Longer life, programs, care make Jewish Home’s wait list daunting

As bombs dropped over Germany, aerial photographer Arthur Oxenberg would lean out of a B-17 Flying Fortress with his camera to snap a photograph. His photos were a way the U.S. Army Air Forces could tell whether bombs hit their targets.

Based in Italy, Oxenberg flew 62 combat missions with the 301st Bombardment Group, 419th Squadron, bombing factories and military installations in Germany, Hungary and Austria. Seventy years later, he still has the log that recorded those missions.

On Nov. 4, 1944, Oxenberg wrote, “I hope that today’s mission was the ‘rough’ one. I don’t like to think of having another one like it. It was one of those days. Everything happened. … Twice I passed out for short periods because of lack of oxygen.”

“His big fear was that he would die over some country where no one would know him,” said Jan Oxenberg, his daughter. “When he came back to the United States after his final mission, he literally bent down and kissed the ground.”

After the war, he made a name for himself starting several of his own businesses. But today, Oxenberg, who turns 90 on Sept. 2, is suffering from Alzheimer’s disease and requires 24-hour care.

Like many people his age, Oxenberg is seeking admittance to the only dedicated Jewish elderly assistance facility in Los Angeles. The Los Angeles Jewish Home, in Reseda, is the largest multilevel senior living facility in the Western United States. But it is also the smallest Jewish senior living facility, based on Los Angeles’ per capita Jewish population, according to Jewish Home CEO and President Molly Forrest. The Jewish Home caters to the needs of more than 1,900 in-residence seniors each year, providing services that include independent living accommodations, residential care, skilled nursing care, short-term rehabilitative care, acute psychiatric care, and Alzheimer’s disease and dementia care.

Arthur Oxenberg as a photographer during World War II. Photo courtesy of Jan Oxenberg

Consequently, the Jewish Home has a wait list of up to two years. On any given day, there are about 400 people on the list, and only 100 to 200 of those are actually admitted each year, according to Forrest.

“Our promise to provide for the comprehensive needs of our residents means that current residents who require a change in the level of their care are the first in line for any newly available space at the Home—before new applicants,” she said. “While the Home does have a wait list, each person is considered on a case-by-case basis. We make accommodations when we can, but we can’t simply have one person move ahead of others on the wait list.”

Jan Oxenberg, a television writer, contacted the Jewish Home in February when she moved her father from Florida to Los Angeles, where two of his four children reside. Since then, Arthur Oxenberg has lived in private assisted living facilities and a VA-contracted nursing home.

“It is so painful to see him like this. He grabs his head and says, ‘Make me real again!’ ” Jan said. “The amazing thing is that he knows who we are. He is still very talkative, friendly and social.”

Because of his condition, Jan sought to admit her father to the Jewish Home’s Auerbach Geriatric Psychiatry Unit program. Like all other applicants, Oxenberg was faced with the daunting wait list.

“We try to be responsive, but it’s hard when we are 98 percent filled at all times,” Forrest said.

The first priority for new admissions is those in unsafe living conditions.

“Preference may also be given to those who can benefit from the Home’s unique programs and services, including survivors of traumatic life events such as the Holocaust, violent crime or elder abuse,” she said.

“In reviewing applications, we do take hardships into consideration. However, each person is an individual who is considered on his or her particular and unique basis. We do give preference to those who have served the Jewish Home and Jewish community, including employees, volunteers, rabbis and Jewish communal workers,” Forrest said. “Making a donation is never a condition of admission to the Jewish Home. In fact, the vast majority of our residents are financially needy.”

For dementia care with skilled nursing, someone can be on the wait list for six months to two years.

This lengthy wait list is partially because the average age of Jewish Home residents is more than seven years above the national average and the average length of stay is more than eight years, compared with two to three years in similar settings, according to Forrest.

“Because of the quality of our home, we like to say that we add life to years and years to life,” she said. “Our statistics are unlike any other programs. We ask people why they want to come here. Half of the applicants on the wait list say because of the quality of our medical services, and the other half say that they are lonely and want to make friends.”

Reasons like this are why the Oxenbergs and other families are drawn to the Jewish Home.

Jan Oxenberg said that it’s important for her father to be able to socialize, something she knows the Jewish Home will provide. And so, Jan, and hundreds of other families, endure the wait in hopes of securing a spot in one of the Jewish Home’s facilities.

“One of the great things about the Jewish Home is that they honor our people,” Jan said. “It is very important for him to be in a place where he can be around people and socialize.”

Center’s Studies Aid Care for Frail Elderly

Rose Sino sits in her wheelchair as lunch is placed before her. Her son offers her a forkful of cheese blintz, which Sino quickly chews before accepting another bite.

While this scene might appear routine, its significance is not lost on her son, David Swartz, or her caregivers at the Jewish Home for the Aging of Greater Los Angeles (JHA). Sino, 88, is a resident of JHA’s Goldenberg-Ziman Special Care Center, a facility that serves elderly residents with dementia. Five years ago, Sino lost all interest in eating and required a feeding tube to get sufficient nutrition.

For Sino and many other frail, elderly nursing home residents, lack of appetite is a common problem, one which can lead to a rapid decline in health, said Dr. John Schnelle, director of the Anna and Harry Borun Center for Gerontological Research.

Weight-loss prevention is one of the principal areas of investigation at the Borun Center, a joint venture between JHA and UCLA’s David Geffen School of Medicine. Housed on the JHA campus in Reseda, the center was established in 1989 to identify and test nonmedical measures that could improve daily care and quality of life for nursing home residents. Given that the number of people 85 years or older is expected to almost double in 25 years, the center’s research is of growing interest to the government, private industry and the public.

While the Borun Center utilizes JHA to test and pilot numerous interventions, it also conducts research at facilities throughout the country. In addition to preventing weight loss, current projects focus on preventing mobility decline, detecting pain, preventing pressure ulcers and managing incontinence.

The center has used research findings to develop protocols, available on its Web site, for use by nursing homes. The strategies focus on everyday routines, rather than on medical interventions.

“Once a person is frail enough to enter a long-term care facility, they’re usually taking five to six medications,” Schnelle said. “They are less inclined to do surgical or pharmacological interventions. What they want is for their pain to be managed and their incontinence taken care of and for staff to treat them in a reasonable way.”

The Borun Center is currently working with the federal government’s Center for Medicare and Medicaid Services to improve methods of evaluating nursing home care. Current methods don’t always provide the most reliable information, according to Schnelle. Not only are the elderly less likely to complain, he said, but the phrasing of questions can influence their responses.

“Asking, ‘Are you satisfied with how often you are taken to the bathroom?’ will typically generate a yes response, even if that is not the case,” he explained. “Asking, ‘How many times would you like to be helped to go to the bathroom?’ and ‘How many times are you taken to the bathroom?’ is more likely to reveal the discrepancy between what residents want and what they get,” he noted.

Schnelle said that most nursing homes are understaffed and that in the typical facility, residents are taken to the bathroom only once a day. (He also said that, in all measures the center looks at, JHA exceeded all other facilities studied.)

The Borun Center’s nutrition and weight-loss study at JHA identifies strategies to prevent the decrease in eating and fluid intake common to nursing home residents. Schnelle cited depression and appetite change as two principal causes.

“Food doesn’t taste as good, and they simply don’t care as much about it as they once did…. But you can reverse the decline if meal time becomes social.”

Sino’s improved eating came about not because of a change in her food, but in how it was presented and served. Using Borun Center study results, JHA’s Special Care Center systematically incorporated eight measures — including greeting residents by name and providing verbal encouragement — which had been shown to boost caloric intake among certain residents by about 300 calories a day.

“At some facilities, a food tray is placed in front of the resident, and that’s it,” said Susan Leitch, community manager for the Goldenberg-Ziman Building.

In her facility, servers take plates off the serving tray and place them, restaurant style, before the residents. Containers are opened and meat is cut for those who require assistance. Residents are greeted by name and offered substitutions for foods they dislike.

Nursing aides and other staff sit with residents or stop by their tables with encouragement. “Try this. This is good,” one says. “I know you like chocolate,” says another as she presents a bowl of ice cream to a resident.

In addition, snacks are incorporated into activities as a way to boost caloric intake, and family members are encouraged to bring treats that they know their relative enjoys. Sino, for example, ate the pieces of chocolate her son offered her, even when she was still using the feeding tube. He credits the chocolate with renewing her interest in eating.

Not surprisingly, the interventions identified by the Borun Center require greater staff time. That means higher costs.

Molly Forrest, JHA’s CEO, acknowledged that those costs present a challenge. Approximately 80 percent of JHA residents are on Medi-Cal, and the reimbursement received does not cover the expenses incurred.

“Quality is a costly item,” Forrest said. “The needs are so great, and those needs can only be met by the hands of a caregiver.”

Schnelle suspects these interventions also prevent hospitalization and prolong life. But even if they did not improve clinical outcomes, he believes improving quality of life for the frail elderly is justified from a moral point of view.

“I think we have to be very clear about the staffing requirements needed to provide good care and let people make choices,” he said.

For David Swartz, the choice is clear. Sitting with his mother at lunchtime, he beams. By the time she’s done, only one tiny bite of blintz remains on her plate.

For more information, visit www.borun.medsch.ucla.edu.


JVS Program Heals Immigrants’ Lives

Balancing a large tray on her shoulders, Nahide Kafri dashed from table to table serving dinner to patients with Alzheimer’s disease at the Los Angeles Jewish Home for the Aging (JHA). Despite the hard work, a smile crossed her face.

As a certified nurse assistant (CNA), Kafri earns less than $9 an hour, barely enough to support her husband and four children. She commutes two hours a day in heavy traffic to get to and from work.

She said she couldn’t be happier.

"I like working here so much, maybe too much," said Kafri, clad in white shoes, a floral gown and white pants. "I’ve always liked to help people, and now I can help old people, people who really, really need me."

Just six months ago, the 46-year-old Iranian immigrant was unemployed and on welfare. Now, she has a bright future.

In the past year and a half, Kafri and 29 other immigrants and refugees, mostly from the former Soviet Union and Iran, have moved off the dole and into stable jobs after completing a five-month program sponsored by Jewish Vocational Service (JVS) . After earning their state certification, they have gone on to work as CNAs at JHA, where they bathe, dress and feed the elderly, among other tasks.

In the process of becoming nurse assistants, immigrants like Kafri have regained their pride, said Tatyana Kodner, director of the department of refugee and immigrant services at JVS.

"This program creates miracles in their self-perception, ego and consciousness and makes them feel equal to anybody and everybody who’s functioning independently and not waiting for handouts," she said.

And they make wonderful CNAs, said Molly Forrest, chief executive of JHA, adding, "They’re really good workers."

So talented, in fact, that area nursing homes have inquired about hiring them. Country Villa Health Services, a Marina del Rey firm that operates 26 skilled-nursing homes in Southern California, has had discussions with JVS about possibly tapping program graduates for future positions, said Martha Schwegler, County Villa’s director of education and training.

The state’s nursing shortage has meant a strong job market for participants in the Certified Nurse Assistant Training Program at JVS. With California’s residents graying and its population growing, nursing homes, hospitals and other medical facilities are hungry for CNAs, licensed vocational nurses (LVNs) and registered nurses (RNs), said Donna Gerber of the California Nurses Association, a Sacramento trade group. New state guidelines mandating minimum staffing requirements are expected to boost demand even more when they take effect next year, she added.

For Kafri, completing the JVS program has been nothing less than life altering.

Coming to the United States in 1998 to escape anti-Semitism, Kafri, her husband and their children found themselves crammed into a one-room Los Angeles apartment with no language skills and even less confidence. Isolated and depressed, Kafri and her spouse fought bitterly, feeling like outcasts in their adopted country. She cried herself to sleep many a night.

In Iran, the Kafris lived a comfortable, middle-class life. They owned their own home in Tehran. Kafri’s husband, Khosrov, ran a successful company that manufactured baby shoes. Although some prospective buyers steered clear because of his Jewish heritage, he earned enough so his wife could stay home to raise their family.

In the United States, however, the couple relied on government assistance to survive, a source of great shame. They nearly lost hope, sometimes wishing they had never uprooted themselves.

Then a social worker told Nahide Kafri about the JVS program, and she saw a way out of her predicament. At first, her husband discouraged her from pursuing a career in nursing because of his opposition to her working outside the home. After several heated discussions, he finally relented.

She began her journey toward self-sufficiency when JVS officials interviewed her to ascertain whether she had the English-language skills, intellect and physical strength to pursue a nursing career. The agency also performed an extensive background check on her, as well as on other interested immigrants and refugees. After the vetting, she and a handful of other qualified applicants were chosen to start formal training at JHA.

At the Jewish Home, Kafri and fellow trainees received more than 160 hours of classroom and hands-on training. Cyril Kincaid, the main educator, taught them more than just how to feed stroke victims properly and perform rehabilitative exercises to prevent bed sores and keep the blood flowing. Trying to breach cultural barriers, he talked about such subjects as death and dying in America, noting that some people are agnostics and atheists and prefer nonreligious burials. He stressed the need to respect patients’ customs and wishes, no matter how seemingly exotic.

During the training, Kafri earned $7.15 an hour, and JVS assigned her a mentor to give her career and life advice. Her salary increased to $8.75 after she passed state exams and gained her certification. After three months on the job, JHA hiked her pay to $8.88, plus health benefits.

Kafri isn’t getting rich at the new job. However, she manages to save enough to surprise her children, including her 21-year-old son, Rayan, a UCLA senior.

"I hand them some money and say, ‘Here, spend it for yourself,’" she said, smiling with pride.

JVS started its program after executives noticed that many job-seeking immigrants and refugees on welfare had previously worked as medical technicians and nurses in their home countries. That, coupled with the state’s acute nursing shortage, made agency executives confident that they had a winning idea.

Los Angeles County agreed, granting $197,000 and, recently, another $150,000 for the program. Several private foundations have followed suit.

Although little new money is expected from the county because of the budget crunch, JVS Chief Executive Vivian B. Seigel said the program will continue without interruption, because additional private-sector grants should offset the loss of county funds. The Jewish Venture Philanthropy Fund recently said it had preliminarily agreed to invest $125,000 in the program.

JVS executives said they hope to partner with local community colleges so that program graduates could easily go on to train to become LVNs and RNs.

Like the freshly minted nurse assistants, JHA has benefited from the program. Not only has it hired more than two dozen program graduates, but it also receives $1,350 for each CNA it trains in conjunction with JVS, said Shelly Ryan, the home’s chief of human resources.

More than that, the program has given a real opportunity to people down on their luck, she said.

"We have so many people from so many countries who come here for no other reason than to make a better life for their families," Ryan said. "Now, they are."