Dealing with end of life issues is truly acknowledging the “elephant in the room.” For patients facing a terminal illness and their loved ones, the topic itself and ensuing discussions are always difficult and filled with emotion. The staff of Delmar Gardens’ Pathways Community Hospice — the only accredited Jewish hospice program in St. Louis — understands these complexities and tensions as they help patients and families move through the final stages of life.

Hospice is not an institution. It is a philosophy of caring for patients who typically have a life expectancy of six months or less. The care is provided by a team of specially trained, qualified professionals who focus on improving the quality of life for the patient and their loved ones.

“The focus is on the patient and the family,” said Yvonne Schwandt, Pathways Community Hospice Director. “We take care of all aspects of that unit, physical and emotional.”

Providing hospice care is very individualized, taking into account the needs of each patient, the illness, the family and their physical, emotional and spiritual needs. A couple of years ago, the members of the Pathways team realized they did not have the necessary knowledge to truly meet the needs of their Jewish patients and families.

“We didn’t have all the tools and understanding to help with the specific spiritual and cultural issues affecting our Jewish patients and their loved ones,” Schwandt said. “We wanted to give exceptional care but there were so many things we didn’t understand.”

Pathways received accreditation from the National Institute for Jewish Hospice, an organization established in 1985 that provides on-site training with a Jewish approach to hospice. Their yearly training program includes an understanding of Jewish traditions, medical ethics, vocabulary, the different branches of Judaism and rituals.

“Education in paramount,” said Pathways Support Services Manager, Rebecca Wallace. “Our entire staff was trained on Jewish life and culture.”

The establishment of a local advisory council including leaders and representatives from throughout the St. Louis Jewish community is another big piece of Pathways commitment to their Jewish hospice program. The council meets quarterly and acts as a bridge to the Jewish community.

Some of the suggestions have included providing Jewish ritual objects and designing a Jewish-specific bereavement program.

“Their input and suggestions have enhanced and enriched our program,” Schwandt said.

One crucial member of the hospice care team for many Jewish families is their rabbi.

“We are very committed to working with family rabbis, who are very much a part of our team to help care for the patient and their loved ones,” said Pathways Hospice Chaplain Sharon Weissman.

Linda Markowitz of University City consulted with her rabbi and was comforted with the goals of Pathways and their commitment to be “consistently sensitive and open to the family’s religious needs.” She learned about Pathways after her mother, Madeline Hirsch, had undergone a series of very invasive hospitalizations and the attending physician suggested hospice.

“I thought hospice was about giving up and there was no way to reconcile that with Orthodox Judaism,” Markowitz said. “I was impressed with the willingness on the part of Pathways to work within the framework of halacha, Jewish law.”

Another big part of Markowitz’s decision came after her mother’s last hospital stay. “My mother said she didn’t want to fight anymore,” Markowitz said. “The doctor said we could keep going but it was not sound medical practice.”

The choice to use hospice often allows family members more time and energy to support their loved one and each other.

Trudy Traub of Olivette had been caring for her husband Allan in their home for quite some time before he died in August 2008. She took advantage of the Jewish Community Center’s Adult Day Services at the beginning of his illness. It offered an opportunity for socialization for Allan and respite for Trudy.

It became more difficult for Traub to care for her husband on her own as the disease progressed.

“I always said I would never put him in a nursing home,” she said.

She continued to care for Allan in their home with assistance from family members, nurses and aides. Traub learned about Pathways from those caregivers.

“The Pathways team came and evaluated our situation,” Traub said. “I got a hospital bed for Allan based on their suggestion.”

Pathways involvement made it easier to care for Allan, said Traub. She was very happy with the care team who responded to whatever needs they had “within hours or the next day.” They even sent additional help as Allan Traub neared his last days.

“As hard as it was to see him go, I can’t say enough good things about Pathways,” she said.

“Chaplain Weissman and all the staff were wonderful.”

“Hospice allows families members to use their time together for connection and resolution rather than worrying about providing the physical care,” Wallace said. “We encourage communication; many times patients and families are trying to protect each other.”

The care team takes its cues from the patient and family to provide the most comfort for the individual. This includes the specific emotional and spiritual needs of Jewish families.

“The key is we have a Jewish chaplain,” Schwandt said. “She provides us with a Jewish specific assessment to identify the aspects of Jewish life we need to provide to give the best quality of care for that individual and their family.”

Lee and Mark Scissors of Olivette had used Pathways for Mark’s father and were very pleased with the program.

“However, dealing with the impending death of someone 90-something-years-old is very different than your 39-year-old daughter,” Lee Scissors said.

The Scissors’ daughter Marla died in June 2008. She had been diagnosed in August 2006 with amyotrophic lateral sclerosis, Lou Gehrig’s disease (ALS). Marla wanted to be in charge of her own care as long as she could and “we respected that” said Lee Scissors.

It was Marla’s decision to use Pathways — anticipating when the time would come and the extra care would be required.

“They were there for Marla’s needs and for our own needs,” Lee said. “The people were so wonderful, professional, thoughtful and kind. It is hard to express something so deeply felt; hard to put your gratitude into words.”

The Pathways team helped Marla and her family to cope with the physical and emotional aspects of her illness “so much better,” Lee said.

“Sharon was always available whenever we needed her,” Lee said. “And Marla really bonded with Tonia Short, the social worker.”

There are so many challenges when trying to provide physical care for someone suffering from a catastrophic illness, said Lee. However, that physical care can be provided by trained staff rather than family.

“Allowing Pathways into our lives, knowing those physical needs were being met, allowed us the strength to do the things for Marla only family can do,” Lee said. “It allowed us to spend quality time with her, providing the love and support only family can give.”

For more information about Delmar Gardens’ Pathways Community Hospice Jewish Hospice Program, call 636-733-7399.