While the holiday season is a festive time, it can also bring sadness for those that may be alone or missing loved ones. For many, this sadness is situational, brought about by the holidays. For others, it could be much more. Michael Fresé, Ph.D., is a clinical psychologist specializing in geropsychology. He recently sat down with e-Connections to talk about the signs and symptoms of depression among seniors. Do you feel down and depressed, more days than not? Have you lost interest and pleasure in activities you once enjoyed? Are you experiencing difficulty with your appetite, energy level, sleeping? Have you been feeling helpless, hopeless, or very tired? If you can answer yes to some of those questions, you might be depressed. As we age, we often experience the many changes associated with later life – death of loved ones, worsening medical issues, retirement – and depression can creep in like a thief in the night. It can happen when we least expect it and we may not even notice it. Often times, it is our family members and friends who recognize the change in our mood. Depression, however, doesn’t only affect mood - it can impact our appetite, concentration, energy level, memory, physical health, and sleep. As the symptoms of depression vary from person to person, there are several red flags to be aware of: SadnessSleep disturbances (insomnia, hypersomnia)FatigueFeelings of worthlessness, self-loathing, worry about being a burdenLosing interest or pleasure in activities that you once enjoyed and looked forward toIsolation and social withdrawal (not returning phone calls, reluctance to have visitors)Loss of appetite and/or weight lossFixation on death, suicidal thoughts or attempts When asked, many depressed older adults deny feeling sad. Physical complaints such as increased arthritic pain, gastrointestinal distress, or more pronounced back pain are often the symptoms of depression. If you suspect an older adult might be depressed yet they deny feeling sad or depressed, ask yourself if you have noticed any of the following symptoms: Anxiety and worriesDifficulty concentratingFeelings of helplessness and hopelessnessIrritabilityLack of motivation and energyLoss of interest in socializing and participating in activities/hobbiesMemory difficultiesNeglecting personal care (forgetting medications, neglecting personal hygiene, skipping meals)Slowed movement and speechUnexplained aches and pains While depression is a common problem in older adults, it is often overlooked or not taken seriously. People might believe that they have good reason for feeling blue, or that being depressed is part of growing old. Social isolation, which can lead to depression, may result in few social contacts who would notice an individual’s distress. Often times, people don’t realize the relationship between physical pain and emotional pain. Further, people are often reluctant to talk about their feelings or ask for help. There are many causes of depression in older adults, including (but not limited to): fears, health issues, isolation/loneliness, loss of identity/reduced sense of purpose, and recent bereavements. Several medical conditions can cause depression in older adults also, such as cancer, COPD, diabetes, lupus, heart disease, multiple sclerosis, Parkinson’s disease, stroke, thyroid disorders, and vitamin B12 deficiency. If you or a loved one are depressed, the best thing to do is to address it- whether through exercise, social contact with others, or seeking help from a psychologist. The more active you are – mentally, physically, and socially- the better you will feel!

For many aging adults and their loved ones, discussing plans for future care can be a sensitive topic. Jewish Home Chief Medical Officer Dr. Noah Marco shares how important it is to have the discussion and suggests a few ways families can ease into the conversation. While nearly 90% of American seniors over the age of 65 plan to live independently for as long as possible, many find illness and other life events can greatly affect a senior’s desire and ability to live safely on their own. Aging adults might experience difficulty completing household chores, running errands, and even taking care of their personal needs. For many, the humbling experience of admitting they need help with daily activities can become a source of embarrassment or anxiety. Therefore, they tend not to express to others the challenges they are having. Often, family and friends are the first to trigger the discussion. That is why it is important for family member to watch for changes in their loved one's appearance, behavior, and physical ability. An example would be the seniors leaving the stove on and burning a pot. A shift in the aging adult’s aptitude to complete everyday tasks can signal the opportune time to discuss plans for the future. Being proactive in partnering with the senior to select the right care plan can save family and friends from making difficult decision in a moment of crisis later on. If the senior is capable, he/she should be as involved as possible in the decision making. During the discussion, loved ones should actively listen and be respectful of the senior’s preferences, concerns, and decisions. Family members can start the conversation by asking their loved one to share their thoughts, feelings, and opinions on creating a plan for the future. A great way to stimulate a meaningful discussion is to ask, "If something happened that would mean you could no longer live in your home safely, what would you want to do?" Your follow up questions and answers should then be based on how the seniors responds. I often supplement these discussions with the phrase, "I am wishing for the best (that you can always stay in your home), but I think we also need to plan for the worse (you having to leave your home, or have someone care for you in your home)." Ideally, this is not a talk that occurs just once. Care planning works best as an ongoing conversation for seniors and their loved ones. Getting input from a trusted medical professional is advisable. The senior’s doctor(s) can provide insight and offer expert advice tailored to each senior's situation. Although the discussion can be a lengthy and challenging experience, it is important to remember all parties involved are working toward creating a future where the senior is safe, happy, and healthy. To connect with the Jewish Home’s expert staff and learn about the full continuum of quality senior care, call our toll-free Connections to Care hotline: 855.227.3745 or visit our website.

The meaning of life is to find your gift.The purpose of life is to give it away.~ Pablo Picasso Finding one’s gift is often a lifelong pursuit. Sadly, many people never realize their gift, and others do but fail to act. For those who do realize their gift, it can become the driving force in their lives, enabling them to accomplish much, often beyond their dreams. Some fortunate individuals are blessed with multiple gifts, which combine to create a very interesting and meaningful life. Los Angeles Jewish Home resident Michal Robins, age 75, is a musician, composer, singer, researcher, writer, and behavior therapist. As a young woman, she worked as a model in Israel and studied music at The Juilliard School; as an adult, she developed homes for people with developmental disabilities and provided music therapy at senior centers. Her talents have taken her from performing at the legendary Copacabana in New York City to opening a day care center for the elderly and disabled individuals in California. Her unique combination of gifts have led her to live a most interesting life. Michal began studying piano with her mother at the tender age of four. Soon she was playing classical music and improvising jazz. Her musical talent resulted in a scholarship to Juilliard. After her studies, she returned to Israel, where she met her future husband, an American who volunteered in the Israeli Defense Forces (IDF) as a paratrooper. The couple lived in New York and Israel, and had three sons, Gabriel, Sinai and Shani. Michal continued her career as a singer, accompanying herself on the piano. After 14 years of marriage, the couple went their separate ways; Michal and her sons relocated to Los Angeles, where she continued to pursue a career in musical entertainment. As the show business world began to lose its patina, Michal, now age 36, returned to school to pursue another interest: psychology. She first earned a bachelor’s degree in biology, then master’s degrees in clinical and experimental psychology. Her sons, motivated by her academic accomplishments, would go on to earn Ph.Ds. and become university professors, specializing in mathematics, computer science, and psychology, respectively. Michal began her new career as a therapist and conducted workshops in anger prevention for universities and community organizations. She specialized in providing services to young autistic adults, helping them realize their own gifts. Her crowning achievement was collaborating with her son Shani to create The Wisdom Center, a state-of-the-art adult health day care (ADHC) center, offering extensive health services and activity programs for seniors and individuals with disabilities. Michal’s goal was to bring happiness into their everyday lives. As the economy turned downward and expenses rose, she had no choice but to make the difficult decision to close down the center. “That was the saddest time in all of my careers,” says Michal. Not only had she lost all of her savings, she felt she had lost her purpose. Months passed as she searched for a way to try to find a similar path again. “I was lost.” Her sons, who knew how important giving is to her, became concerned about her state of mind. One day, they approached her with an idea: consider moving to the Jewish Home. They believed that at the Home, their mother would receive any help she needed, and, in return, she could help others by sharing her skills and knowledge. That was two and a half years ago, and Michal has not looked back. “The Jewish Home has totally rejuvenated me! Since the Home provides everything I need, I can devote my time to helping others and sharing my positive philosophy of life. It is so rewarding to share my experience with others.” At the Home, Michal has created a new life, combining her two loves: music and helping others. She leads daily music sessions and entertainment for residents, provides musical accompaniment at Shabbat services, and teaches piano to members of the Home’s dietary staff. Michal also facilitates a class on staying young by appreciating the little things in life and diminishing negative thoughts, using her skills to help others navigate their own paths. She also finds time to write for the Home’s Chai Journal resident newsletter, plays piano for the resident choir, and teaches a weekly class in conversational Hebrew. “I am by far the happiest I’ve ever been,” exclaims Michal. “I do exactly what I love to do, and I have so much fun doing it. It’s terrific!” She is living her personal motto – “Live, love, laugh, let it go, and let it be.” Michal also has some sage advice for healthy aging. “Feel well – think young, take care of yourself and don’t focus on aches and pains; enjoy your time with friends, old and new; have fun doing whatever you enjoy; and give of yourself to others. It is amazing…The more you give and do for others, the more energized and happy you will be.” Michal is preparing to take rabbinical and cantorial classes at American Jewish University. “There’s always so much more to learn,” she says. At 75, she’s only just begun.

November is National Alzheimer’s Disease Awareness Month. Today, 5.4 million Americans are living with Alzheimer’s and the number is rapidly growing. Since 1983—the year President Ronald Reagan designated November as National Alzheimer’s Disease Awareness Month—the number of Americans living with Alzheimer’s has more than doubled. By the year 2050, the number of seniors aged 65 and older is projected to triple. Although the risk for Alzheimer’s disease is higher than ever, making the decision to live a healthier lifestyle can help protect you. Here’s what you can do to reduce your risk of Alzheimer’s disease: Maintain a healthy diet. Eating nutrient and vitamin rich fruits and vegetables regularly helps to improve cognitive function and enhance memory. Try adding fresh produce of all shapes, sizes, and colors to your daily meals. Exercise often. Regularly participating in easy to moderate exercise increases blood and oxygen flow to the brain. Gradually build your strength, balance, flexibility, and endurance with a doctor approved exercise regimen. Get enough sleep. Sleep is essential for brain function, memory retention, and emotional well-being. Getting the recommended 7-9 hours of sleep each night will help to reduce stress, improve productivity and focus, and enhance your mood. Stimulate your mind. Studies show having a healthy brain may play a large part in reducing one’s risk of Alzheimer’s disease. Learning a new skill or language, attending a class or workshop, playing an interesting card or board game, or working on a challenging puzzle can help to keep your brain’s connections stimulated and strong. Get involved. Adults who regularly volunteer are more likely to stay socially engaged which helps preserve cognitive ability and gives seniors the option to enjoy an active and independent lifestyle. Look for opportunities in your community where you can share your skills, wisdom, and talent with others. Because much of Alzheimer’s disease research is inconclusive, there is still plenty for us to learn about this disease. Currently, no cure exists for Alzheimer’s. However, some medications can help to slow the disease’s progress. With so many unanswered questions about Alzheimer’s disease, it is more important than ever to take preventative measures to protect ourselves. The Jewish Home's Goldenberg•Ziman Special Care Center (G•Z) provides exceptional care for individuals with Alzheimer's disease and dementia, and support for their families. The Center is known for its award-winning design, pioneering practices and technologies, and compassionate care. "As an industry leader in dementia care, G•Z works closely with residents, families, and staff to spread awareness of Alzheimer’s disease within the community," G•Z community manager Susan Leitch says. "The Home offers a variety of informative training sessions for staff and community seminars like the Sarnat Symposium. With these critical tools, we are able to do our part and spread awareness of Alzheimer's disease, all while helping to provide our residents and their families with the highest quality of life possible." To learn more about Alzheimer’s disease and National Alzheimer’s Disease Awareness Month, visit www.alz.org. To learn about the Home’s Goldenberg•Ziman Special Care Center for Alzheimer’s disease and dementia care, please contact Susan Leitch, community manager, at [email protected] or (818) 774-3113 or visit our website.

November is National Hospice and Palliative Care Month. During this time, hospices across the country are reaching out to raise awareness about the highest quality care for all people coping with life-limiting illness. This year’s theme is Know Your Options! Being aware of your options before a medical crisis can help ease some of the stress that most people experience in that situation. The Los Angeles Jewish Home offers both palliative and hospice services through Skirball Hospice and the Jewish Home Center for Palliative Medicine. Let’s take this opportunity to explore what each service offers. “Palliative” means to relieve or lessen without curing. Palliative medicine is often thought of as only a part of hospice care provided to someone who has been diagnosed with a fatal disease or illness. While it is a crucial component and indeed grew out of hospice care, palliative medicine is a much broader specialty and can treat patients in various stages of their illness, including alongside curative treatment. Palliative care can be provided in a hospital, cancer center, nursing home, outpatient clinic, hospices, or in the patient’s home. Focusing on the symptoms of both the disease and the treatment, palliative care helps with a wide range of issues. These may include pain, depression, anxiety, fatigue, shortness of breath, constipation, nausea, loss of appetite, and difficulty sleeping. It also helps an individual to gain the strength to carry on with daily life and can help improve the ability to tolerate medical treatments. Palliative care also gives an individual more control over their care by improving their understanding of treatment options. Compassionate end-of-life care, provided by hospice services, enables individuals and their families to overcome fear and discomfort, to cope with loss, and to embrace the experience and value of each and every day of life. Hospice care recognizes the needs of patients who choose to remain where they live, outside of the hospital, so they can be surrounded by loved ones when hospitalization is no longer expected to cure their illness. It provides the support that allows someone to spend the last stages of their life in a loving environment, comforted by friends and family, and free from discomfort. While the use of hospice care has increased over the years, many people are still uncertain about the type of services available and when they can be accessed. Hospice is for anyone facing a life-limiting illness. Patients and their families receive care for an unlimited amount of time, depending on the course of the illness. Family members are encouraged, supported, and trained by hospice professionals to care for their loved ones. Hospice staff is on call to patients and their families 24 hours a day, 7 days a week, to help care for their loved ones. Medicare beneficiaries pay little or nothing for hospice care. Most insurance plans, HMOs, and managed care plans cover hospice care. Bereavement services and grief support are available to family members for up to one year after the death of a patient. At Skirball Hospice, this support is available for thirteen months. Both the Jewish Home Center for Palliative Medicine and Skirball Hospice provide compassionate care and expertise through an interdisciplinary team, including physicians, nurses, rabbis, medical social workers, registered dieticians, and certified home health aides. To learn more about your options, please visit our website at www.skirballhospice.org or call (877) 774-3040.

The siddurim, or prayer books, at the Los Angeles Jewish Home were worn with over three generations of use, lovingly touched by thousands of hands over the years. Through countless Shabbat and holiday services, the siddurim provided a foundation for seniors and their families to pray, celebrate, and mourn. Now, through the generosity of supporters of the Jewish Home, the residents have new siddurim, ready to serve them for many years to come. Rabbi Karen Bender, Skirball Director of Spiritual Life, explains how this came to be. “When my predecessor, Rabbi Anthony Elman, began his retirement, he left behind his Rabbi’s discretionary fund. After many discussions about how to best use these funds, we agreed the purchase of new siddurim would benefit our seniors in so many ways.” And they are more than just new. While the prayer books are Conservative-based, as were the ones they replaced, they offer several important improvements: Transliteration: Many of our seniors who enjoy coming to services read English only. The most significant parts of the service are now available in transliteration so everyone can participate. Gender inclusive language: The new siddurim avoids referring to G-d as “Him” and uses more inclusive language, such as referring to our foremothers by name in addition to our forefathers. Contemporary translations: The prayer books offer accessible, modern and poetic English translations and readings that are very spiritually uplifting. A great deal of research and effort went into selecting the siddurim. “We were careful to consider the size and weight of the book, as well as font boldness and clarity in both Hebrew and English,” says Rabbi Bender. “As you can imagine, there were many to choose from. I requested input from our seniors and Rabbi Ron Goldberg of the Eisenberg Village campus. In the end, we chose the 2016 printing of Siddur Hadash.” Fortunately, the discretionary fund was large enough to purchase siddurim for both campuses, which is especially important due to the fluidity of our seniors between campuses. In honor of Rabbi Elman, who is remembered with great fondness by both Jewish Home seniors and staff, a bookplate was placed in each siddurim, thanking him for his years of services. “It’s a “Shehecheyanu” moment,” exclaims Rabbi Bender, “a moment of arriving at a special time!”

On Monday, October 24, Grancell Village residents celebrated Simchat Torah, or the “Rejoicing of the Torah.” During the celebration, 88-year-old Jewish Home senior John Sinasohn was one of several seniors to carry the Torah for the seven “Hakafot” processions it made around the Grancell Village synagogue. “Dancing with the Torah is a thrill,” he says. “It’s a blessing to touch and hold the scrolls. I know my parents would be proud.” John has had the opportunity to hold the Torah on this special holiday once before. “The last time I held a Torah like this was in Germany in the year 1938.” John recalls, “My father was very involved in our synagogue. That year, we were given the honor of carrying the Torah during Simchat Torah. Less than a month later, the synagogue was burned down during Kristallnacht.” Shortly after this act of violence, John’s parents sent him out of Germany. After traveling through Belgium, France, and Portugal, John moved to an orphanage in Los Angeles in 1943. Later, John met his wife Violet and took work as a writer, lawyer, and judge. John eased into retirement, working part-time fixing broken televisions before moving to the Home’s Joyce Eisenberg-Keefer Medical Center in 2011. Here at the Home, John enjoys spending time with his wife and attending weekly lectures and services every Friday and Saturday and during the holidays. “I’ve been lucky all my life. God has been very good to me.”

The Goldenberg•Ziman Special Care Center at the Jewish Home provides exceptional care for individuals with Alzheimer's disease and dementia, and support for their families. The Center is known for its award-winning design, pioneering practices and technologies, and compassionate care. One way the Goldenberg•Ziman Center excels in specialty care for seniors with Alzheimer’s disease and dementia is through employee instruction and training. Since its opening in 2002, the Goldenberg•Ziman Center has incorporated the “universal-worker” concept, where all staff members are involved in the residents’ care. To continue the tradition of excellence at the Center and in the Home as a whole, further staff education was needed. A grant from the Rosalinde and Arthur Gilbert Foundation was received to make the training possible. In order to develop a detailed Alzheimer’s disease caregiver training manual and toolkit, the Eisenberg Village (EV) administrative team partnered with University of California, Los Angeles associate professor and gerontologist Lené Levy-Storms, PhD. Before selecting the curriculum for staff training, the administrative team surveyed the Home’s most experienced Alzheimer’s disease and dementia experts. After collecting data from 59 Jewish Home employees in one-on-one interviews, the team was able to capture valuable information about the staff’s best practices, personal experiences, and insights. This information helped the Home’s administrative team create a detailed lesson plan that is now used in an extensive eight hour training session to be completed by all EV employees this month. “These educational sessions are just one of the many ways we provide specialized training to our staff,” said Susan Leitch, community manager at the Goldenberg∙Ziman Special Care Center and Factor Nursing Building. “Our number one goal is to provide all of our seniors with the best care possible. Thanks to the generous grant from the Gilbert Foundation, we are able to give our staff the tools they need to serve our seniors with exceptional care.” EV administrator Douglas Tucker considers the training session a fantastic learning experience for all employees. “By hosting educational sessions, our entire staff is able to benefit from the knowledge and experience of the Goldenberg•Ziman Center’s expert staff,” Douglas noted. “The training we received provided me with clear guidelines on how to engage with seniors suffering from Alzheimer’s disease,” says Eisenberg Village certified nurse assistant Raquel Jaramillo. “Now I know how to learn from each individual and their unique situation in order to enhance their quality of care.” For more information about the Jewish Home's Goldenberg•Ziman Special Care Center, please contact Susan Leitch, community manager, at [email protected] or (818) 774-3113 or visit our website.

This spring, the Jewish Home was delighted to promote one of our own: Ilene Silberman, vice president of finance, has been elevated to the Home’s chief financial officer. In her new role, Ilene continues to showcase her talent and skills as a dedicated advocate on behalf of the organization’s sound fiscal health – maintaining our ability to serve thousands of Southern California seniors every year. Ilene is a Certified Public Accountant and has over 25 years of combined experience in the accounting and finance fields. Before coming to the Home, she was controller for the Motion Picture Industry Pension & Health Plans (MPI), an agency that helps to administer defined benefit and defined contribution pension plans and provide health benefits to over 120,000 active and retired participants and their families. Ilene’s distinguished employment history also includes high-level positions in the commercial finance field with Wells Fargo Capital Finance, PNC Business Capital and Fleet Capital Corporation. Ilene first came to the Home in 2015, but she is no stranger to the nonprofit community. A strong advocate for economic empowerment, she is a former volunteer tax preparer for elderly and low-income individuals. Ilene also served as an Executive Board Member and Vice President-Treasurer of the Emelita Street Elementary PTA, working to advance educational opportunities for young, school-aged children. Ilene earned her BS in Business Administration – Accounting from California State University, Northridge, where she was on the dean’s list and served as an officer of the Accounting Association. She is married and has two children – a son and a daughter – and lives in Tarzana.