Stepping out at Brent Cross tube station, you don’t need to walk far to notice that you are in the heart of north London’s Jewish community. Kosher shops abound and many of the men in the local area are dressed in variations of the traditional Charedi dress – high-crowned black hats, ringlets and frock coats.
Just round the corner is charity Jewish Care’s Michael Sobell Jewish Community Centre. It is part of the impressive Maurice and Vivienne Wohl Campus on Golders Green Road which, as well as the community centre, consists of:
- Otto Schiff, a 42-bedroom specialist care home for older Jews with dementia.
- Selig Court, purpose-built independent living apartments for rent with one or two bedrooms and access to round-the-clock support if needed. Priority is given to Holocaust survivors and refugees from Nazi persecution.
- Facilities including: Booba Brenner’s shop (booba is Yiddish for grandmother and the shop is named in memory of the original Booba Brenner shop in Stamford Hill) which sells a variety of kosher food, gifts and cards; a café and restaurant; a hairdressing and beauty salon; a library; an arts, craft and pottery studio complete with kiln; a varied entertainment programme (while I’m there the weekly current affairs discussion group is in full swing); book and film clubs; access to a chiropodist, and hearing and optical clinics; and communal celebrations of Jewish festivals.
Jewish Care supports about 7,000 people every year across London and south east England and as many as 1,000 make use of its six community centres each week for a nominal membership fee of £30 per year.
As you enter the centre’s lobby there is huge mural covering one wall depicting images from the Old Testament with Hebrew language that members will recognise and instantly feel connected to. Black and white photos of streets and Jewish people in London’s East End during the early 1900s hang along the corridor walls.
Walking through the centre’s café and lounge area, the atmosphere is friendly and relaxed; groups play rummicub, bridge and cards, others chat over tea, coffee and cake, or read the papers by themselves.
Comfort of community
Taking an individual’s ethnic and cultural background into account should be an integral part of personalised care planning. But sometimes, providers and commissioners think it enough just to provide a kosher meal in an otherwise non-Jewish residential home with no thought for any of the other considerations which make up that person’s identity. This is why so many Jews turn to Jewish Care, and consequently why it is the largest provider of health and social care services to the Jewish community in the UK.
There are obvious reasons why Jewish people look to culturally appropriate care as they age. Firstly, there are the religious laws and rituals, which commonly become more important in later life even if the person hasn’t particularly adhered to them during their life. But, says Neil Taylor, the charity’s director of care and community services, the second part is about identity, “the far more implicit nature of the community, its history, its connection and its culture which is far less easy to describe and is nuanced”.
The comfort of community and understanding cannot be underestimated, he says. “My grandfather had a fierce Jewish identity but didn’t attend synagogue or eat kosher food, but there was only one choice he was going to make when going into a care home and that was that it would be a Jewish one. People would understand him and it’s that sense of belonging – you don’t have to explain your history because it is shared.”
Language is another shared identity. So while Yiddish isn’t strongly used in non-Orthodox communities, for many Jews Yiddish words are nevertheless interspersed in conversation and they are also a throwback to their childhood.
Many older Jewish people return to their faith in the latter years of life, even if they haven’t lived according to Jewish law until then. It’s not unusual for them to want to be buried in a Jewish cemetery according to Jewish laws and practices whereby burial takes place as soon as possible after death, usually within a day or two. The burial is followed by a week-long mourning period known as a Shiva. During Shiva, mourners remain at home and the Jewish community comes and offers comfort to them, joining them for daily prayer.
Discrimination and prejudice
Even in a home care situation, where you might question the importance of culturally appropriate care when someone is coming into your own home for minutes at a time, an understanding of the person’s faith is key to good care, says Taylor.
“When our staff go into someone’s home they understand the significance of two lit candlesticks on a Friday [to mark the beginning of Sabbath]; the significance of a memorial candle that could be alight in the home, or the eight-branch candelabra – known as the menorah – being lit on the festival of Chanukah; as well as the kosher dietary law that prescribes keeping meat and dairy products separate when preparing, cooking and eating food, as well as the cutlery and crockery used to eat them.”
The Sabbath is a very strong element of the Jewish faith and this is reflected at Jewish Care in that it’s a rest day; the offices aren’t open on a Saturday, and care home managers are asked not to send emails.
The rhythm of their care homes changes at Sabbath and during festivals. For example, TVs are not switched on in communal areas although individuals can choose to watch programmes in their own room. This practice has its limits though.
“If there is a risk of serious harm we can break our rules, the sanctity of life is the most important thing and it overrides everything,” says Taylor.
For Jewish people, arguably more than most, their identity is born out of a common experience of discrimination, prejudice and anxieties around anti-Semitism.
It would be difficult for a non-Jewish organisation to truly respond to the needs of Holocaust survivors and refugees. Those who grew up in the east end of London through Moseley and the Second World War, the people we care for, have a great deal of past experiences and trauma,” says Taylor.
As an example he cites an outbreak of lice in beds at one of the charity’s independent living facilities. Across the flats this triggered a memory of being in death camps for many residents. “It generated a great deal of anxiety and our staff’s ability to understand that and respond with sensitivity and compassion was significant. Staff went into counselling mode in a way that others might not have done,” he explains.
Paula Plaskow, north west community support and social work team manager, recounts a story of a Jewish woman who was sectioned because she hoarded food, particularly lumps of bread. “She had been in a concentration camp, so when the approach to deal with her was changed to allow her to hoard food, she calmed down. It’s about understanding why.”
Working with synagogues
As a rule, Jewish people turn to their own for help and generally won’t approach social services. Jewish Care’s helpline is often their first port of call. Each year the helpline receives over 15,000 inquiries. The confidential helpline is run by a small team of advisers providing support and information on a range of issues. Three-quarters of calls are answered directly by the helpline advisers, with the remaining 25% referred on to the organisation’s social work team.
The helpline team carry their own cases in situations where social work input is either not needed, because the person just needs some basic information or signposting elsewhere, or where the person calling doesn’t want to be referred. When a person would benefit from a referral but declines this service, the advisers will sometimes make follow-up calls in the hope that the person may come to trust them and change their mind.
The charity’s community support and social work (CSSW) team has 12 social workers and nine community support workers covering London and the South East. The majority of their caseload supports members of the Jewish community living at home. They are also involved in admissions to Jewish Care’s care homes.
Additionally, the CSSW team is split into branches in different areas and each branch links with the synagogues in their locality – through the synagogues’ welfare coordinators – to offer advice and information, which often generates new referrals.
Plaskow works in Barnet, Brent and Ealing. “Welfare coordinators are approached by members of the synagogue if they are struggling with health or social care issues but they don’t want to go to the local authority for fear of stigma and not wanting others to know they have issues.
“To start with they often don’t want to go straight to Jewish Care either because they don’t feel confident, so they go to the welfare co-ordinator who speaks to the social worker. So there is strong collaboration and then eventually you will get a referral. It could happen quickly, or it could take a few months.”
Jewish Care sees working with synagogues as community social work at its best. When assessing clients, social workers ask questions to try to understand the individual’s personal journey and background in order to deliver personalised care – for example, where they were born; where they grew up; when they arrived in the UK; whether they have siblings, a partner or children; and whether they belong to a synagogue.
They find out whether they have a community they can work with to help support them or whether they are isolated, and ask where they feel most comfortable and understood by those around them – this can be a vital part of establishing whether they have an existing support system.
They also look at whether aspects of culture, foods and sounds – such as traditional prayers or songs in Hebrew; songs connected to ritual and festivals like prayers over wine on the Sabbath; those sung together from a young age while lighting the candles on the festival of Chanukah, or around a festive meal at Passover – remind them of their younger days that could be revisited.
Almost two-thirds of residents in Jewish Care’s care homes are local authority funded. The charity’s social workers provide an advocacy role on their behalf, as well as for self-funders, to ensure they receive the culturally appropriate outcomes they are seeking.
The team has information on and contacts with a range of local services both within and outside the Jewish community. If there is no availability at Jewish Care’s homes or from its services, its social work team refers to other Jewish homes and domiciliary care services.
“Our social workers are at the heart of what we do,” says Taylor. “They understand what’s on offer and what someone is looking for when they need support.”
When someone approaches Jewish Care for support, their expectation is that they will be cared for by fellow Jews, so I was surprised to discover that 95% of the charity’s 1,500 staff aren’t in fact Jewish. Instead, all staff attend a one-day Jewish way of life induction programme which aims to give new staff an understanding and a basic level of knowledge for working within a Jewish environment. It covers:
- The Jewish calendar of festivals.
- A basic understanding of Kosher dietary food laws and the foods permitted in a Jewish Care resource.
- The origin of Jewish law and the significance of Jewish religious objects; Sabbath (Shabbat) and religious practices in the home and synagogue; and in life in general.
- A background to the length of Jewish history and how Jews spread across the world as a result of persecution.
- An awareness of the emotional and psychological needs of Holocaust survivors.
- The Jewish life cycle of events, births, bar mitzvahs, marriage and procedures relating to death and mourning.
The training aims to ensure that staff understand that being Jewish is complex and multi-faceted and more than just a religious belief, so that they understand more about the range of cultural and religious diversity in the Jewish community. For example, when a member of the social work team is advocating for a client who is in hospital they will help to ensure that they are able to follow any religious or cultural customs that are relevant during their hospital stay. This could be receiving a kosher meal or not being given bread to eat over Passover, or keeping meat and dairy food separate. Getting these elements right and respecting the individual’s cultural beliefs can play a vital role in their sense of wellbeing and recovery.
In the majority of cases it isn’t an issue that staff aren’t Jewish, but where it is, rather than change the practitioner allocated to work with them, we challenge the prejudice, explaining that all staff are well trained to deliver excellent quality care and have taken part in the Jewish way of life training,” says Taylor.
However, unusually for a charity, the number of volunteers are double those of staff and the majority are Jewish.
“We are a community organisation which gives us the ability to harness a lot of resource in the community because people identify with it, which is why we have so many volunteers,” explains Taylor.
When advocating on someone’s behalf to local authorities about why they should be placed in a Jewish care home, it’s about getting them to understand the importance of belonging and the shared history.
Ironically, sometimes it’s the family that social workers find themselves having this conversation with. Faith is often diluted down a generation and the adult children may not understand the significance for their parent of being in a Jewish care home.
Usually though, for the older Jewish person’s family it’s a relief to know that they are being looked after by Jewish Care.
Jewish Care’s services
The charity is the largest health and social care provider for Jewish people in the UK, working across London and south east England, touching the lives of 10,000 people each week. It has 1,500 staff and 3,000 volunteers.
- nine care homes for older Jewish people, the majority of which support people with dementia;
- one residential home for Jewish adults aged 18-65 with physical or sensory disabilities;
- two residential homes for Jewish adults with mental health support needs, one for young adults and the other for those over 50;
- two sets of independent living apartments with 24-hour support available.
- three day centres for people with dementia;
- a Holocaust Survivors’ Centre;
- six community centres;
- a home care service;
- respite care at several of its care homes;
- four Memory Way cafés; and
- a helpline: 020 8922 2222 or email firstname.lastname@example.org Jewish Care Interact, an online service for the Jewish community jewishcareinteract.org
Services for people with dementia are an important element of Jewish Care’s work. It was given seed funding from the Department of Health 12 years ago to create a dementia development team with responsibility for developing best practice in dementia care across the organisation.
This initial grant, along with a generous grant from the City Bridge Trust in 2010, has helped the organisation to grow its dementia care expertise across all its services. The City Bridge Trust grant enabled members of the arts, disability and dementia team to work with one care home at a time for a number of months, shadowing staff and delivering on-the-job support for their work with people with dementia.
In addition home care staff received training to deliver activity based stimulation to a person living with dementia which includes activities such gardening, cooking, reading, or games for an afternoon whilst their relative/carer to give their carer some respite. This was an extremely successful pilot which is now embedded in the homecare provision.
The majority of its care homes support people with dementia, plus there are three specialist day centres and four Memory Way cafés. The latter meet in various places in Golders Green, Redbridge and Hendon and people with dementia attend with their carer.
It has a twofold aim, says community support worker Barbara Edwards, “for carers to meet other carers, and [for] couples to do something social together. Sometimes couples are excluded from other social activities because they are only aimed at the person with dementia, and friends have fallen away because it’s too difficult [to keep in contact once someone has dementia]”.
The charity’s three specialist day centres are for the person living with dementia and are designed to give cognitive and social stimulation to enrich their day as well as some respite to the carer. They’re open five days a week and have an intimate environment with no more than 25 people a day so that activities can be individually focused.
Plaskow is passionate about care for people with dementia and the particular importance that culturally sensitive practice plays in good care: “Things like festivals are triggers back to childhood and it helps them to have those intrinsic memories brought to the fore and enjoyed again. Short-term memory can be limited but long-term memories are still accessible, so the familiar aspects of culture, sights, sounds, smells and tastes of a community can provide enjoyment and promote wellbeing and you don’t get that unless it’s culturally specific.
“We know that for many people living with dementia, religion can play a major role in their wellbeing. This doesn’t need to be ‘religious’ activity. Many of our customers don’t see themselves as religious but they do feel Jewish and have connections with people, the community and the traditions that have shaped them. It may just be the smell of donuts at Chanukah, the lighting of the Shabbat candles or a song sung at our Hebrew school. Whatever it is, it is likely to be ‘hard wired’, evoking memories which for people living with dementia can create, for that moment, a sense of wellbeing.
“Triggering a positive memory from the past can enable a person living with memory loss to engage in the present and help them to remain more active and socially engaged. Our staff and Jewish Care volunteers in our homes and community centres often comment on the way that many of those people who are living with dementia are more responsive and become stimulated by the sensory triggers associated with religious practices.
“For example, sitting down to a table laid for the Friday night dinner on Sabbath with wine, challah (bread for Sabbath), the smell of chicken soup and chicken, will be comforting and evoke positive memories of family for many Jewish people who are living with dementia. This weekly and annual cycle of the Jewish year helps to mark time.
“What’s really important is that both the client and their relative or partner can feel that they have chosen the right culturally appropriate care and support, with fantastic staff who are really caring and are culturally sensitive to them as an individual. A dignified place where they can spend the later days of their life.”
Hannah and David (not their real names) have always been heavily involved in their north London Jewish community; Hannah was a yoga teacher and David was involved with their synagogue’s community work.
David came across Jewish Care about 30 years ago when he went to his great uncle’s 100th birthday party at the charity’s residential care home Rubens House in Finchley. Later, one of his aunts and Hannah’s mother went to live in another of the charity’s homes.
“When I retired, Hannah thought she would do some community work and I thought about Jewish Care and Rubens House which wasn’t far from where we live. Hannah started teaching yoga with residents sitting on chairs and in wheelchairs. I used to take her and when staff found out my profession – a tailor – they asked me to do various jobs like alter clothes. And while I was there I’d always play dominoes with residents, that was my job!”
After Hannah had a couple of falls she could no longer teach yoga and then in 2012 she was diagnosed with dementia and David found himself in the new role of carer. Rather than volunteering for Jewish Care and supporting others, now it was their turn to seek help and because they had a long-established connection with the charity it felt like a natural progression.
Community support worker Barbara Edwards is their contact at Jewish Care and the couple come to the Michael Sobell Jewish Community Centre once a week for a chat with her to check how things are going, and she provides support with any paperwork that needs to be filled out or queries that they might have. While there, Hannah attends an exercise class giving David a break to read the paper and then they have lunch together afterwards.As Hannah’s dementia progressed, Edwards supported her to start attending the Sam Beckman Centre for people living with dementia once a week, which she enjoys. This gives David time to have coffee and lunch with a friend, but he is adamant that respite care isn’t for them: “I couldn’t leave her, we’ve been married for 56 years and we have only been apart for 10 days, when I was in hospital for an operation and Hannah was in hospital after her falls.”
They also both go to the Memory Way café. “You meet people you have things in common with,” says David. “They always have a speaker on all different subjects, we’re reading poetry today. It’s good for Hannah and I enjoy it too, otherwise we’d just stay in.”
Hannah says: “We have always had some contact with Jewish Care, it’s a fantastic organisation because you can meet all sorts of people and you can enjoy it. Barbara explains things – you need someone to tell you what’s going on.”
Adds David, “Jewish Care has got everything – the cultural side and the nursing aspect. I know if I ever need any extra help it’s here at Jewish Care, so it gives you confidence to carry on as you are.”