There are nearly 500 people waiting for a bed at L.A.’s largest senior living facility, the Los Angeles Jewish Home. Waiting, in many cases, for someone to die.
“It’s very depressing,” said Marlene Markheim, 80, of Encino. “We know that there’s a waiting list, and when a bed becomes available, we know what that entails. A bed becomes available when somebody else passes away.”
Markheim’s sister-in-law, Miriam, who is deaf and cannot see because of macular degeneration, has been on the waiting list since 2010. It’s not the Jewish Home that has her spirits low — quite the opposite; she’s heard great things — but rather the current state of eldercare in America.
“I rue the day when I’m going to need it,” Marlene Markheim said.
To people like her, it’s little solace that the Jewish Home — the largest single-source provider of senior care in Los Angeles — has 950 beds at two campuses in the San Fernando Valley and serves more than 2,300 people. How can that compare with the vast need faced by a city with more than 14,000 Jews over the age of 85, according to a 2008 estimate by Hebrew Union College-Jewish Institute of Religion sociologist Bruce Phillips?
The case of Markheim’s sister-in-law, who has bounced between a couple of private assisted-living communities in her search for better attention, is emblematic of a senior-care crisis. Americans are getting older and living longer, while lawmakers are cutting back on help for them. This year alone, Medi-Cal and Medicare funding for skilled-nursing centers is slated for double-digit percentage reductions.
Stuck in the middle are long-term care providers like the Jewish Home.
“It’s pretty devastating,” said Joanne Handy, CEO/president of Aging Services of California, a membership organization that represents the not-for-profit senior living field.
It should be no surprise that these tough times have arrived —and that more are on the way. Nationally, there were nearly 40 million Americans at least 65 years old in 2009. By the time the final baby boomers hit retirement around 2030, that figure is expected to balloon to more than 72 million, according to an Administration on Aging report. That’s an increase of 80 percent in just over 20 years.
And while 13 percent of today’s Americans are age 65 or older, that figure was already close to 20 percent for Jews when the latest available data came out in the 2000-2001 National Jewish Population Survey.
“We’ve all talked about how baby boomers are coming. Well, now baby boomers are here,” said Molly Forrest, CEO/president of the Jewish Home, which turns 100 in 2012 and will begin its centennial celebration this week.
In fact, this was the topic of a speech Forrest gave to the American Jewish Press Association in 1993. She still has her notes from that address, titled “Why Is Aging a Jewish Community Issue?”
“Our numbers of Jewish elderly are almost twice that of the general population,” she said then. “If America is concerned about the ‘graying of America,’ Jews are the ‘white-haired’ members of the growing elder population.”
David Feldman, 84, is one of the home’s hoary-haired elders, figuratively at least. He has been at the Jewish Home for eight years, ever since his late wife overheard their kids talking about the future of the aging couple and decided to take matters into her own hands.
To them, the Home was more than a place where they could grow old together and live comfortably as Orthodox Jews who keep kosher. They needed access to the facility’s medical care for his heart and lung problems, diabetes and other chronic diseases. There was something else that drew them to it, too: peace of mind.
“It’s a not-for-profit, and they promise not to throw you out,” Feldman said.
That, of course, takes money. Seventy-five percent of the Jewish Home’s residents receive government assistance. Any reduction in such aid represents an additional challenge to funding the Home’s services, which include independent living, assisted care, dementia care and skilled nursing.
Still, as the Jewish Home prepares to celebrate its centennial next year — kicked off at its annual Reflections gala on Sept. 18 — its leaders reassure worried residents that they will continue to stand by old promises.
“We’ve been here 100 years,” Forrest said. “We would never consider throwing them out.”
In Los Angeles, the Home has long been the face of Jewish eldercare. It was founded in Boyle Heights in 1912 as the Hebrew Sheltering Home for the Aged, with just five residents.
Its first president was a Polish immigrant and grocery store owner named Simon Lewis, who was moved by the plight of the destitute elderly and enlisted the support of colleagues to provide shelter to the needy, according to the Jewish Home’s official history.
What started as a home for transient men blossomed over the years, protecting those who might otherwise have been deliberately taunted at the county poor house with offers of pork. By 1916, Lewis and others had raised enough money to provide a permanent home on Boyle Avenue with 16 rooms and five adjacent lots for expansion.
When the Jewish community migrated to West Los Angeles and the San Fernando Valley, the Jewish Home traveled with it. Leaders purchased 11 acres on Victory Boulevard in Reseda in 1967 for what is now known as its Eisenberg Village. In 1979, it merged with the nearby Menorah Village on Tampa Avenue, which dated back to the 1930s, to create a second campus in the Valley.
Today, the Jewish Home’s reach extends to more than 2,300 people, through residents and community-based programs. The average age is 90, and 36 people are over 100. One-third of the residents do not have a living spouse, sibling or child.
Yet the need remains great. Of the 476 people waiting to get in, more than 30 are Holocaust survivors. (There are 57 who currently live there.) The giant gap between available rooms and applicants troubles Forrest deeply.
“That’s unconscionable,” she said. “We are the smallest Jewish home in the nation on a per capita basis. We need to build more. We need to build in a way that makes sense.”
Forrest admits that even building won’t be enough to meet immediate needs, so she’s calling for a plan that will expand services to the community as well.
Therein lies the challenge.
These bold words come at a time when everyone else seems to be cutting back. Earlier this year, state legislators voted to slash Medi-Cal reimbursements to nursing facilities by 10 percent. If the measure receives federal approval, it could mean a loss of up to $3.5 million in revenue at the Jewish Home, which has an $86 million budget.
“These were difficult reductions and not ones that we wanted to make,” said Tony Cava, spokesman for the California Department of Health Care Services. But, as a huge part of the General Fund, it had to be part of a solution to a massive state deficit, he said.
Just as bad, the feds plan on pulling back 11 percent of Medicare funds later this year, according to Handy of Aging Services of California. Those are painful cuts to absorb for providers that care for some of society’s most impoverished.
“We don’t have millions in the bank,” Forrest said. “You can’t go through and whack off $3.5 million in a month without us having to close a building. But part of the obligation when you’ve been here 100 years is you have to have a longer view of things.”
So, although no buildings closed, the Jewish Home did lay off 20 staff members, including one of its three rabbis. It also renegotiated employee health care contracts to save $700,000 a year.
But something else was working in its favor. Because of careful planning, groundbreakings for state-of-the-art facilities and celebrations for new programs that took place years ago were bearing valuable fruit, both for residents and the Jewish Home’s bottom line.
“What we made the decision to do as a board is, moving forward, we’re not building any new facilities unless they’re at least cash flow-even, therefore allowing us to further subsidize those in need,” explained Michael Heslov, board chairman. “We’re looking for ways to inject new income.”
That meant broadening the way the Jewish Home serves the community while tapping varied funding sources, public and private.
“We brought in some programs we thought would give us money that wouldn’t be dependent upon welfare, that would meet a community need, and would help keep people home,” Forrest said.
That’s not only smart, it’s necessary, according to Handy.
“They’re diversifying what they do. They are not putting all their eggs in one basket,” she said. “They’re not expanding with the same old services. They’re finding new ways to augment their mission.”
In the last decade, for example, the Jewish Home has started offering short-term rehab and opened the Skirball Hospice and the Auerbach Geriatric Psychiatry Unit. It even established the Annenberg School of Nursing, effectively creating its own source of medical professionals and cutting down on overtime and recruiting costs. Most recently, Fountainview, a luxury senior living center featuring an 80-seat movie theater and rooms with granite countertops, opened last year.
The strategy isn’t unique. The 140-year-old Jewish Home of San Francisco has spent the last three years re-envisioning its campus to potentially add options like independent living, assisted living and memory care, said Sherie Koshover, its chief advancement officer.
The timing, however, couldn’t have been any more urgent. The Medi-Cal cuts proposed for this year would erase $11 million in the San Francisco Home’s funding. With 86 percent of residents on Medi-Cal, increases in other expenses and a total budget of only $70 million, “That represents an untenable threshold,” Koshover said.
Still, she said, “The plan is not to contract. The plan is actually to expand because the need is there.”
Forrest couldn’t agree more, and if she has her way, this is only the beginning.
Next year, the Jewish Home is expected to roll out its first Program of All-Inclusive Care for the Elderly (PACE) at its Grancell Village campus. A federal program, it will be known at the Jewish Home as the Brandman Centers for Senior Care, and it will provide a full range of health care services for seniors living independently in the community in order to help keep them at home. This could include everything from meals to therapy to medical care.
“It’s a health care system for the elderly, is what we’re evolving into being,” Forrest said. “We call it the 5,000 Plan. We want to be serving 5,000 people within the next five years.”
Other efforts also are in the works to make that happen. In Culver City, a new campus is on the drawing board to reach out to the area’s significant Jewish population. Referred to as the Gonda Healthy Aging Westside Campus, it will offer a clinic, PACE center and range of living options for about 500 people.
The campus will sit on a 2.4-acre site that the Jewish Home has negotiated the right to purchase from the Brotman Medical Center. Architectural plans have been submitted to the Culver City Planning Commission but are being revised to deal with a circa-1930 American Legion Post at the location that has been designated a city historical site, Forrest said.
Back in the Valley, the Jewish Home is developing two acres in Reseda on the corner of Tampa Avenue and Sherman Way as the Hirsch Family Campus. It will allow for the expansion of the nursing school and creation of more residential units while the nearby Grancell Village campus builds a PACE center and adds other facilities.
It’s a lot to take in. Forrest describes the situation more simply: “We plan to be here, and we have plans to grow.”
Years ago, such assurances wouldn’t have been necessary.
“There was a time when California was a leader in helping the elderly,” said Paul Castro, CEO of Jewish Family Service of Los Angeles (JFS).
Those days are gone, and Castro has a chart to prove it. It shows state programs to help the elderly that have been slashed or eliminated since 2008. The body count: 25.
JFS has its own services to help seniors, including case management, transportation, meals and wellness programs. And while Castro celebrates the work done by the Jewish Home, he sees these other services becoming increasingly important as baby boomers get older and resist the notion of going to a nursing home. It won’t be easy to support all of them, he said.
“At some point, there will be a redefinition of the safety net,” he said. “How do we maintain programs when funding is pulled back? We don’t have all the answers yet.”
Consider those seniors who currently benefit from Adult Day Health Care, a program scheduled to close later this year. What happens to the thousands of them around Los Angeles who are affected? Are they able to find other services to help them? Are they forced to add their names to nursing home waiting lists?
Jay Sanderson, president of The Jewish Federation of Greater Los Angeles, said addressing the issue of the elderly has to be a “top priority.”
“My hope,” he said, “is the positive that may come out of this budget crisis is that agencies in this community will work more closely together. The Federation needs to be in the middle of that conversation.”
That should include the Jewish Home, he said, even though the latter has historically maintained its independence. It does not receive funding from Federation or the United Way.
After all, it’s not just a community issue. It’s a Jewish issue, too.
“Many Jews looking for a nursing home, everything else being equal … do prefer for the facility to be under Jewish auspices,” according to Ira Sheskin, director of the Jewish Demography Project at the University of Miami’s Miller Center for Contemporary Judaic Studies.
It’s not because most of them care about kosher food; it’s because they’re not used to eating bacon or setting up Christmas trees, he said.
There’s no chance of that at the Jewish Home, where the meals are kosher and a large, colorful stained-glass window depicting the 12 tribes of Israel from the old facility in Boyle Heights remains on display.
Sure, it’s important to residents that they receive a high level of care. And yes, many of them love to play bingo just like seniors elsewhere. But for the ones who make it to the Home, that’s not what makes it special, especially as it turns 100.
“When I found out that the Jewish Home would accept me, oh my God, I can’t begin to tell you how lucky I felt,” said Marilyn Hirsch, 81, who moved in more than five years ago after falling and encountering other health problems.
“I’m not a practicing Jew, but … I was raised Jewish,” she said. “I came here to be with my own. I feel comfortable with them. I wanted my last days to be with my own.”