Speyer was not on staff with the facility, and her schedule is more than full. She works full time as a chaplain at the Veteran's Administration Hospital and serves on the Red Cross Disaster Team. She is also a community chaplain with the Board of Rabbis of Southern California, which is the hat she was wearing when she went that day to the nursing home.
"When your dishwasher breaks, don't you call a plumber?" Speyer responded to the administrator. She had driven out to the Valley in Friday morning traffic for a fee that would barely cover the cost of her mileage, and she couldn't believe the administrator's attitude, although it was one she had encountered many, many times before.
"Why is spiritual counseling something you should give for free?" she said recently. "People feel as Jews, we're supposed to care for one another. But we have multiple needs in the community, and people do not understand what is involved in maintaining and sustaining a Jewish community."
Indeed, the Jewish community has many needs that require funding, manpower and programming, and they are often called "crises": There is the Israel crisis, the intermarriage crisis and the disengaged youth crisis.
But the one crisis hardly spoken of is the aging crisis: Some 23 percent of the Jewish population nationally is older than 60, compared to 16 percent in the general population, according to the National Jewish Population Survey 2000-2001. In Los Angeles, between 1979 and 1997, (the last survey of Los Angeles' Jewish population), for example, the number of Jews older than 65 grew from 11.1 percent to 20.4 percent. Put simply, the Jewish community is aging rapidly -- and not necessarily healthfully, as medical advances in areas such as chemotherapy and kidney dialysis prolong life spans, while also sometimes adding extra years spent in hospitals, nursing homes, under medical treatment.
Who will provide spiritual care for the needy?
The crisis, for those involved, like Speyer, who is past president of the National Association of Jewish Chaplains, is not merely physical care -- Medicare is a benefit afforded these people -- her concern is the huge gap in provisions for another very important kind of sustenance.
"There is very little spiritual care being ministered to those who are in need," she said. "I mean, we all need spiritual care. We have a large society of the elderly who spend their time alone," either at home or in nursing homes and often not affiliated with any synagogues or religious organizations. "No one is attending to the needs of these people."
"People are becoming more aware that there is more than just the curing process. There's also the healing process that must go on with a patient and his or her family," said Cecile Asikoff, national coordinator of the association, the umbrella organization for national and international professional Jewish chaplains, totaling some 300 members. A chaplain is a spiritual counselor who provides guidance, comfort and care to people in institutions -- hospitals, nursing homes, prison and the military, and the National Association of Jewish Chaplains sets standards and can qualify Jewish chaplains.
"An important element in the healing process is the spiritual process. The healing process can be helped by confronting the spiritual issues of, 'Why me, why now?'" Asikoff said. Which is where the chaplain comes in -- or should come in -- to offer spiritual guidance and counseling, to sit with the patient and his or her family.
"A person is not just his or her disease any more than he or her eye color. The disease is part of who the person is. Part of the pastoral piece is helping people come to terms with very difficult, life-threatening or life-ending conditions, the piece of transitioning from one place in life to another place in life, the elderly, the transitioning piece of hospice, those are all pastoral pieces that are not outside his or her illness or medical condition," Asikoff said.
In 2002, The Jewish Federation of Greater Los Angeles published a study, "Services to Jews in Institutions," originally sparked by the United Way's elimination of a prison chaplaincy program. The 42-page study was divided into two parts: "Jews in Prisons," and "Jews in Hospitals and Nursing Homes." Although the first part sparked the study, the second half was what attracted people's attention.
"There is a significant shortage of trained volunteers, chaplains and others to meet the needs of those in hospitals, nursing homes and hospice. Not enough professionals are entering and remaining in these fields," the study reported.
This is something that people like Asikoff and Speyer know very well: Many elderly and sick Jews need spiritual care and are not receiving it. And there are not enough people who can provide it.
The concept of chaplaincy originated among the Christians, though, bikur cholim (visiting the sick) is considered one of the most important mitzvahs in the Torah.
Historically, members of a Jewish community and rabbis have attended to sick people. But these days, for many of the unaffiliated sick -- and even those who are affiliated -- a rabbi's time is often not sufficient to provide real care.
Rabbis often serve vast communities and with those communities come myriad other obligations, like weddings, bar mitzvahs, speeches, functions, counseling and fundraising. Often rabbis have time only to visit the terminally ill and even then not on a regular basis.
Still, with equal rights for all religions, the demand has been increasing. Many institutions have begun to seek out Jewish, as well as Christian ones, and, of late, Muslim, Buddhists and many other religions. And the requirements are stringent: A professional chaplain today must be board certified, having completed 1,600 hours of clinical pastoral education working at a hospital or institution.
The problem for the Jews? Not enough Jewish chaplains.
One outcome of The Jewish Federation-Board of Rabbis study was the founding of a new Jewish chaplaincy school, the first of its kind anywhere. The Academy for Jewish Religion|California a pluralistic rabbinic and cantorial school, first opened a chaplaincy school in 2003, and it graduated its first three chaplains in June.
"We felt we could help fill this need in Southern California, and that's what we did," said Rabbi Stan Levy, chairman of the board of AJR. "We know that a lot of people want to be chaplains, and they want to be at a school that really prepares them. They don't want to study at a secular or quasi-Christian place where they don't feel like they were getting thorough Jewish background and the imprimatur of a Jewish Institution."
At AJR's three-year program, students learn clinical pastoral skills, study Judaica -- including prayers and Talmud and midrash pertaining to healing and medical ethics. They also take courses in Hebrew. Students also must get additional clinical pastoral education training outside the school.
Dvora Epstein, one of AJRs first three graduates, started off as a volunteer at St. Joseph's Hospital long before she had even thought about chaplaincy -- or Judaism for that matter.
When her husband died 12 years ago, she wanted to do something "more meaningful" (her first career was in retail), so she started volunteering at the senior outreach department. One day, the Catholic chaplain looked her in the eye and said, "You're meant to be a chaplain. Do me a favor and go back to your birth religion."
Epstein hadn't been active in Judaism for 30 years, but she joined a temple and began to reconnect. When AJR opened its new program, Epstein signed up. This fall she started a full-time job at St. Joseph's Hospital as one of six chaplains. (Another AJR graduate, Judith Sommerstein, is also working there.)
At AJR, Epstein said, "I learned to be present for patients. I learned to relate or to help relate patients' feelings and emotions to sacred text."
In addition to the Hebrew and the ancient teachings about healing, she said, "I learned an appreciation, a deep, deep-founded appreciation and joy in the Torah in the teachings and ancient wisdom of our forefathers."
But some people say that AJR's kind of training is not enough. They believe a chaplain should be a rabbi, well versed in rabbinic studies and not only those pertaining to life-cycle issues.
"I think there's a role for chaplains who are not rabbis," said Rabbi Mark Diamond, executive director of the Board of Rabbis. "But where we sit, there's always been a role for rabbis to be chaplains, particularly in Jewish law and life or death matters. The calls we get typically are from patients and their families who want to see a rabbi in their time of crisis or need," he said. "Yes, there's a role for a professional chaplain who is not ordained as a rabbi, but the rabbi is the most important person to help someone in crisis."
The heads of AJR's new chaplaincy program disagree.
Mel Gottlieb, dean of AJR's Rabbinic School and chaplaincy program, points to differences in education and approach.
"A rabbi has longer training, is exposed to talmudic erudition and all the practiced tradition, familiar with liturgy, and a greater part of tradition, but nevertheless," he said, "in some ways [our chaplains] have superior ability."
Rabbis are trained to be orators, motivators, leaders. Chaplains, on the other hand, are counselors -- more akin to therapists and caregivers.
"We found that many rabbis do not have training nor the natural capacity to sit and listen to a patient; they'll come in with advice or reassurance, which is not what the patient needs ... they need to be heard," Gottlieb said.
For example, he said, suppose a person lost a loved one; the chaplain might say, "'Tell me about (your husband), that must be awful; tell me about your relationship....' You get to feel, clear out, and you need that solid training. Many rabbis are not trained to do that."
It is a challenge, he said, to change perceptions toward "lay," nonrabbinic chaplains.
"I think it's the transference toward a holy figure who will guide them and has the competence to bring them the tradition; it's the feeling of being represented by a wise sage, who represents tradition and the knowledge of the ages in terms of death and dying," he said. Jewish lay chaplains can do this, he said.
Yet to some extent, the argument is a moot point, since most rabbis historically haven't been going into full-time chaplain positions.
"For too many years, rabbis who chose chaplaincy, their work is underappreciated -- not seen as essential as rabbis who choose pulpits," Diamond said. "I do believe we need to raise salaries to compensate those rabbis."
For all their hard work of ministering to the sick each day, chaplains earn in the range of $40,000 to $50,000 annually. To be competitive with other rabbinic and professional options, they should make at least $70,000, according to Asikoff.
Why are chaplains so low-paid? First, theirs is still a relatively new profession; second, their clients are not usually ones in position of power and wealth by comparison to, say, a synagogue board. And third, the source for funding the positions: With health insurance in crisis, many hospitals are undergoing tremendous budget cuts, and the first thing to go are the "extras," including the chaplains. In many states, regulations mandate that long-term care facilities for the elderly, such as nursing homes and hospice, must provide for the religious needs of their patients, but, Asikoff said, they can "get around it" by, say, holding a seder, or Friday night service. "We believe there should be a chaplain on-site."
The question is not only about money but about worth. "The community has to value this service," Asikoff said.
Speyer believes "the Jewish community should pick up the bill."
Indeed, some Jewish communities have full-time chaplains to provide services around the city.
Los Angeles has a 24-hour emergency hotline through the Board of Rabbis, created in response to The Federation study. The hotline has a dozen rabbis on call who can provide emergency chaplaincy services to some institutions for unaffiliated Jews in life-threatening or crisis situations. The hotline, which costs $30,000 annually, is just a small step in meeting the growing needs of the elderly and sick, 50 percent, at least, of which are unaffiliated.
Diamond is dreaming bigger: "My dream would be to have three community rabbis, one for the city, one for the valleys and one for inmates.
"It is a dream awaiting funding," he said, estimating the cost at $500,000 a year.
Or, as Speyer said, "Where is the priority for the people looking for some meaning to the end of their lives?"