|Holy Name Hospital’s Villa Marie Claire in Saddle River will be Bergen County’s first freestanding inpatient palliative care facility.
Signalling a growing emphasis on end-of-life care tailored to the needs of North Jersey’s sizable Jewish population, Holy Name Hospital in Teaneck recently received accreditation from the National Institute for Jewish Hospice as it prepares to open Bergen County’s first freestanding inpatient palliative care facility on a 26-acre estate in Saddle River. Just last month, Englewood Hospital and Medical Center launched a Jewish Community Hospice Program, although it is not NIJH-accredited at this time.
“For the Jewish patients in our in-home care hospice over the last 25 years, we have relied on their own spiritual counselors for support and guidance,” said Dr. Charles Vialotti, Holy Name Hospice medical director. “Then, two years ago, we started renovating a magnificent 100-year-old villa to become an in-patient hospice with 20 private rooms and up to 17 rooms for family members to stay in. In order to meet the spiritual, physical, and emotional needs of residential patients of all faiths, we needed a much more formal program.”
Among its other facilities, including an Olympic-sized pool and other amenities to encourage family time with residents, Villa Marie Claire will have a kosher kitchen, Sabbath elevator, and Sabbath guest rooms.
Vialotti attended the November NIJH training conference along with Hospice Unit Director Ellyn Ward, Holy Name Hospice Spiritual Adviser Sister Regina O’Connell, and Holy Name Community Relations Coordinator Jacqueline Kates. The hospice is in the process of hiring a rabbi to serve both inpatient and outpatient Jews.
Kates explained that accreditation provides Holy Name’s hospice with materials, support, and assistance, including a 24-hour hotline offering end-of-life counseling and information to Jewish families, patients, and caregivers. The NIJH was founded in 1985 by Rabbi Maurice Lamm and his wife, Shirley, former Englewood residents.
Vialotti called the training “enlightening.” Held near JFK Airport to accommodate participants from across the country, it featured sessions on “Jewish Medical Ethics & End-of-Life Care,” “Connecting across Religious Lines with Integrity,” “The Psychology of the Dying Person,” and workshops related to observances of Jewish life, customs, and laws.
“I learned that before initiating any treatment in a futile situation, we should involve the program’s or the family’s spiritual leader,” said Vialotti, who will live at the new facility. “With that guidance, families won’t feel they’re failing their family member or violating their religious beliefs.”
Periodic religious sensitivity training sessions are planned for staff and volunteers.
Rabbi Larry Zierler of the Teaneck Jewish Center, a former student of Lamm’s at Yeshiva University, renewed his own accreditation at the November conference. A rabbinic consultant to the Hospice of New Jersey in Bloomfield and head of its ethics committee, Zierler also serves on the ethics committee at Holy Name Hospital.
He outlined several areas where Jewish hospice patients typically need knowledgeable assistance.
“One major issue between hospice and halacha [Jewish law] is nutrition and hydration,” said Zierler. “Hospices historically have believed that once a patient is in a futile care situation and is no longer responsive, artificial hydration is counter-indicated. Some believe that patients are comfortable without eating because endorphins kick in to sedate them naturally. But in halacha, nutrition and hydration are considered basic needs … to sustain life. The Hospice of New Jersey has a liberal policy about this for those who have religious or cultural sensibilities.”
Another issue is what Zierler terms the cure vs. care conundrum. “Hospice provides a care pathway when patients can no longer be cured. But artificial impediments to the natural process of dying – such as a ventilator – are easy to introduce today.”
The question is whether such measures truly benefit the patient or merely postpone the inevitable. “We do have a clear awareness of medical futility in Jewish tradition, and while there is no obligation to get in the way of the natural process of death, we are not allowed to hasten death.”
A related matter, continued Zierler, is the “double effect” issue. A common example is morphine, which alleviates pain but also suppresses respiration. “We have to contend with how to titrate properly so the benefit is more prominent than the deficit,” he said. “The patient’s rabbi will work with the palliative care team to determine the difference between palliative care and terminal sedation.”
Zierler educates hospice workers to assess at-home patients’ “religious constellation” by noting sacred books, mezuzahs on doorposts, and even preferences regarding attire and physical contact with a healthcare worker of the opposite sex.
“I teach them how to understand the high points in the Jewish calendar, because that has a strong effect on death and dying,” he said. “People tend to hold on to life through the High Holidays or Passover.”
Zierler said religious sensitivity can prevent a dying patient from feeling dehumanized. Even a non-Jewish hospice worker can be trained to help a Jewish patient pray or wind the straps of tefillin around his arm. “When rabbis are involved, we’re giving hospice workers more tools to reduce the sense of alienation patients feel from the activities of daily living. There are so many things that can bring quality of life at the end of life.”