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When life is ending: Jewish hospice

Milissa Barres and Rabbi Sara Gilbert of Beth Nehemiah HospiceHOSPICE has revolutionized the way human beings die. Surrounded by family, tended by a compassionate staff and chaplain, the dying person can leave this world with dignity and peace.

Only patients who have exhausted medical treatment and receive a six-month or less prognosis from their doctors are allowed to receive hospice care.

Patients usually decide to “die in place” — wherever they feel comfortable.

Palliative care is provided around the clock to alleviate pain.

Comforting the dying takes many forms — whispered reassurances, playing favorite music, holding hands, saying “I love you” again and again.

It’s been said that death is beautiful but dying is not. In hospice, an element of poignant beauty often accompanies dying.

The US hospice movement was inspired by British physician Dame Cicely Saunders and Dr. Elisabeth Kubler-Ross, women who escorted the once secretive subject of dying into modern consciousness.

Dr. Saunders founded the first modern hospice in 1967 in London. Deeply touched by a dying patient who requested words of comfort and acts of kindness, the  doctor established the philosphical heart of hospice: “We do not have to cure to heal.”

Dr. Kubler-Ross published On Death and Dying in 1969. Her gentle, informed and fearless embrace of the dying led to the creation of hospices throughout this country. 12 more articles in Generations – order your copy! (303) 861-2234 or email@ijn.com

Initially viewed as depressing last-minute destinations for the terminally ill, hospices acquired reputations as sanctuaries of compassion, acceptance, pain management and peace.

Families are an integral part of hospice. Instead of restricting their visits or ordering them into hallways, hospice encourages constant interaction with the loved one. Hospices also routinely provide grief support to families.

All states cover hospice care under Medicare, and most states offer Medicaid hospice coverage.

According to the National Hospice and Palliative Care Organization, about one in four Americans who were terminally ill in 2000 sought hospice care.

Those numbers have almost certainly increased.

AT the beginning of the hospice movement, Jews who entered hospice care were treated by staff members and clergy who knew little if anything about Judaism. The Jewish family, if sufficiently motivated, tried to create an appropriate religious atmosphere for their loved one. They also arranged for rabbis or Jewish para-chaplains to visit.

The National Institute for Jewish Hospice was established in 1985.

With 52,000 members comprised of community and professional leaders, NIJH speaks to hospices, health-care agencies and hospitals about specific Jewish needs, customs and rituals.

Beth Nehamah, which serves many non-Jews, is Denver’s primary Jewish-specific hospice. Founded in July of 2007 on the Shalom Park campus, it encompasses Jews throughout the metro area.

“There is a misunderstanding that Beth Nehamah was created only for Shalom Park residents,” says hospice executive director Milissa Barres. “Since its inception, the goal, the vision, was to accommodate the entire community.”

The Denver Hospice, arguably Denver’s largest hospice network, and Hospice of St. John in Lakewood now utilize rabbinic chaplains and train non-Jewish personnel in the Jewish tradition of dying and death.

All three hospices place chaplains and staff inside the patients’ particular environment.

The Jewish hospice chaplains interviewed by the Intermountain Jewish News voiced unanimous respect for their work, which they say is challenging, rewarding, and the antithesis of morbid.

They are dedicated to the particular spiritual needs of the patient and family, even it those needs differ from their own orientation.

RABBI Sara Gilbert, one of two Jewish chaplains at Beth Nehamah Hospice, has witnessed death many times. She has sensed the awesome beauty “when the soul departs the body.

“Of course I don’t have any concrete answers,” she qualifies, “but I’ve acquired a deeper awareness of life’s fragility, the finiteness of life, since I began this work. I believe all of us are on journeys. Death is one more passage.”

For patients plagued by end-of-life questions, “having the ear of a rabbi really helps,” she says.

Regardless of where the dying person is on the religious spectrum, Gilbert attests that Jewish liturgy, traditions, even a common language, eases the transition.

“I know the common language of our experience, whether spiritual, religious or family dynamics,” she says.

“If the person is no longer conscious or is non-verbal due to dementia or other conditions, I offer traditional prayers,” Gilbert says. “I think certain prayers stimulate memory: the Sh’ma, the V’ahavta, songs associated with holidays. I believe they communicate a sense of comfort.”

According to Gilbert, the dying often inquire about the Jewish view of the afterlife — “and there are multiple responses. I can discuss the journey of the soul, especially for those who lack traditional rabbinic responses. I tell the family about Jewish practices at the time of death and explain the mourning period.”

Gilbert joined Beth Nehamah in December.

Rabbi David Zucker, Shalom Park’s ubiquitous Jewish chaplain, is also instrumental in Beth Nehamah.

“One of the goals of hospice is to alleviate fear,” Gilbert says. “People fear dying, and death —two very different things.”

She says pain management, one of the hallmark’s of hospice, eradicates the fear associated with dying.

To allay the fear of death, which is related to what might follow this earthly existence, Gilbert draws upon her rabbinical expertise.

The hospice team — nurses, social workers, CNAs, physicians and bereavement counselors — wraps the patient and family in a supportive network.

“Our primary goal is making sure the person is comfortable, and that the family is comfortable and supported,” Gilbert says.

Accredited by both the National Institute for Jewish Hospice and the Joint Commission (another accrediting organization), the Beth Nehamah staff receives training in Judaism.

Despite her Jewish knowledge, Gilbert’s understanding of dying and death transcends texts and teachings.

“There is a rhythm to dying,” she says. “It’s connected to breathing, color, or rather pallor. The nurses see it too. You can certainly sense when death is near.”

The goal of a hospice chaplain is creating “sacred space at the end of life, wherever the person is — at home or in a nursing home,” she says. “And using available liturgy and prayer right there makes that space and time sacred.”

Gilbert, who reiterates that she lacks corroborating evidence, says her experience with the dying intimates a higher plane of being: “the grand palace; the ballroom, if you will.

“I’ve sensed that moment when the soul departs the body. It’s like a birthing —part of the same cycle. And it’s beautiful.”

RABBI Ted Stainman, part-time Jewish chaplain for The Denver Hospice, answers his cell in a low voice. He explains that he’s visiting an elderly Jewish man in a hospice room at a local nursing home.


“He’s unresponsive today,” says Stainman.

Incomprehensible yet audible murmurs suddenly claw the air. Realizing the sounds might upset the listener, the rabbi moves away from the bed.

The elderly man has been in and out of hospice care since 2003, which is uncommon. Generally, individuals enter hospice when they have only six months — or less — to live. Sometimes patients linger for weeks, even months. In other cases, death arrives within a few days.

The Denver Hospice, which provides end-of-life care in nursing homes, assisted living centers and private residences, hired Rabbi Stainman three years ago to accommodate the needs of Jewish clients and their families.

“When you called me, I was having a hard time getting through to this man,” Rabbi Stainman says. “The nurse encouraged me to wake him, but he’s not really conscious today.”

Even when a person’s consciousness is impaired, the mitzvah of being present is crucial. “I’d like to believe that my presence is of some benefit,” he says. “It’s not always measurable. Hopefully, on some level they recognize that I’m here.”

Rabbi Stainman says he encounters three levels of Jewish practice in hospice.

“First, people who are more traditional in their Judaism generally only require the medical side of hospice care. They are surrounded by a tight-knit community that has its own resources and rabbis.”

Then there are patients who belong to non-Orthodox synagogues who enjoy a good relationship with their congregational rabbi. “When they have a close relationship with the rabbi, I offer support but don’t play an essential role.”

The third level, which accounts for the majority of individuals in the nursing home situation, “are unaffiliated. They wouldn’t even know what a Vidduy (final confession to G-d) is.

“Sometimes a family member says to me, ‘My father is Jewish and wants to speak to a rabbi — but you will be the first rabbi he’s seen in a very long time.’”

During his three years with The Denver Hospice, Rabbi Stainman says he can’t remember a dying Jew who didn’t receive emotional sustenance from family, friends or clergy. “And that speaks very well for the Jewish community.”

The Denver Hospice’s primarily non-Jewish staff attends conferences and workshops to broaden their awareness of Jewish rituals associated with dying and the treatment of the body.

“Hospice allows you to confront the death of a spouse or parent and see it as a normal part of life,” Stainman says. “We normalize death to the degree that you can deal with it; that you can survive it and not be devastated . . . Perhaps we don’t ‘normalize’ it. But we make it doable.”

Being a hospice chaplain fulfills one of Stainman’s highest rabbinical priorities. “Often in religious life, you are consumed by institutional survival: synagogue politics; fundraising, etc. And they’re important, because without those things we wouldn’t have institutions to support us. In hospice work, you are freed from the bureaucracy and trivia. Nothing distracts you. Outside pressures are stripped away. You can do some good for humankind — participate in the most significant human moment.”

How a person dies, he believes, is directly related to how he or she lived.

“Angry people die angry. Contented people feel that their time has come and make peace with death. People who are connected, either in a relationship or with their community, die peacefully. For others, there is no peace.”

“Death is an equal opportunity employer,” Rabbi Stainman says. “And I’m not being glib. Death knocks on all our doors.”

HOSPICE of St. John, founded by the late Father Paul von Lobkowitz in 1977, hired Orthodox Rabbi Benjamin Last as its full-time Jewish chaplain in September of 2008.

“I’ve taken the word ‘help’ out of my vocabulary,” Last tells the IJN. “Help indicates I can fix something. I can’t fix what’s happening. But I can travel through the process with them.

“Can I fix their emotions, now or later? No. But I can be there with them so they don’t feel alone. That’s the power of presence, which is a very powerful entity.”

When he first assesses patients, he tries to determine their individual needs: Do they want a hand to hold, or are they seeking something specifically Jewish? Additional talking, and as much time as circumstance allows, determine his response.

Last says he meets three classifications of Jews: those who are Jewish and admit it; patients who are Jewish but don’t let their religion define them; and others who won’t acknowledge their Judaism.

People in the latter categories often desire cremation, which is forbidden by Jewish law.

Treading a fine line between respecting the person’s wishes and his own adherence to Jewish law, Last informs them that cremation “is a big no-no. I talk them through what they’re coming up against if they do that.”

He recites prayers and psalms, is present for the confession if the patient or family requests one (the Vidduy can be read to an unconscious person), and assists with burial needs.

“Whether I do anything religious depends on the person and family,” Last says. “I don’t necessarily have to do anything more than be a comforting rabbi. Sometimes I help through the sheer action of being present.”

Last acknowledges that some family members still feel that putting their loved one in hospice care is synonymous with abandonment. “But this couldn’t be further from the truth,” he says. “Hospice allows their loved ones to live the rest of their days in dignity and comfort.”

His experience at St. John, and the recent loss of own parents in quick succession, has sensitized Last to the profound significance of Jewish ritual, the power of presence and G-d’s guidance.

The Vidduy, he says, “asks for a complete forgiveness for any sins that the person has committed during his or her life. It’s not like Yom Kippur, when we atone to others. When someone is dying, the Vidduy expresses the relationship between the person and G-d, no one else. It’s quite powerful.”

Like his fellow hospice chaplains and workers, Last has witnessed several instances where the individual resists death until the family arrives — or succumbs entirely alone.

“I’ve seen many cases where death seems imminent but the person holds on until a loved one comes in the room,” he affirms. “I’ve also seen the opposite. Recently, two brothers were here holding vigil over their mother. They never left her alone for two-and-a-half weeks. One night I was on call, and the brother’s left the room for 20 minutes. Their mom passed away during those 20 minutes.

“The brothers felt terrible, but I said, ‘You don’t get it. Your mom wanted to leave on her own terms, without you there.’

“You may not feel death is fair,” Last says. “But if you really feel that G-d is in the front seat, you don’t need to worry so much. G-d will make the right decision.

“The soul — the neshamah — knows what it’s doing.”

12 more articles in Generations – order your copy! (303) 861-2234 or email@ijn.com



Andrea Jacobs

IJN Senior Writer | andrea@ijn.com


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