Yom Kippur 5781 ~ September 2020
"It’s our national shame.” That’s how Dr. Nathan Stahl, a geriatrician at Mount Sinai Hospital, who grew up at Beth Tzedec, described the impact of COVID-19 on older adults in Canada, especially those in nursing homes. And he’s right, it is a national shame.
The numbers speak for themselves: 81 percent of all COVID deaths in Canada occurred in nursing homes. That’s 7,400 out of 9,200 deaths were residents or staff in nursing homes.
Let that sink in for a moment.
It’s not just Canada’s shame. "Early data collected by the London School of Economics suggest that between 42 and 57 percent of deaths in France, Italy, Spain, Belgium and Ireland are occurring in long-term care homes and other residences for senior citizens.” (Globe and Mail, April 15, 2020). Recent reports in the US show that more than 40 percent of the now more than 200,000 COVID-related deaths are connected to people living in or working in long-term care homes. No wonder The New York Times lamented, “As Covid Hit, The World Let Its Elderly Die.”
It’s no mystery how this happened. The virus flourishes in crowed spaces. According to a recent report in The Globe and Mail, “In Ontario, almost 40 percent of nursing homes do not meet current provincial government design standards banning wards.” (August 12, 2020) Experts knew that physical distancing measures would keep the Coronavirus in check, “But Ontario’s emergency plan did not include measures to reduce crowding in nursing homes.” (Ibid) “They would have known beforehand,” said Dr. Stahl, “that four-bed rooms are a bad idea.” (Ibid)
Nursing homes are also filled with people who are already at risk because of underlying health problems making them a “gift to any infectious disease”. (The Globe and Mail, August 15, 2020)
Moreover, even before the coronavirus, experts have been warning for more than a decade that nursing homes have chronic staffing shortages and difficult working conditions that leave them “unsanitary, undignified and unhealthy”. (The Globe and Mail, August 11, 2020). As a result, “[t]ens of thousands of people died—casualties not only of the virus, but of” (NYTimes, August 9, 2020) years of neglect. Neglect that continued as “[p]ublic health officials around the world excluded nursing homes from their pandemic preparedness plans and omitted residents from the mathematical models used to guide their responses.” (Ibid)
Dr. Stahl said, “It’s almost as if the house was lit on fire, we locked the door and told them to fend for themselves.” (Ibid)
As reported in The Globe and Mail, “The Covid-19 pandemic is a reckoning for Canada and its treatment of its aging population.” (April 15, 2020) Yom Kippur, too, is a reckoning for us—individually and communally—and our living up to the highest ideals and values of our tradition. This Yom Kippur, I hear ringing in my ears the verse from Psalms 71:9, part of Shma Koleynu—“al tashliẖaynu l’et ziknah, do not cast us away in our old age; do not abandon me as my strength fails.”
When thinking about our relationships with older adults, Jewish tradition naturally begins with our relationship with our parents. The mitzvah “Kabed et avikha v’et amekha, Honour your father and mother,” (Exodus 20:12 and Deuteronomy 5:16) is considered, not surprisingly therefore, one of the most important and fundamental principles of Jewish ethics. Its placement as number five of the Ten Commandments gives rise to the rabbinic notion that it functions as a bridge between two categories of mitzvah: mitzvot ben adam l’makom—between people and God; and mitzvot ben adam l’havero—between human relations. There is, therefore, a profound relationship and reciprocity between honouring parents and honouring God and honouring all humanity.
The Talmud makes this connection explicit when it teaches that “[t]here are three partners in the creation of a human being: the Holy Blessed One, the father and the mother. When a person honours their father and their mother, the Holy Blessed One says, “I ascribe merit to them as though I had dwelt among them and they had honoured Me.” (Kiddushin 30b)
The use of the word Kibbud, from the Hebrew kaved, meaning “weighty” is noteworthy. The mitzvah is not to love your parents. There is no v’avata et hahorim, like v’ahavta l’reiekha kamokha—Love your neighbour as yourself. (Leviticus 19) Parental relationships can be complicated. Honouring one’s parents in our tradition has a sense of heavy responsibility; it’s weighty. The rabbis saw the fulfilment of honour, therefore, to be related to ensuring our parent’s physical well-being. We are obligated to ensure housing, the activities of daily living—like eating, bathing and toileting—doctors appointments and managing finances.
These are, of course, huge responsibilities. Tradition understood that a person may not be able to fulfill them on their own. Connecting the word honour in “Honouring your father and mother,” and "Honour the Lord from your wealth” in Proverbs, the rabbis taught that "wealth, here, too,” means food, drink and a new garment”. (Mekhilta D’Rabi Yishmael 20:12) In other words, if you cannot personally fulfill the mitzvah of kibbud av’ v’em, then you could pay someone else to do so. For Judaism, our responsibility is simply to ensure it is done. It is because of these values that in 17th century England and France the Jewish community established the first long-term care facilities for the elderly.
Al tashlichaynu l’et ziknah—As a Jewish community we should make sure that our residences for the elderly protect them and not just house them. There are, of course, examples of excellence in Canada in this regard. Baycrest is one of them that has managed to contain the virus by employing basic measures such as using personal protective equipment, routinely testing employees and residents, bringing on extra workers and limiting visitors.
The restriction of visitors, especially family members and private-care givers, has had an unfortunate side effect on the emotional, mental and spiritual well-being of older adults. “Changes to routine, such as being confined to their rooms because of an outbreak, often causes confusion and worsen symptoms.” (The Globe and Mail, June 4, 2020) Furthermore, so much of care, 75 percent according to Dr. Stahl, is unpaid, meaning family members and volunteers. The pandemic restricted the access of these “plus” care-givers increasing the loneliness and isolation of older adults in nursing homes. The “lack of social interaction has cause emotional suffering and deprived them of physical and mental stimulation …accelerating cognitive decline”. (The Globe and Mail, September 14, 2020)
Our tradition recognizes the importance our parent’s spiritual well-being when the Torah tells us: ““Ish imo v’aviv tira’u—You shall revere your mother and father.” (Leviticus 19:3) The rabbis ask what is the difference between kavod (honour) and yira (reverence)? If honour referred to ensuring our parent’s physical needs, then reverence, meant attending to our parent’s social, psychological and spiritual well-being.
The Globe and Mail shared the experience of Susan Mills who before the lockdown “used to spend several hours a day with her mother who has vascular dementia. She would accompany her mother to the dining room for dinner and they’d watch the news together and catch up on what was happening with her mother’s five other children. When visitors were banned in March, her mother was still able to hold a phone to her ear and chat from the other side of the window. But by early September, the 84-year-old barely had the strength to lift her hands. Her side of the conversation had dwindled to one-word responses. … The deterioration is very real,” Susan said, “noting that her mother will never regain much of her strength and cognitive function she has lost over the last six months.” (September 14, 2020). We have heard from so many of you—family members and professionals—how difficult and heartbreaking this reality is.
Al tashlikhaynu l’et ziknah means that we also have an obligation to see to the emotional well-being of older adults.
Studies have shown that “chronic loneliness and social isolation are serious health hazards. Lonely people are not only more likely to develop a range of illnesses from cardiovascular disease and cancer to depression and dementia—they tend to feel worse when they fall ill than those who are not lonely.” (Ibid) Our Centre for Spiritual Well-Being, before the pandemic, was gearing up to address these issues, because our Advisory Committee had identified loneliness and isolation among older adults as one of our core priorities. The pandemic has only exacerbated trends that were in motion long before.
The cry of the Maẖzor Al tashlichaynu l’et ziknah this Yom Kippur keeps me up at night. We are failing. Too many of our parents and grandparents, of our older adults are suffering.
In addressing these issues, Dr. Stahl distinguishes between long-term care facilities and community. To do better with our long-term care facilities we have to ensure they have the staffing they need and access to COVID-19 expertise, PPEs, diagnostic testing, prevention and control. As a community we need a more nuanced balanced approach to further regular physical contact while minimizing the risks of collateral pandemic damage to our older adults and to us.
As a synagogue community, we surely should be able to address the communal needs better than we are. But, we need help. I’m asking for help. We need volunteers to call and simply chat with our older adult members on a regular basis. We need volunteers with patience galore to help our older adult members navigate technology to speak and see family members and to participate in synagogue and communal activities and games. We need volunteers to help us imagine and design opportunities for our Torah and prayer services, along with music, conversation and laughter, to seamlessly enter into senior housing in the GTA. And while the weather is still decent, are there ways we can safely bring older adults together?
This is what Hannah Sandler did with Hallah for Hesed, a program she and friends ran last spring and summer. She writes about it in our Olam Hesed Yibaneh reader. Each week she delivered hallot to elderly members of Beth Tzedec. “I’ve always taken for granted having a hallah on my table every Friday night, even through the COVID-19 pandemic. Being able to give others the opportunity to have a sentimental Shabbat experience, coupled with meeting a handful of amazing and kind men and woman, brought a smile to my face with every delivery that was made.” (High Holy Day Reader, page 36)
There are so many talented people listening and watching right now, what can you offer to engage our older adult members intellectually, artistically, with entertainment and Yiddishkeit? We make so many resolutions as the New Year begins. It’s an attainable resolution for many of us to make this year to give some time to volunteer in creative programming for our older adults. This week we will put a registration form up on our website making it easy for you to let us know that you will volunteer so that we can say collectively that we heard the cry of older adults in the Maẖzor: Al tashlichaynu l’et ziknah—do not cast me out in my old age and that we responded.
There are countless ways to honour older adults. We can all find more ways to help directly and advocate for their needs. Rabbi Nachman of Breslov wrote that one can, “Gauge a country’s prosperity by its treatment of its elders;” let us ensure our country’s greatness by fulfilling our mitzvah to honour our older adults.