeli medical care remains world class.

Though APF members prefer to work quietly, they’ve been positively secretive about one aspect of their mission. In close cooperation with the Israeli government, they’ve compiled a registry of American health care professionals willing to travel to Israel in case of national emergency. The APF list emerged in the aftermath of the Yom Kippur War, when American doctors took over for Israeli counterparts pressed into military service. The list has not been reactivated, but APF stayed on high alert during the Gulf War.

New York University medical student Justin Friedman explains why he joined APF: "I decided to become a physician to make a difference in people’s lives…. APF has benefited countless thousands of people by helping [Israeli] physicians obtain a better education, and thus, positively affecting their patients’ care. APF is something everyone should know about, but they don’t. So, I feel compelled to tell them."

California Jews Lobby for Medi-Cal

Nearly 200 Jews descended on Sacramento this week to lobby California’s most powerful politicians to protect major programs that serve the poorest and frailest Jews and other Californians from the budget ax.

Jews from throughout the state, including Los Angeles, San Francisco, San Diego and Orange County, canvassed the state capital Monday, May 19 and Tuesday, May 20 to fight against proposed cuts to Medi-Cal, the state’s health insurance for the poor. They also networked, learned how to become effective advocates for Jewish causes and attended workshops on issues ranging from how to manage the media to the need for Jews to build coalitions.

The mood among participants, against the backdrop of a ballooning state budget shortfall estimated by some at more than $38 billion, appeared less ebullient than in the past.

"In prior years, when the state had a surplus, the discussion was on expanding programs and creating new initiatives," said Esther Netter, executive director of the Zimmer Children’s Museum in Los Angeles. "This year, everyone had a defensive posture, and the mood was more somber."

State Controller Steve Westley warned participants at a breakfast speech that California’s budget problems were even worse than they seem.

Attendance for the two-day mission, which was sponsored by the Jewish Public Affairs Committee (JPAC) of California, the state’s main Jewish lobbying group, was 190 — off by more than 8 percent compared to last year, organizers said. They attributed the drop to holding the event a week before Memorial Day weekend, the poor economy and a belief among some Jews that their voice wouldn’t make a difference.

Still, Cliff Berg, JPAC legislative advocate, said he thought the group’s collective message would get through to legislators because of participants’ commitment to deliver it in person.

"I think the fact that you’re willing to take a couple days off work and come to Sacramento will resonate with [the politicians]," he said. "It shows there are others who feel the same way you do and others behind them."

Gov. Gray Davis has proposed cutting Medi-Cal reimbursements by up to 15 percent to help close the growing state budget deficit. That belt-tightening would save more than $1.4 billion, but would do so at the expense of California’s most vulnerable. Medi-Cal underwrites a slew of programs that cater to a largely Jewish clientele locally, including the Valley Storefront Adult Day Heath Care Center in North Hollywood, and the Multipurpose Senior Services Program (MSSP), which provides indigent elderly with taxi vouchers, home-meal preparation and other services to keep them out of nursing homes.

The Valley Storefront would have to close down, along with an estimated one-quarter of the state’s 307 adult day health-care centers, if the Legislature enacts the suggested cuts. MSSP would shed 110 of its 734 monthly clients and lose one of its two full-time social workers.

"I think it’s immoral to turn our backs on the elderly," said Jessica Toledano, director of government relations for the Jewish Community Relations Committee, a department of The Jewish Federation of Greater Los Angeles. "These programs keep their [seniors’] dignity, and also keep them out of nursing homes, which are far more expensive."

Motivated by Toledano’s and others’ speeches, mission participants made their way to the state capitol where they collectively lobbied 60 legislators or their aides, admonishing them to forego the proposed Medi-Cal cuts. The newly minted lobbyists also asked politicians to support a resolution condemning the Arab League’s revived economic boycott of Israel and to support legislation that would train teachers on the prevention of hate crimes in schools.

It is unclear whether their efforts had much impact.

Assemblyman Leland Yee (D-San Francisco) told a group of five neophyte lobbyists that many Democrats opposed Medi-Cal reductions, but that Republican unwillingness to raise taxes or other fees to balance the budget muddied the picture.

"You need to talk to Republicans about revenue generators," he said.

Even if Medi-Cal cuts pass, mission members deserve credit for fighting a battle on behalf of those who sometimes go unheard, said L.A. attorney Matthew Ross, a former business-affairs executive at CBS.

"We’re up here talking about the poor, immigrants and the elderly, people who don’t often have lobbyists," he said. "We’re their lobbyists. We’re their voices."

To become legislative advocates, mission participants attended a nearly two-hour session in the nuts and bolts of lobbying. JPAC’s Berg told group members to be clear, "stay-on-script," exchange business cards with politicians and, most important, to remain polite, regardless of the reception to their ideas.

"Our broader goal is to build relationships and work on [getting the politicians] to nurture and understand the Jewish community," he said.

Sarah Jaffe, a 19-year-old sophomore at UC Santa Barbara, said participating on the mission gave her a chance to try to create positive change. For her, cutting Medi-Cal is akin to slashing the social safety net that might one day be needed catch her parents — or herself.

"Being a young person and seeing the changes affecting Medi-Cal makes me worry about the future," she said. "Even though I’m not affected now, in a few years, cuts could hurt my parents and, a few years later, me."

Bringing Caring and God to the Sick

"So teach us to number our days, that we may get a heart of wisdom…." (Psalm 90:12)

Truth be told, there are no "soft issues" in medical ethics, unless by "soft" we mean the human issues, the matters of the spirit that so influence people’s capacity to heal and even (as research seems to be showing more and more) their ability to be cured. "Soft" is the "how" dimension of medical ethics, a critical complement to the "what" decisions that are often its salient province or overriding focus.

Perhaps the best place to start is to ask, "What are the psychosocial needs of people going through serious medical experiences?"

Let it first be acknowledged that the needs of these people are not unlike everyone else’s — just, perhaps, more so. People who are suffering, or struggling, or facing mortality — and those who care for them — need what we all need, if more urgently, boldly, unavoidably.

These universal needs include: a restoration of connection, a new relatedness — to a sense of self, the community, creation, God, the big picture; transcendence, growth, meaning, affirmation of their total identity (including but not limited to their diagnosis, condition or illness), an expanded sense of hope and possibility; re-empowerment, striking a balance of dependence and independence, taking charge and letting go; tools to integrate major losses or fundamental life-disruptions into their life-narrative.

Jews who are suffering, and those who care for them, similarly need and deserve resources of guidance, strength, insight, comfort, solace and hope — and, for centuries, have looked to Jewish tradition and the Jewish community for these resources. In diverse host cultures and civilizations, Jews developed a very strong tradition of bikur cholim (reaching out to those who are ill and those who care for them). This mitzvah was understood as a basic and far-reaching commandment that requires and enables us to emulate God’s own care and concern, indeed, to partner with God in making that care and concern manifest and tangible. Bikur cholim was highly developed through our treasured, evolving corpus of both narrative and legal texts.

"The essential feature of the mitzvah of visiting the sick is to pay attention to the needs of patients, to see to what is necessary to be done for their benefit, and to give them the pleasure of one’s company. It is also to customary to pray for mercy on their behalf." (Kitzur Shulchan Aruch 193:3).

What a cogent summary of what folks need. Practical and individualized help, social and interpersonal connection and intercession/dialogue with God in echoing or amplifying the patients’ needs, wishes and prayers.

The good news is that these efforts, at least in my experience, are on the rebound in our community. More and more synagogues, Jewish community centers, day schools, healing programs, family service agencies, and other Jewish organizations are developing or revitalizing bikur cholim efforts, sometimes called G’mach for gimilut hasidim (deeds of loving kindness or caring committees). More than 200 bikur cholim organizers and volunteers, from more than 75 different sites in all corners of the Jewish community, took part in the November 2002 15th annual Bikur Cholim Conference in New York City. Jewish chaplaincy, long the terribly underfunded and neglected professional field in our community, is experiencing a growth in recognition, support and status. Rabbis, cantors and Jewish educators are devoting more time in training and continuing education to expand their skills and enhance their effectiveness in reaching out to the ill and their families and professional caregivers. And materials that help Jews hope and cope are multiplying.

Yet, so much remains to be done. We live in a society that desperately seeks not only to avoid disease and pain at all costs but also to deny vulnerability, aging, disability and mortality — and the Jewish community is not immune from these biases. Though it is somewhat more comfortable than it was in recent decades to utter the "c" word — cancer — Jews, like everyone else, recoil from serious illness, and we need to strategize how to restore illness and death to their natural and important place in our lives.

There are many ways to bring about the reintegration of illness and death into communal life. School curricula, youth group projects, film series, concerts, art exhibits, public programs where people tell their stories, rabbinic sermons and bulletin pieces can all work to undo the denial of suffering and death and enable Jews of all ages, backgrounds and affiliations to share the vulnerability and burdens of disease and disability. In these and other ways, we can reach for a time when Jews will feel freer to let others know of their challenges, more secure in asking for help and less constrained in offering it.

Complementing these educational and cultural innovations and communal change ought to be substantial advocacy efforts that work for a more humane and holistic approach to pain, suffering and healing. Convention resolutions are fine, but we must do more to "walk the walk." Synagogues, schools, service agencies and JCCs must join in challenging the current health-care systems that render so many suffering people alone, confused and despairing. Practical efforts directed at changing legislation, policies, and managed-care companies must go hand in hand with the one-on-one, direct support and service provision.

Our generation, as those before and after us, will be judged by how we listen and attend to those who are sick and vulnerable and to those who care for them. In the end, there is actually no "them"; there is only "us."

Reprinted from the Journal Sh’ma, a service of Jewish Family & Life!

Rabbi Simkha Y. Weintraub, a certified social worker, is rabbinic director at the National Center for Jewish Healing/Jewish Board of Family and Children’s Services in New York.

Health Care Requires Resuscitation

Eric Moore is frustrated. Within weeks after losing his computer consulting job, the 30-year-old UCLA graduate collapsed from a pulmonary embolism. He has since recovered, but faces a $14,000 hospital bill.

Dr. Alexandra Levine is frustrated. The head of the USC-Norris Cancer Center faces numerous barriers to providing the care she’d like to provide to her patients. One patient required a medication that could be taken at home via injection. Since Medicare doesn’t cover prescription drugs, but will pay if the drug is administered in the hospital, Levine’s 91-year-old patient was forced to make a thrice-weekly trek from the Valley to the center, and each time the tab to Medicare was twice as high as it would have been had the medication been taken at home.

Luis Jiminez is frustrated. The 29-year-old entrepreneur started an online marketing and Web business, which now boasts a staff of 11. But he can’t afford to provide health insurance for his employees.

"We have a continuing crisis in this country of millions of Americans without health insurance, and that’s just plain wrong," said Rep. Henry Waxman (D-Los Angeles), who will speak Friday, April 25 at Leo Baeck Temple as part of a series on health care.

In 2001, approximately 41 million Americans — more than 14 percent of the nation’s population — went without health insurance for the entire year, and another 20 to 30 million lacked coverage for part of the year. With health care premiums increasing at about 11 percent a year, big companies are paying a smaller percentage of those premiums, and small businesses are finding they can no longer afford to provide health care at all. These factors, combined with job layoffs resulting from a weakened economy, have left a growing number of people without health insurance.

Meanwhile, health care costs are skyrocketing. In 2000, $1.3 trillion was spent on health care in the United States, a 7 percent increase from the prior year.

According to Rabbi David Saperstein, director of the Religious Action Center of Reform Judaism in Washington, D.C., the average family spends four times as much on health care today as it did in 1980.

"This country has yet to make a decision that every man, woman and child has a human right — a civil right — to health care," said Los Angeles County Supervisor Zev Yaroslavsky, speaking at Leo Baeck Temple last month. While implementing such a decision "may be complicated and expensive," he said, "it’s not as expensive as not doing it — not as expensive financially and not as expensive morally."

Because those without coverage tend to postpone seeing a doctor, preventable conditions become severe illnesses, needlessly harming patients and unnecessarily driving up health care costs. The uninsured also tend to use emergency rooms as their only source for medical treatment, limiting the ability of those facilities to provide more urgent care. And while many believe the majority of uninsured are unemployed, 80 percent of the uninsured come from working families.

In Los Angeles County, one out of every three residents lacks health insurance. More than 80,000 of the uninsured are children. Budget shortfalls spur continued cuts to county health services. Twelve public care centers and four school-based clinics have closed since June 2002, and High Desert Medical Center in Lancaster and Rancho Los Amigos National Rehabilitation Center in Downey are currently targeted for closure. These closures put an added burden on remaining facilities, raising the troubling specter that crucial services will be unavailable when we most need them.

"Whether you live in Bel Air or in Torrance or in Pomona … you have a stake in providing health care to the maximum number of people," Yaroslavsky said. Otherwise, he said, you had better hope "that a mother who has a kid with an ear ache doesn’t come to the ER … and gobble up space … while your heart attack is going on."

For those who consider the predominantly poor, immigrant patients who use county facilities somehow less deserving of care, USC’s Levine had sharp words.

"Who we see at this hospital is you — your mothers, your grandmothers, your great-grandmothers. All of us were immigrants in this country…. And what do these people do? They train every physician in the U.S. Did I learn how to do a spinal tap on you? No I did not. I learned on someone in the county hospital…. We owe them because of our roots and because of what they do for all of us on a daily basis."

As for the national picture, "reform must become a reality because we have no other choice," Saperstein said. "The question no longer is whether there will be health care reform, but what form these changes will take."

A number of proposals are on the table nationally and on the state level. Some aim to expand availability of health care coverage by pooling individuals or small employer groups into large groups. Others seek to expand Medicare, Medicaid and/or the State Children’s Health Insurance Program. Still others propose use of tax credits to help families purchase insurance or tax incentives to encourage employer-sponsored plans and benefits.

Waxman is particularly critical of the Bush administration’s approach to health care.

"The Bush administration is trying to undermine the programs we’ve got, and nowhere is this more obvious than Medicare. They refuse to add a meaningful prescription drug benefit to traditional Medicare…. Instead, they want to use a drug benefit … to force people into private insurance plans or HMOs, where they won’t have guaranteed benefits or assurance that they can see their own doctors."

Saperstein and Yaroslavsky say the way to get effective legislation passed is to make sure lawmakers know health care is a priority for voters. Politicians need to hear from their constituents about this issue, and to know that it drives contributions and votes.

"We have got to raise the political stakes nationally to make provision of health care a priority," Saperstein said.

Rep. Henry Waxman will speak about "The National Crisis in Health Care," on Friday, April 25, at Leo Baeck Temple, 1300 N. Sepulveda Blvd., Los Angeles. Services begin at 8 p.m. For more information, call (310) 476-2861.

Humanist Approach a Must in Medicine

Medical practitioners today are faced with onerous economics and an increasingly depersonalized and technically complex health-care system. This reality presents serious challenges to practicing humanistic medicine. It is therefore especially important now to value and re-emphasize the intrinsic connection between compassion and competence in the practice of good medicine.

In the early 1980s, I began to notice that my students seemed to be more engaged in science and technology than taking care of people. Why? Did medical students begin school with idealism, altruism, compassion and empathy, only to have it depleted during their educational experiences? Or, was the medical admission process simply selecting less-humanistic applicants?

Research examining the attitudes of 3,500 entering medical students from across the nation concluded that most were indeed empathetic and humanistic when they began their studies. Clearly, some time during medical school and the end of the residency experience, many caring young doctors change. Why do some students maintain a humanistic orientation while others lose it?

How can we teach medical students a more humane approach to medicine and promote a medical system that fosters relationship-centered care? Nearly 15 years ago, colleagues at the Columbia University College of Physicians and Surgeons, philanthropists and community leaders co-founded a public charity, the Arnold P. Gold Foundation, to create opportunities for meaningful ritual, recognition, role modeling and research, as well as national conferences, curricular change and building "caring hospital communities." These programmatic themes (the four Rs and three Cs) are customized for the four populations we serve: medical students, medical school faculty, hospital residents and the public.

Ritual and tradition are central to Judaism and to the work of the foundation. We encourage medical students to make a psychological contract — to incorporate compassion as part of their professional responsibilities through the public recitation of a professional oath. Foundation programs such as the White Coat Ceremony, a rite of passage for entering medical students, and the Student Clinician’s Ceremony, for third-year students beginning their relationships with patients, provide an opportunity for reflection and a renewed commitment to humanistic values.

The Hippocratic Oath, written 2,500 years ago, has been a keystone for physicians throughout history. Its admonition to "do no harm," treat patients with respect and to "lead lives of uprightness and honor" is taken seriously throughout Western medical education. Jewish tradition embraces these same ideas, as well as additional ethical and spiritual considerations. The Physician’s Oath and Prayer, attributed to Moses Maimonides, the 13th century physician and philosopher, articulates ancient Jewish values and goes beyond the Hippocratic Oath in delineating appropriate behavior and practice. In his prayer, Maimonides speaks about social justice in medicine: "May I never see in the patient anything but a fellow creature in pain," acknowledging the potential biases of wealth, power and personality as barriers to equal treatment for all patients. It is important that all practitioners develop both skills and values that reflect these oaths.

Medicine is an apprenticeship profession, where humanism can be taught and behaviors associated with humanism can be learned. Medical students are quick to adapt to formal curricular expectations; they also absorb the attitudes, habits and ethics found in the cultural environment. In other words, students of medicine at all levels imitate role models, adjust to the culture in which they work and adhere to the values expressed or demonstrated by their teachers and peers. Therefore, if we teach the role model humanism as "the best medicine," we will create more humane physicians. Such competent caring will increase trust, enhance the healing process and result in better patient outcomes.

A growing focus on physician professionalism has instigated a strengthened interest in humanism and its role within the definition of "the professional." This bodes well for greater pressure within the medical culture to include the art and "habit of humanism" in its formal and informal curricula, and in accreditation criteria and standards. If we are to be successful in challenging the negative pressures from commercial and legislative interests, we will need an educated and vocal public to partner with like-minded professionals. We invite you to join us in this struggle to re-emphasize humanistic medicine.

In sum, what is the role of a physician? A humanistic physician demonstrates concern and respect for the values, autonomy and cultural and ethnic background of others, and provides skilled, compassionate and empathic help to someone with a problem or need.

Reprinted from the Journal Sh’ma, a service of Jewish Family & Life!

Dr. Arnold P. Gold is professor of clinical neurology and clinical pediatrics at Columbia University College of Physicians and Surgeons.

Planning Ahead Can Save on Health Care

Eva, 74 and a widow, was a healthy and independent woman until she went shopping one day last December and was mugged. She was attacked with a screwdriver and thrown to ground, breaking her shoulder in four places.

"I ended up on the sidewalk, totally helpless," said Eva, who lives in Westwood and prefers to not give her last name. "I went from being very active to being disabled. My recovery was very painful, and I am still not done."

Eva was hospitalized for a month, and when she came home, she found that she needed nursing care and help doing basic tasks around the house, such as bathing and getting dressed.

"A nursing home just didn’t appeal to me," Eva said, and so she found home care. The cost of such care was between $17 and $20 an hour, and Eva needed it at least 16 hours a day for six months.

The cost of her care could have totaled in excess of $55,000 for those six months. However, Eva was able to avoid the expenditure because she had a long-term-care insurance policy that she bought the year before. The premium cost $2,273.

Because elder care can be an enormous drain on an individual’s resources, with nursing homes costing in excess of $100 a day and home care costing even more, planning ahead and buying long-term-care insurance is one way of preventing the costs from being too overwhelming.

For some in the Jewish community, long-term-care insurance — and particularly the home-care policies — can also have a religious significance. They see it as a facet of the mitzvah of Kibud Av V’em (honoring one’s parents), because it allows children to have peace of mind about their aging parents living out their last years with dignity.

In a 1998 article written by Joel Schwartz in the Association of Orthodox Jewish Scientists Newsletter, Schwartz argued that according to Torah, home care is preferable to nursing-home care, because institutionalized living brings with it a certain loss of honor. While some nursing homes are cheery and bright, others may be drab, unfriendly and, in some cases, even detrimental to the health of those who need care.

Government regulations require nursing homes to provide 3.2 hours of care per patient per 24 hours. In some cases, a nursing home might cut corners because it does not hire enough staff to meet the requirement.

In such a scenario, which some experts in the field say is not uncommon, patients who are severely incapacitated will suffer. They said bed-ridden patients might develop bedsores, because they are not turned often enough, and incontinent patients might be diapered to save labor costs.

Few people want their parents to suffer such problems, but many with aging parents have their own families to provide for and do not have the time or resources to take proper care of their parents themselves.

For many people, long-term-care insurance provides the answer to the problem. Although the premiums might appear high — and even seem useless if the person paying them is healthy — they can end up saving people tens of thousand of dollars if the need for long-term care should arise.

Karen Shoff, a Santa Monica gerontologist, insurance agent and author of "There’s No Place Like a Nursing Home: Four Powerful Steps That Will Change Your Life" (Invisible Ink, 2002), believes that planning for one’s physical retirement is as important as planning for one’s financial retirement. Shoff advises people to start planning for their twilight years in their 50s and 60s, so that they will be able to avoid both nursing homes and the costs involved with home care.

Shoff’s plan involves buying a long-term-care policy, appointing a geriatric-care manager who can assist with legal and medical issues and find services, making a living will that spells out how a person wants to be cared for in the event of an illness and finding an ally who will help carry out the plans.

"You can’t wait until the fire’s there, and people are tearing their hair out," she said. "You need to plan ahead logically."

However, there are some who shy away from long-term-care insurance because they see it as unnecessary to pay premiums above and beyond health insurance and Medicare, which they believe will cover most emergencies. Furthermore, many people argue that, depending on the circumstances, nursing homes can provide better service and offer a wider variety of resources than a home care, in addition to having a social setting that might not be available at home.

"There is an understanding in halacha [Jewish law] that sometimes a parent needs to be put in an institution — for example, if the parent has dementia, and the children can’t handle the burden" said Rabbi Elazar Muskin of Young Israel of Century City. "You need to weigh up the circumstances."

Still, others credit their long-term-care insurance and the home care it bought them with peace of mind. "When I took out the policy, my children kept telling me that I was throwing money out the window," Eva said. "But after I was mugged, they were relieved that I had this help, that I was OK and that I was not going to be dependent on them."

Russia’s Jews Rediscover Roots

Lev Entin, a 90-year-old resident of St. Petersburg, has spent the past year relearning something he spent most of his life trying to forget: his Judaism.

Entin’s father was a shochet (ritual slaughterer), and until Entin was 12, he attended a cheder (Jewish school). But after that, Entin, "a product of the Bolshevik Revolution," as he puts it, did not pay attention to his religion.

But in the past year, Entin has reintroduced himself to his tradition by reading books and brochures he receives from his local Hesed welfare center.

"Only this year did I become a Jew again," he said.

Roughly 175,000 Jewish elderly in Russia are now served by the 88 Heseds across the former Soviet Union. These centers, run by the American Jewish Joint Distribution Committee (JDC), account for about one-half of all Jewish social and welfare organizations in the former Soviet Union.

They provide basic services, such as food and health care, to the large numbers of elderly who were impoverished both by the chaos of post-Communist Russia and by last August’s economic collapse. But the Heseds, which mean "charitable deed," also play a role that is just as important in creating a Jewish community for the Russian elderly.

When the JDC began opening Heseds in the former Soviet Union earlier this decade, the organizers were afraid of two things: that the centers would be overwhelmed by requests from non-Jewish clients, and that the centers would lead to an anti-Semitic backlash. None of the fears has come true.

Indeed, in some places Hesed centers serve as a model for similar state-run organizations. In St. Petersburg, for example, Hesed Avraham is among the most successful welfare organizations in the city of 4 million. Last year, Hesed Avraham started a joint project with a local government-funded welfare organization, where one of the Hesed dining rooms is now feeding 100 non-Jewish needy elderly.

The success of the Hesed program has led to some problems. Indeed, in some cities, local authorities ignore the needs of Jewish clients because there are other organizations to take care of them.

"The state sometimes wants to lay its responsibility onto the Heseds. But Jews are citizens of this country just like non-Jews and the state has certain obligations toward them," says Benjamin Haller, director of the JDC’s William Rosenwald Institute for Communal and Welfare Workers in St. Petersburg, which trains Jewish social workers and conducts sociological research of the Jewish elderly in the former Soviet Union.

But there is one aspect of the Hesed activities where the state welfare system cannot help: reconnecting people to their Judaism.

"People are coming to Heseds not only to get a piece of bread. They come to taste the spirit which makes us unique, distinct from other similar organizations. This is the spirit of belonging to the Jewish people," Haller said.

For example, in the city of Tula, some 190 miles south of Moscow, about 50 elderly Jews gathered on a recent Friday night at the Hasdei Neshama center. A concert by a local klezmer band was followed by a Shabbat service and a meal conducted by a Moscow rabbi who comes to the city every weekend.

In St. Petersburg, Hesed Avraham publishes Hesed Shalom, a bimonthly newspaper with a print run of 15,000.

This process of creating a community extends beyond the clients served by the Hesed centers to the volunteers who assist.

Last year, about 7,000 volunteers participated in the provision of welfare and other social services in the centers.

"Any program we run involves people helping other people. Even a bedridden person can call another bedridden [person] so that they will not feel lonely," Haller said.

In most communities, youths and students of Jewish schools occasionally volunteer in some social programs. But the average volunteer is recently retired and is in his early 60s. These people deliver food to the homebound, do home repair or work once or twice a week as hairdressers, shoemakers, electricians. Medical doctors conduct regular free consultations for Jewish elderly in almost every Hesed center.

Despite all the good work they are doing, the future of the Heseds is not entirely rosy. With the ongoing economic crisis and the depreciation of pensions, money is becoming rare, particularly to supply medicines.

The multimillion-dollar annual budget of the Heseds comes from several sources. Most Russian Heseds operate with the money channeled by JDC from funds raised by the joint campaign of the United Jewish Appeal and local federations in the United States. These funds go primarily to support the most fund-consuming part of the Hesed operations — food programs, including monthly and holiday food packages and distribution of hot meals through community dining rooms and meals-on-wheels programs.

While the activities are operated by the JDC in conjunction with local groups, including the Russian Jewish Congress, a majority of the funds for the multimillion-dollar project are provided by the Conference on Jewish Material Claims Against Germany — particularly in Ukraine and Belarus, which were under Nazi rule during World War II.

Most observers say Hesed programs have been the most successful — in their scope and outreach — of all similar projects supported with local and foreign funds.

They appear to be successful for Sofia Shapiro, an 80-year-old retired engineer who receives several services from her local Hesed in Yekaterinburg. The homebound Shapiro and her bedridden blind sister, Vera Brook, have no relatives and a caretaker from Hesed visits them daily. The center also gave Shapiro a walker made by some of the eight staff workers and 39 volunteers who assemble a total of 2,500 wheelchairs, walkers, walking canes and crutches a month at a plant in St. Petersburg.

"There is a sticker here," Shapiro says, pointing at the bottom part of the walker. "It says, ‘Live with Hope.’ So I do."

Caring Across the Miles

Fifty-eight-year-old Ruth recently took early retirement from her bookkeeping job so that she and her retired husband, Harry, could see more of their children and grandchildren, who are scattered around the country. The two have also been looking forward to doing some traveling overseas.

In the past year, though, Ruth’s mother, who lives alone and is a two-and-a-half-hour drive away, has become increasingly frail and is starting to show signs of forgetfulness. Ruth finds herself worrying about her mother daily and making an increasing number of phone calls and car trips to check on her. Often she ends up staying for the weekend when she visits.

She and Harry have put their travel plans on hold.

Ruth is just one of approximately 7 million Americans involved in the care of an older adult — usually a parent — who lives in a different area, be it an hour’s drive or a plane trip away. The average travel time to reach their relative is four hours.

At the best of times, caregiving involves a certain amount of stress, but often, the anxiety is compounded when there are many miles between the caregiver and care recipient.

Long-distance caregiving can be emotionally and financially draining. Worries about a parent’s physical, mental and emotional health and safety can be overwhelming at times. You may wonder if plans you’ve set up are being implemented properly, or if you’re going to get a call that there’s a crisis.

You may also feel guilty that you can’t be there on a daily basis to see how your parent is doing — which may be quite different from what he or she reports — and provide assistance as needed. You might wonder if you should be making more sacrifices — either moving closer or inviting mom or dad to live with you.

Then there are the financial costs: the many long-distance telephone calls, travel expenses, wear on your car and perhaps the cost of hiring a companion or personal support worker because you can’t be there yourself. If you’re employed, you may have to take time off work to deal with crises; some employers are less sympathetic than others.

Despite these challenges, there are many ways to maintain peace of mind while providing long-distance care:

  • Make it easy for people to get in touch with you. Get an answering machine if you don’t already have one and perhaps a cell phone or pager as well. E-mail may also be advantageous.

  • Set up a regular time to call your parent (many people choose Sunday evenings).

  • Find someone local who can check with your parent daily, either by phone or in person. This could be a reliable neighbor or relative or even a volunteer from a telephone reassurance service.

  • Keep important phone numbers handy: your parent’s neighbors, close friends, family physician, local pharmacy and any home health-care providers. Ensure all of these people also have your name and contact information and encourage them to call you with any concerns. Stay in touch to get their ongoing perspectives on how your parent is doing and don’t forget to express appreciation for their assistance.

  • Shop around for a good long-distance savings plan so you don’t have to be too concerned about the frequency and duration of caregiving-related telephone calls. You might consider getting a private, toll-free number so that friends, neighbors and health-care providers have no reservations about regularly calling you.

  • Maintain a file of key information, such as your parent’s medical conditions and surgical history, medications, medical specialists, banking institutions and other financial contacts, lawyer, clergy and daily or weekly schedule, plus any upcoming appointments. Obtain a local phone directory if possible.

  • If your parent has a chronic illness, obtain information from the appropriate organization (for example, the Parkinson Foundation) to help you understand the disease and get an idea of what to expect in the future.

  • Investigate other available resources in your parent’s community, which might include: personal emergency response systems; letter carrier or utility company alert services; accessible transportation; adult day programs and other leisure programming; outreach services, such as foot care and seniors’ dental clinics; home health services involving nursing, homemaking, therapy and companion services and alternative housing. Such information can be obtained from the local area agency on aging. (To find the appropriate office, call the Administration on Aging’s toll-free Eldercare Locator Service at (800) 677-1116 or search online at

When you do have an opportunity to visit, pay close attention to your parent’s physical condition, mental functioning and mood. Consult his or her family doctor if you have any concerns.

Perform a safety assessment of the home environment to identify potential hazards — for example, throw rugs that don’t stay in place — and do what you can to remove them. Visit a medical supply store and check out the many products that might make daily activities easier and safer for your parent. Better yet, locate an occupational therapist who performs home assessments and can make recommendations in this regard.

If you have siblings in the area, arrange a family meeting to discuss your parent’s needs and determine who can provide help.

Ideally, plan to stay with your parent long enough so you’re not rushed. That way, you’ll have ample time not only to attend meetings (try to set these up in advance of your arrival) and run errands but also to enjoy your parent’s company.

Even if he or she appears to be managing well right now, it’s a good idea to begin learning about resources in the community should your parent require help in the future.

Keeping one step ahead will help make your role as long-distance caregiver a little easier.

Lisa M. Petsche is a geriatric social worker and freelance writer.

Visiting the Sick

You’d have no trouble finding me in the treatment area of Cedars-Sinai Cancer Center. Even from a distance, mine is the little roomlet that rings with soft laughter and the sound of — well, yes — a party going on.

How dare I have fun during chemotherapy? It’s not that I look forward to seven hours of treatment. But with four of six rounds behind me, I no longer feel I’m heading into an abyss.

I load up my suitcase with fresh flowers, pretzels stuffed with peanut butter (nurses love them), chocolate-covered peanut butter cups (Leslie, my friend from college, loves them), Raisinettes (I love them). As I pack I’m thrilled that the whole day’s dance card is filled. I will not be left alone.

My small room looks just like any other, with a bed, three chairs, a television and videoplayer. But it’s my friends that make the experience one of pleasure and healing.

Yes, you’re right, I’m heading down my favorite river: Denial. I’m letting my friends distract me from the fact that I have lung cancer for which the word "cure" does not exist.

Certainly I know from A to Z what a typical chemo day brings: large doses of anxiety over whether my white-blood-cell count will be high enough to qualify me for treatment, coupled with large doses of Zofran, the high-octane anti-nausea drug that makes Carboplatin and Taxol tolerable. I will sit until past sunset with my portacath plugged like I’m some electric coffee pot into an IV drip filled with poison trying to kill the bad cells without killing me.

But why should I dwell upon such puny details when I know that Diane, a romance writer and swell raconteur, is driving me to my CAT scan? Leslie is bringing lunch. And before Jill, the Cedars art therapist, has a chance to take out her brushes, I will see Cynthia, Susan, Rona, Marilyn, Marika or any number of surprise guests. Soon enough, we’ll be laughing and talking as if I weren’t as bald as a cue ball and the nurse wasn’t monitoring my blood pressure every 15 minutes. Yes, even in chemotherapy a girl can still have fun.

This is not the attitude I started with. My initial bias was to tough it out alone, to attend my own funeral, working grimly through long months of my illness with my trusty laptop; to let one friend sit with me for the long day to watch "Silence of the Lambs."

But even if I didn’t have Chemo Brain incapable of focus, that scenario does not fit me. And it does not adequately fulfill the Jewish principle of bikkur cholim, visiting the sick.

Bikkur cholim is designed as a community effort, a way in which we all, sick and well, face mortality together. The Talmud states that a person who visits the sick removes one-sixtieth of the illness. Either Cynthia could visit me 60 times or 60 people can visit me once, which is what happened during my lung surgery when intensive care was filled to overflowing. It drove my surgeon crazy, but soon I was feeling fine.

I’ve learned that my illness is not mine alone, after all. It has caused my terrified friends and fellows to schedule long-overdue physicals, begin exercising and get chest x-rays. Who knows, maybe I’ll save their lives, just as they, through their visits, are saving mine.

And yes, I do believe that visiting, like prayer, is saving my life. The story is told of Yochanan Ben Zakkai, a great healer. One day Ben Zakkai became ill. He was visited by Rabbi Hanina, who held out his hand. Ben Zakkai took the hand and stood up. Why couldn’t Ben Zakkai stand up by himself? Because a prisoner cannot free himself from prison, notes the Talmud, especially from the prison of fear, which, along with travel and sin, are the three elements that destroy a person’s health.

That’s why, as Rambam explains, every sick person needs visitors, except those suffering intestinal disease (gas embarrasses the patient) or headaches (conversation creates a racket).

I know people can get through chemo alone. I’ve heard about the lawyer with the laptop whose practice never missed a beat. She put no demands on anyone. But she gave no one the privilege of service, either. The rules of visiting are simple: stay upbeat. Avoid morbid gossip about, say, others who just died of lung cancer. Enemies and depressed people stay away.

During chemo no. 4 last month, the conversation rivaled the best soirée in town: it included the wisdom of the Bush administration, the problems of picking a middle school and college, the question of whether women need breasts after child-bearing, the value of Botox injections, memories of an affair with Warren Beatty (not mine), reviews of the best movies and theater shows, and advice on how to get a film produced in Hollywood.

Some of the best times of my life have happened during treatment. Imagine that.

How Can We Stand By ?

With the Days of Awe just behind us, it might do us all good to consider the content of the prayers we collectively uttered. Many were personal prayers for one’s self and loved ones, but many also included prayers for the faceless poor and needy as expressions of our concern for the larger community. These prayers highlight the essence of what it means to be a Jew and reinforce how essential it is to reach outside one’s own neighborhood to assist the larger community of man.

In America, children are suffering without health care coverage. As Jews and human beings, how can we silently stand by? With both state and federal budgets reflecting healthy bottom lines, now is the time to fully fund both education and health coverage for all children. If we don’t do this now, we simply lack the will and not the means.

These issues are intertwined. The lack of funding for medical coverage contributes to school absenteeism.
At the 80-year-old Pediatric & Family Medical Center (PFMC) in downtown Los Angeles, we see this every day.

We recently treated a child at PFMC who had no family medical coverage and suffered permanent hearing loss due to recurrent, untreated ear infections, severely limiting his ability to learn in the classroom.
Children with chronic asthma are treated with home remedies and regularly miss school. Without prescription drug coverage, inhalers are not affordable.

We see developmentally delayed children who do not receive crucial developmental screenings at an early age because they do not see a doctor on a regular basis.

Hundreds of other clinics across the state see the same shameful thing. And with California’s uninsured population growing by nearly 70,000 a month, the problem is not going away any time soon. In this country, we accept the fact that education is a right – not a privilege – for our children. Education, it is argued, establishes a strong foundation for future individual endeavors as well as for society as a whole. Yet health care, amazingly enough, still remains a privilege.

While funding public education is vital, the right to health care cannot be overlooked. Without good health, children cannot benefit from their education. This is an important policy, and it is time to bring this debate into the public forum.

There is absolutely no question that this funding is vital to build a strong future for our children and the country. Unfortunately, our country does not give the health of our children the same priority.

California has been as lax as the federal government in its dedication to the health of our children. During his election campaign, Gov. Gray Davis crusaded for education reform, but his dedication to children’s health care coverage lags far behind. While the governor recently signed legislation making small dents in the needs of our uninsured, a great deal more must be done.

The state’s budget surplus led Davis to cut visitor’s fees to California’s sprawling park system. If he can make it cheaper for children to visit Malibu Creek, there must be a way to make children’s health care coverage affordable and available.

It’s time Davis and the California legislature fully recognize the findings of a recent Field Poll indicating that health care is the voters’ no. 2 concern, and it actually ranks as the top issue among Latinos.

Research from the American Association of Retired People indicates that the number of uninsured children under age 18 increased to 10.7 million in 1997 – or 15.1 percent of all children. How does this lack of coverage impact our young? According to a 1997 National Center for Health Statistics survey, children without health insurance were six times more likely to go without needed medical care, five times more likely to use the emergency room as a regular source of care and four times as likely to have necessary care delayed.

The Children’s Defense Fund indicates that uninsured children are at greater risk for preventable illness. The majority of uninsured children with asthma and one in three uninsured children with recurring ear infections never see a doctor during the year. Many are hospitalized for acute asthma attacks that could have been prevented or suffer permanent hearing loss from untreated ear infections. A report from the state of Florida indicates that uninsured children are 25 percent more likely to miss school.

Researchers have shown that investing in children’s health coverage actually saves taxpayer dollars. One in four uninsured children either uses the hospital emergency room as a regular source of health care – a costly endeavor – or has no regular source of care.

Florida found that when parents were helped to buy coverage for uninsured children, children received health care in doctors’ offices rather than hospital emergency rooms. In 1996, emergency room visits dropped by 70 percent in areas of the state served by the new program, saving the state’s taxpayers and consumers $13 million.

While educating our children remains essential, it is just as essential that we keep the issue of health care coverage for children on the front burner during 2000.

Healthy children are, in the long run, better educated, and our society will undoubtedly benefit from both. The richest nation on earth need not sacrifice health care for education. Surely we can make room in the U.S. budget for both.

Raise your voice for all of America’s children. They deserve no less.

Carl E. Coan is president and chief executive officer of the Pediatric & Family Medical Center.