Sam Schlesinger, 98, downloads The Jerusalem Post's online edition every day and distributes it to other residents of Mission Viejo's Heritage Pointe. Vera Rabina, 63, is the community's youngest resident and a political asylum seeker from the former Soviet Union. Her daily routine is to board a city bus or walk to a nearby junior college, where she is enrolled in English-language classes.
Â Â For six years, Evelyne Fidler, 87, also lived in the community, enriched by the socialization of new-found friends. Rabbis came to rely on Fidler's adult grandson, Steve Sachse, to hoist the Torah and carry it through the in-house synagogue during holidays.
Now, Fidler is befuddled by dementia, unable to use a spoon, recall a friend's last name or, as importantly, respond appropriately to a potential emergency. Her need for 24-hour care outstrips the facility's licensed services. By mutual agreement, Sachse last month relocated his grandmother to a non-Jewish board-and-care facility, licensed for Alzheimer patients.
The 169 residents of Orange County's only Jewish retirement home possess a varying range of physical and mental limitations. Yet, compared to the original occupants who moved in 12 years ago, new arrivals to Heritage Pointe are considerably older and more frail. The average age is 89.
That demographic shift is changing expectations about Heritage Pointe's targeted population, which is less independent than anticipated. Older residents are also likely to spur in the near future a broadening of services, such as a contemplated dementia unit. Yet, despite an over-60 county population of 13 percent that far exceeds the 4 percent state average, there is no waiting list for Heritage Pointe's 178 units, which average $2,600 monthly. Occupancy has declined to 88 percent, which administrators blame on a proliferation of newer, rival facilities that make the county one of the nation's most densely populated for senior housing.
The trends are presenting new challenges for the nonprofit facility, its community-based leadership and their pledge to subsidize 20 percent of the population. Last year, Heritage Pointe supporters raised $800,000 to underwrite in varying degrees 33 residents, contributing 7 percent toward the facility's $11 million annual operating costs. Private-paying residents make up the rest. There is no government reimbursement or United Way funding.
"If we had nothing but very old people with no money, it's not sustainable," said Fred Forster, of Newport Beach, the volunteer president of Heritage Pointe's board. "We've got to have a mix. We don't want broader financial challenges."
The most successful senior housing model, he said, is assisted-living, where residents receive help for personal needs such as dressing or showering. Other more established Jewish homes, such as Reseda's Los Angeles Jewish Home for the Aging and Encinitas' Seacrest Village, offer a broader care continuum, including 24-hour nursing. "We're the new kid on the block," he said.
The advancing age of a still-healthy elderly population is an issue throughout the nation, said Nancy D. Zionts, who specializes in aging issues at the Pittsburgh-based Jewish Healthcare Foundation. The elevated personal needs of older residents are forcing providers to redefine services, edging closer to the environment of skilled-nursing homes, where residents share rooms, but lack kitchens and patios.
"Five years ago, we couldn't accept anyone who was incontinent," said Renata R. Loveless, Heritage Pointe's administrator. "What they thought assisted-living was going to be, isn't so."
Two-thirds of Heritage Pointe residents live independently, filling their days with activities ranging from lectures to movies, cards and services by itinerant rabbis. They rely on the 110-person staff only for housekeeping, food service and bus service. About 74 residents require varying amounts of fee-based personal services. Six are Holocaust survivors. There is a contingent from New York and Florida, who moved to be closer to children, and a group of former residents of Leisure World, a local retirement community.
While many older people resist moving into a communal facility until forced by a crisis, many find their health improves with a better diet and medication-management, Loveless said. "We have quite a few rough moments," she said. "Most are changed for the better. We take away a lot of stressers."
To ensure that doctor-prescribed diets and medications are taken as ordered, a nurse leads the facility's health department. Precautions for residents rather than state regulation dictate hiring such professionals, said Loveless, hired by Generations Management Group LLC, which also manages two San Diego senior homes. Yet, lower occupancy required Loveless to layoff three people in resident-serving jobs while adding two full-time marketers.
Aesthetics, though, rather than services, influence decision-making by the children of potential residents. "It takes a 'wow' to get them through the door," she said.
To compete with fresher-looking rivals and revive occupancy rates, a $1.2 million facelift is underway. The refurbishment will replace care-worn carpets, add decorator paint to doorways and reconfigure a little-used common room into a gym with equipment especially designed for the elderly. The renovations are the most extensive since the then-incomplete facility was purchased in 1989 for $10.5 million.
In deference to a dozen or so Orthodox residents, Heritage Pointe keeps a kosher kitchen and its buses are stilled on Saturday. Mezuzahs are in most doorways. Shabbat services and holidays are celebrated in a central 120-seat synagogue. Each year, about 50 teens adopt "grandfriends" as part of their b'nai mitzvah. A small army of 900 community volunteers, organized similarly to hospital and orchestra guilds, bring in speakers, raise scholarship funds, shelve library books and shop for residents.
"A lot of wonderful things happen when the community is involved and brings itself into the home," said Loretta Modelevsky, of San Clemente, a founding organizer and volunteer organizer. "Part of our heritage is to take care of the elderly."
Although no one who sought financial aide was turned away in the last year, Loveless predicts more applicants for assistance as older residents outlive the assets they liquidate to pay their way. Of 17 new additions to the "scholarship" list, six are long-term residents whose financial resources are depleted. "Scholarships" are awarded based on need. Some applicants are rejected, such as one 84-year-old woman whose son owns racehorses. A committee of the professional management company evaluates an applicant's tax records and those of their immediate family. The expectation is that the family should contribute financial assistance before tapping community-raised charity.
"The fact we are caring for people who are more frail is an imperative for Heritage Pointe," said Meryl Schrimmer, 71, of Laguna Beach, the founding president, whose 93-year-old mother-in-law, Rita, is one of the oldest residents. "Before, it was a social imperative to avoid isolation. Now, physical care is even more important."
When a Jewish home for the elderly was proposed in 1984, some feared it would rob support from the Orange County Jewish Federation. "Just the opposite has happened," said Schrimmer, adding that the facility's eight support chapters are strengthening the Jewish community's bonds. "Heritage Pointe didn't take away from anybody." Â