"Why did you come? Go, go before it's too late," Laja Szydlowski warned her daughter, Hanna. She then whispered, "They're killing people here. You don't understand."
This encounter did not take place in 1940, with Szydlowski holed up in a cramped apartment in the Lodz ghetto in Poland. This happened less than a year ago, in a cheerfully furnished room at the Los Angeles Jewish Home for the Aging (JHA). However, in Szydlowski's mind, she was back in Lodz. This time the ravages of Alzheimer's disease, rather than the Nazis, imprisoned her.
"What happens," explained Dr. Marla Martin, a clinical psychologist who has worked intensively at JHA for more than 10 years, "is that the sense of time is impacted by dementia, and the person again becomes the young man or woman struggling against all odds to survive."
Szydlowski, 93, has been reliving the Holocaust for the past six or seven years, according to her daughter, Hanna Golan. However, her Alzheimer's disease has now progressed to where she can no longer verbally communicate. "She is constantly crying," Golan said.
Szydlowski is one of an estimated 11,000-12,000 Holocaust survivors living in Los Angeles County, whose average age is 81. With nearly half of all elderly people 85 or older affected to some degree by Alzheimer's or other dementias, according to the Alzheimer's Association, the number of those Holocaust survivors, who are reliving in their minds the roundups, selections, starvation, brutality and the killing of family members, often in their presence, is significant.
Even without dementia, many survivors have nightmares, fear abandonment, act secretively and read anti-Semitism into innocent interactions. They react adversely to such seemingly normal activities as standing in lines or dealing with uniformed personnel. Some even avoid the oil well on the Beverly Hills High School campus, now painted with flowers, because it is a reminder of the smokestack at Auschwitz.
Helen Zisner, 82, who is in early stages of dementia and living at the Vista del Sol Care Center in Culver City, is not catapulted back into the Holocaust but reacts to certain stimuli.
"You can't approach her from behind," her son, Benjamin, said. "She'll ask, 'Who are you here for?' because she's reminded of guards entering her concentration camp barracks."
But for survivors with more pronounced dementia, the Holocaust experience exacerbates the paranoia and suspiciousness, and, Martin said, "Those people are much more likely to experience flashbacks."
JHA, with a population of 800 residents, houses only 41 Holocaust survivors in its residential and skilled-nursing facilities, according to Laurie Manners, administrator of the Grancell Village campus. The number is small but, with over two-thirds of them suffering from some degree of dementia, the behaviors stand out.
"We have people who hoard food, who stockpile it in their rooms," Manners said. "And we have one resident who is convinced that noxious fumes are coming in through his air conditioning vent. 'It's poison gas. I'm suffocating,' he tells us."
Holocaust survivors, who felt so deprived, often cannot adjust to living with a roommate, whom they may believe is plotting against them or stealing their possessions. Some are very distrustful.
Haya Berci, JHA's executive director of nursing, said, "If something goes wrong, some survivors are afraid to say anything, for fear of retaliation."
They also have issues surrounding money, such as one resident who believed a rabbi had stolen her $50,000. Many want to sleep with their cash. These behaviors happen more readily in an institutional setting, where survivors feel less in control, according to Martin.
"They can react to showering or to undergoing a medical procedure," she said. "They think the hospital is performing experiments on them and their family has been murdered."
Also, she said, many lose the ability to speak and understand English and are frightened by people talking in what they perceive as a foreign language.
Most survivors, however, according to Paula Fern, director of Jewish Family Service's (JFS) Pico-Robertson Storefront and the Holocaust Survivors Program, like most elderly, generally live in their own homes, alone or with paid caregivers or with relatives.
JFS works with about 650 survivors in their 60s and older, about 10 percent of whom suffer from some type of dementia. Caseworkers in four storefront facilities make home visits, assisting the survivors and their families. Additionally, JFS provides adult day care for Alzheimer's clients in three locations, as well as respite time for families.
Still, JFS has seen its share of survivors with Alzheimer's or dementia who, according to Fern, "are caught in the moment of the Holocaust and relive all that terror, anguish, anxiety and peril."
Fern tells of a past client, a physically fit man in his 70s, who, donning a suit, tie and hat, and putting his financial papers and money into a leather briefcase, disappeared. He stayed with various friends, a few days at a time, and only occasionally resurfaced.
"It took a long time to figure out he had been a courier in the Paris underground and was re-experiencing those days," Fern explained. Because he had no family, JFS arranged for a private conservator.
"This phenomenon is not a new revelation," Fern said. JFS has had survivor clients since 1945 and began a program specifically for aging clients in 1997.
Currently JFS has an extensive program for survivors and their families funded by the Conference for Jewish Material Claims Against Germany and the Morgan Aging With Dignity Fund, as well as private donations. Additional training on Alzheimer's and other aging issues is provided by the Alzheimer's Association and JFS staff.
"Training, training, training," stressed Berci of JHA, which provides training to new employees, along with ongoing education for all staff members, on Jewish culture and issues, including the Holocaust. Recently, JHA received a grant from Wells Fargo Bank to set up a comprehensive program specifically to assist Holocaust survivors, including those with dementia, and their families.
Interestingly, while the Holocaust population in general is decreasing, this subset is actually increasing as survivors, like the general population, are living longer, and thus are more likely to become demented.
"The cruel irony," geriatric psychiatrist Daniel Plotkin said, "is that dementia doesn't protect these people. Their long-term memory remains intact."
Plotkin stressed the importance of a trusting relationship, whether it's with the spouse or a hired caregiver.
For Szydlowski, that trusted person is her husband, Michael, 94, who also lives at JHA and comes to his wife's room every day before she rises.
"He is afraid to have her wake up and have him not there, because that would be terrible for her," Golan explained. "He doesn't sleep because he's afraid of oversleeping."
He stays with her in the Alzheimer's day room, taking time off only to eat and, at his daughter's urging, to play bingo a couple times a week.
"I'm not sure she recognizes my father or me, but she feels safe with us," she said. "With everyone else, even nurses who have cared for her for years, she struggles."
For some, artistic pursuits help tame the Holocaust demons. Sam Gal, 81, entered JHA in 1998 and took up painting for the first time. He spent every day in the art room, creating a prolific portfolio of paintings, which gradually became lighter, in both content and appearance. About two years ago, as dementia set in, he was forced to stop.
Medication can sometimes help control the agitation and paranoia, though it can't prevent flashbacks. People can also often be distracted, with a song or a walk. For those with severe dementia, just holding their hand or talking to them in their language of origin can comfort them.
"Our philosophy is to know each person," Manners said. "What were his hobbies? What did he do for a living? Often, we can calm someone by doing something familiar."
Some known triggers can be eliminated, even in institutional settings. In JHA, patients can be given baths rather than showers. The overhead paging system is rarely used. Bank statements have been simplified, to make them more understandable, and residents have a locking drawer in their room, to securely store their possessions.
Facilities can also be made as homelike as possible. JHA's Goldenberg-Ziman Special Care Center, which opened a year ago on the Eisenberg campus with 96 beds for residents with dementia, offers lots of sunlight, with floor-to-ceiling windows, carpeted rooms and a soft décor. Some residents simply become less agitated as they become familiar with their surroundings and staff and relax into a routine.
"However," Fern said, "most children are extremely reluctant to place their survivor parents in facilities. It's a tough sell even to get them into adult day care."
Miriam, who declined to give her last name and whose mother, 78, suffers from Alzheimer's, arranges care for her parents in their own home. That is also their wish.
"They've gone through so much in life," she said. "I don't want anything at the end of their lives to resemble the hardships they went through at the beginning."
Golan's parents, on the other hand, independently made the decision to move into the JHA in 1995. She visits them several times a week, though she's not certain her mother realizes she's there.
"She's fighting for her life," Golan said, explaining that her mother's first husband was beaten to death in front of her, just before her 2-year-old daughter was taken away. She subsequently spent time in Auschwitz, Treblinka and Mauthausen.
"Once was enough," Golan said. "Once was too much."
Remembrance Rites to Mark Holocaust
Two Holocaust remembrance events will be held on April 29 and May 4 at the Los Angeles Holocaust Monument in Pan Pacific Park.
The April 29 observance, starting at 11 a.m., will bring together approximately 1,600 students from 25 public, Jewish and Catholic schools for a memorial program conducted by students and for readings by Holocaust survivors. Each participating school will receive four books for its library.
One of the books is "Abiding Hope, Bearing Witness to the Holocaust," by Benjamin A. Samuelson. The author, who uses a pen name, was forced to work as a member of the sonderkommando, which operated the crematoria. He later was wounded fighting in Israel's War of Independence. The books are being donated by the Greta Savage Memorial Foundation.
The other three books are "Witness to the Truth," by survivor and philanthropist Nathan Shapell; "The Children of Willesden Lane," by Mona Golabek; and "In the Shadow of the Past, Lest We Forget," the stories of 12 survivors.
Both events are being underwritten by Jona Goldrich, chairman of the Los Angeles Holocaust Monument, and co-sponsored by the Los Angeles Museum of the Holocaust, The Jewish Federation of Greater Los Angeles and Second Generation.
The Holocaust Monument is located at the north end of Pan Pacific Park, between Beverly Boulevard and Third Street, adjacent to The Grove and Farmers Market.
The May 4 observance will be held at 1:45 p.m. Free transportation will be available from Westwood and the San Fernando Valley by preregistration. For information, phone (310) 280-5010 or (310) 821-9919. -- Tom Tugend, Contributing Editor