Delmar Gardens Enterprises has instituted many firsts in its 40-plus-year history. In the late 1970s it introduced the continuum of care concept and the campus approach to senior living, locating a retirement home and assisted living facility together. In the late 1980s it pioneered the idea of intergenerational care, where an infant-toddler-preschool facility is located in a nursing center. Today Delmar Gardens is on the verge of another first: Its Pathways Community Hospice is about to become the only hospice in the state to be accredited by the prestigious National Institute for Jewish Hospice.

“In light of the large Jewish population we serve, we’d had many previous discussions about the role of hospice and the balance between Jewish ideology and end-of-life issues. So offering Jewish hospice seemed to us to be a great fit,” says Gabe Grossberg, president of Delmar Gardens. “In addition, over the last decade there has been a clearer understanding and broader acceptance of hospice among the Jewish community.

“Also,” he notes, “our founders are Orthodox, and that’s my upbringing, so we are blessed to have this strong component of Judaism behind us.”

Adds Delmar Gardens Executive Vice President Howard Oppenheimer, “We are always looking for ways to provide better service to the Jewish community and this accreditation, I believe, fills a very significant need. Obviously it’s unfortunate when hospice is necessary, but it’s a service so many people are grateful for. So it’s important to us that the Jewish hospice program will address a broad spectrum of the Jewish community and that the community will feel comfortable with it.”

Established in 1985, the NIJH serves terminally ill Jewish patients and their families. It was founded by Rabbi Maurice Lamm, best known as the author of the renowned book The Jewish Way in Death and Mourning, and also professor at Yeshiva University’s Rabbinical Seminary, where he holds the Chair in Professional Rabbinics.

The NIJH offers authorized endorsement for Jewish hospices within non-Jewish hospitals and nursing facilities. It also provides intensive training for medical and other health care staffs and offers continuous consultation on issues relating to hospice and the Jewish community. There are more than 50 NIJH-accredited Jewish hospice programs in the U.S. and Canada. Pathways Community Hospice will join them on Nov. 20, once the staff completes on-site training led by Rabbi Lamm.

The Idea

Pathways Community Hospice Director Yvonne Schwandt co-founded the agency in 1996. It was acquired by Delmar Gardens in 1998. The company serves about 120 patients per day in St. Louis City and County, Jefferson County, parts of Franklin County and St. Charles County.

“Gabe Grossberg wanted to add hospice to the Delmar Gardens family for the right reasons, to provide a service to the community,” Schwandt says. “Now we are adding Jewish hospice to provide our services to the Jewish community. Everything we do is to enhance the services we offer.” Like all hospices, private insurance and Medicare and Medicaid will cover a patient’s costs.

Schwandt says she learned about the NIJH accreditation through an article in a hospice magazine. “A peer sent it to me, knowing we take care of a large percentage of Jewish population,” she says. “I researched it and talked to our team about it, and we decided it was something we wanted to do.” Also, Schwandt shared the information about the Jewish hospice program with Grossberg and Oppenheimer and their reaction “immediately was very positive,” she says. “They asked me to move forward with it “

Schwandt is not Jewish, nor are most of her staff. “I felt we did not necessarily understand the culture and important customs related to caring for Jewish patients. In many cases it’s very different,” she says. “In addition, because we are part of Delmar Gardens, which is owned by Jewish families, this accreditation was a way to honor the founders. Also, one of the visions Gabe Grossberg had when he acquired our hospice program was to enhance Delmar Gardens’ continuum of care. So the Jewish hospice program seemed like the right thing to do.”

While researching the program, Schwandt became reacquainted with social worker Sharon Weissman, who is now a Pathways chaplain. The two had known each other through their work at an area hospital. “Sharon told me she was in the chaplain residency program at St. Luke’s. It was perfect fit for Sharon to join our hospice team to support the spiritual needs of our Jewish patients,” Schwandt says.

Weissman had been an oncology social worker for many years. “After a while I came back to my Judaism and decided I wanted to make the move to providing more spiritual care for patients,” she explains. Weissman sees patients of every denomination, “but part of the reason I joined Pathways was to reach out to the Jewish community.”

Schwandt explains Pathways services are not designed to replace the patient’s current spiritual relationships: “Offering the services of Sharon or our other chaplains is in addition to that spiritual support. Having our Jewish chaplain enhances the program very much. In fact, Sharon already has trained our staff in many Jewish customs.”

Getting ready

“When we decided we wanted to pursue the Jewish hospice program, we weren’t really sure what course it would take,” Schwandt says. “So we decided to research the needs of the community to see if it made sense and if people would use it.” The first step was to arrange a meeting of some area rabbis. “That first meeting in May lasted almost four hours,” Schwandt says. “It was incredible. The enthusiasm was outstanding and they were extremely supportive.”

Rabbi Mark Fasman of Shaare Zedek Congregation and Rabbi Laurence Glestein, the community chaplain for Jewish & Family Children Services of St. Louis, were among those who attended. Rabbi Glestein says, “From my own observation and involvement with the community, it was clear to me that a lot of families just aren’t sure where to turn at a time of illness, when roles are changing, when a provider becomes dependent, when a fair amount of conflicting feelings surface. Add to the mix just when the person needs the comfort of his or her faith, they’re not sure how to approach the act of dying and they’re not sure of the resources available. So put it all together and I think a Jewish hospice program is a natural step in the right direction. In fact, it’s overdue.

“It seems like a very solid approach to bring together a traditional and authentic Jewish perspective at a critical time to the people who truly need it.”

Once the rabbis blessed the program, Schwandt formed an advisory council that continues to meet regularly. “We invited others from the Jewish community to come together just to brainstorm and decide how to pull together the resources for implementing the program,” she says.

Adds Oppenheimer, “The rabbinic members on the advisory council have been very instrumental in moving the Jewish hospice program forward. We are grateful to them for donating their time and efforts.”

Training and beyond

Hospices seeking NIJH accreditation can send their staff to NIJH headquarters in North Woodmere, N.Y., or have Rabbi Lamm and his associates conduct on-site training. “We decided to have Rabbi Lamm come here, so more of our hospice team could receive the training,” Schwandt says. The session will last four hours and cover topics including the unique concerns of Jews about entering a hospice, their expectations at the end of life, their fears about their families and futures, Jewish religious rituals at death and during the mourning period, and practical strategies to ease suffering and comfort patients. Discussion also will include the specific belief systems, customs, traditions and needs of Orthodox, Conservative, Reform and secular or non-practicing Jews.

“Our Jewish patients range across the spectrum of religious beliefs, so it’s important that we offer the right support in keeping with their religious and philosophical outlook,” Grossberg says. “We want to find what’s best for each patient in response to their physical and spiritual needs. Our approach is very proactive. We cater to the individual.”

Schwandt points out, “Since we already take care of many Jewish patients, the Jewish hospice program will allow us to improve the care we provide for them. The Jewish population has different beliefs and needs, related to death and mourning. We need to understand these differences to make death more peaceful for them.”

One family that recently benefited from Pathways’ hospice services was the Scissors family. Mark Scissors’ father was in Pathways’ hospice care from March 2005 to May 19, 2006. “He was a resident of Delmar Gardens so he was referred to hospice by his doctor and the nursing home staff. I had no hesitation about it,” Scissors says.

He especially appreciated the “special attention” his father received. “He was in good hands so I could relax,” Scissors says. Sharon Weissman offered great assistance to the family too. “She sat with my father, talked to him and held his hands,” Scissors says. “We knew my father’s condition was not going to improve so the spiritual considerations she afforded both of us were appreciated. Although it was a very sad time, it was a very positive experience too.”

Scissors says, although Pathways has not yet been accredited by NIJH, “the Jewish dimension of his care was well taken care of and I’m sure that will continue to be the case when Pathways is accredited as a Jewish hospice.”

Point of pride

Schwandt points out Pathways’ Jewish hospice “will not be a separate agency but a specialty within our agency.” Among the 50-60 volunteers, she says, “there may be a group that will work just with our Jewish patients. Over time, Schwandt, Pathways staff and hospice volunteers will continue learning. “We have discussed future speakers or workshop leaders with our advisory council,” she says.

Grossberg is unabashedly proud of Pathways. “This group of caregivers are phenomenal. Yvonne is always looking for ideas and programs to better serve our clientele. I am honored to be a part of this,” he says.

“I believe the accreditation says we take Jewish hospice seriously,” says Weissman. “By receiving this additional training and having the certification, our intent is to show how important it is to us, and how important it will be to the people we serve.”