‘For You Know The Heart of the Stranger’ By Cary Kozberg

Posted on August 3rd, 2009 | Filed under Best Practices/Non-Profit, In Print: New Books, InterViews

"For You Know The Heart of the Stranger": Addressing the Spiritual and Religious Needs of Non-Jewish Residents in Jewish Long-Term Care Venues. This article is reproduced from Flourishing in the Later Years: Jewish Perspectives on Long-Term Pastoral Care with permission from its editors. The book may be purchased from the Victoria Press and was edited by Rabbis Cary Kozberg and James Michaels. It is the first in a series of special articles for the interViews "In Print" Supplement.

In the United States, the "faith-based" focus of faith-based agencies addressing the needs of older adults is largely to help their respective faith communities fulfill as completely as possible the Scriptural command of Leviticus 19:32: You shall rise before the aged, and show deference to the old".  This is certainly true of such agencies that are under the auspices of Jewish communities around the country. In cities and towns where there is a Jewish Family Service or a long-term care institution sponsored by the local Jewish community, the spirit of this verse and the sense of moral and religious obligation it communicates-along with that of the Fifth Commandment-pervades whatever efforts are made for the physical, emotional and spiritual benefit of older adults.

Notably, juxtaposed to this verse mandating deferential treatment to older adults is another mandating that strangers be not only welcomed, but also loved and treated as members of the community are treated:  "The stranger who resides with you shall be to you as one of your citizens; you shall love him as yourself, for you were strangers in the land of Egypt" (Leviticus 19:33).

Loving the Stranger

Traditional Jewish exegesis assumes that Holy Scripture--particularly the Torah, the five books of Moses-is of divine origin, and therefore perfect. Unlike modern scholars who approach Biblical texts from a more critical perspective, traditional Jewish exegesis has always affirmed that there are no linguistic or stylistic coincidences or accidents in the text--no unnecessary repetitions, nor is there anything "haphazard" in Scripture, or in the way it is presented.   In this spirit, adherents of this traditional approach would understand that in Scripture's linking these two commandments, there is an important lesson to be gleaned: that not only are we mandated to respect older adults and defer to them, but we are also forbidden from treating them as if they were strangers: we are to keep them connected to the community of which they are a part; we are to make sure that they are not ignored, marginalized or disenfranchised.

Among the reasons that Jewish homes for the aged--now known as "long term care facilities (LTCs)--began to proliferate after World War II, the need to help older Jews maintain their social, cultural and religious ties to Judaism and the Jewish community was paramount. In a time when there was widespread discrimination against Jews in all areas of American society, not only did such institutions insure that older Jews (many, if not most, of them immigrants from Eastern Europe) would have places where they could live and be cared for as they grew older and more frail in environments that would be familiar and nurturing to them.  In such environments, kosher food would be served, Jewish culture would be promoted, religious services would be available, Jewish sacred times-Sabbath and holidays-would be observed.  The ambience would have a recognizably Jewish tahm (flavor).  For these reasons Jewish "homes for the aged" were intended to be populated exclusively by Jews, and until recent years, most have been.

Recent years, however, have seen significant changes (e.g. eligibility criteria, payor and funding sources, etc.) that have impacted all nursing homes and long-term care facilities.  These, along with demographic and cultural changes within the American Jewish community have steered many LTCs under Jewish auspices, particularly those in locales with smaller Jewish populations, into re-thinking and revamping their admission policies to include non-Jewish residents.   To be sure, such changes in admission policies have sometimes elicited some resistance from certain quarters of the Jewish community. Given the collective memory of persecution and friction experienced by Jews who lived in close proximity to non-Jews, older Jews feeling somewhat "xenophobic" about non-Jews living among them, is at least understandable, if not forgivable.

However, a larger concern is usually that with the admission of non-Jewish residents to a Jewish LTC, its cultural and religious life, and therefore its authenticity, will be significantly compromised. Indeed, when a Jewish home's admission policy becomes more "open", a host of other questions that impact both the facility's integrity as a "faith-based" institution and residents' individual rights are raised.  These questions may include, but are not limited to:

--Are non-Jewish residents and their families expected to observe the Jewish dietary laws?

--Are non-Jewish residents and their families expected to observe the restrictions associated with Jewish Sabbath and other sacred holidays?

--Do Jewish religious tenets and guidelines regarding bioethical and end-of-life issues apply to non-Jewish residents of Jewish LTCs?

--Is the facility expected to provide for the religious/spiritual needs of non-Jewish residents as it does for its Jewish residents?  If so, to what extent?

It should be noted that every Jewish LTC as an autonomous organization addresses these and other pertinent questions in its own way.  And yet, with so many Jewish LTCs caring for both Jewish and non-Jewish residents-sometimes with the non-Jewish census being at least 50%-it is a good bet that these types of questions against the backdrop of economic necessity (keeping beds filled) present themselves on a daily basis.  But for those of us who believe that Jewish religious and cultural integrity is of primary importance, they and their solutions present themselves as part of a larger ethical and religious challenge: how does a Jewish LTC maintain its Jewish integrity when non-Jews are part of the population?  Can it maintain an authentic and substantive Jewish ambience, while admitting and welcoming (as opposed to merely tolerating) those who are not "members of the tribe"?

As someone who not only works in a Jewish LTC, but is also primarily responsible for its Jewish religious and cultural ambience, I have found that not only does the presence of non-Jewish residents not compromise Jewish authenticity, but it arguably enhances it.  Indeed, their presence may be necessary.   How?   Admitting non-Jews as residents to a Jewish LTC is certainly a tangible fulfillment of the religious commandment to "welcome the stranger".  As mentioned above, this commandment is referenced in Leviticus 19:33, and there are several other similar references in Scripture.  The fact that Scripture mentions this commandment in several different places indicates not only the importance of welcoming the stranger, but also the need of addressing feelings of ethnocentric xenophobia.  As is clear from the text, the prohibition of mistreating the stranger is based on an expected feeling of empathy, born out of the Jewish experience as outsiders: You know the feelings of a stranger, for you were a stranger in the land of Egypt.

Furthermore this core tenet is amplified by the Talmudic sages who advocated for responding to misfortunes of non-Jews, along with those of their own community.  Specifically, they taught that for the sake of harmonious relationships between the two communities, non-Jews who are poor must be helped, those who are sick must be visited, and their dead must be properly buried, when necessary.

And lest this directive be understood as rooted only in political and "utilitarian" motives, it should also be noted that proof texts for the moral and religious correctness of helping non-Jews are provided by other Scriptural references. These include: 1) the affirmation that every human being is created b'tselem Elohim, (in the divine image), and 2) the oft-repeated reminder that the raison d'etre of the Jewish community to role-model Godly behavior among human beings by exhibiting these attributes in their dealings with others.

Thus, in light of so many religious imperatives regarding both how older persons and strangers are to be treated, one could deduce that there is a certain "more-amplified" obligation on the part of a Jewish LTC to be welcoming to residents who are both elders and non-Jews.

What might a non-Jewish resident expect when coming to live in a Jewish LTC?  To be sure, it depends on how the term "Jewish LTC" is understood.  If the facility is "Jewish" merely because most or all of its residents are Jews, but the facility's programming includes few, if any, expressions of Jewish religion and culture (i.e. Jewish holidays are not celebrated, Jewish dietary laws are not followed, Jewish cultural programs are rare), then a non-Jewish resident might find it easier to fit in more quickly.

However, if the facility is "Jewish" in more than its census, if it is a place where Jewish people not only live, but is also "faith-based"--where Jewish religious practice and ethical tenets inform and guide almost every aspect of life, from quality of nursing care and activities to relationships among residents, family and staff-then the non-Jewish resident may find his/her acclimation a bit more challenging, although (from my observations) not necessarily so.

As mentioned above, questions regarding any expectations for non-Jewish residents viz. Jewish practice, are addressed by every Jewish LTC that cares for non-Jewish people.  To be sure, the sort of questions mentioned above--the observance of dietary laws and Jewish sacred days, whether non-Jewish residents are bound by Jewish teachings on bio-ethical issues, etc.-as well as others, do not have set universal responses.  They are addressed by each Jewish facility as an autonomous institution.  Even with input from rabbis and other sources, solutions to any given issue may vary from facility to facility.   What follows is a description of how Wexner Heritage House (WHV), a Jewish LTC with a 35-40% non-Jewish population, has addressed the challenge of meeting the spiritual/religious needs of its non-Jewish residents, while maintaining an authentically Jewish religious and cultural ambience.

"Tolerance is practiced here"

From the day that our first non-Jewish resident came through our doors over 15 years ago, the attitude of our professional and lay leadership to admitting non-Jews has generally reflected the religious and ethical tenets mentioned above.  To be sure, initially there were one or two "ethno-centrics" from the community whose responses were less than gracious, but these were in no way taken seriously by the rest of the administration and board.  I believe that this was largely due to the fact that WHV had-and continues to have--a "faith-based" Jewish ethos that is well-established, robust and ubiquitous.  For this reason admitting non-Jews into a facility that had heretofore been "all Jewish", posed little if any threat.

At the same time, knowing the kinds of difficulties that Jewish residents sometimes face in LTCs that are unfamiliar with (or unsympathetic to) their needs, we wanted our "new folks" to feel as comfortable and as acclimated as possible.  Happily, as our non-Jewish population has grown, the spirit of openness, tolerance, and discernment has grown as well.  Indeed, this is reflected in the increasing resources devoted to meeting the spiritual and religious needs of these individuals over the years.

For example, years ago when there were 2-3 non-Jewish residents out of a total census of 200, Christian clergy might agree to conduct worship and offer pastoral visits on a volunteer basis.  This arrangement had limited success because of the inconsistency of the volunteers. As the population grew, we contracted with Lutheran Social Services for regular weekly visits from a pastor, in addition to weekly visits from the Catholic priest in whose parish our facility is located.  Presently, a full-time Protestant chaplain is part of our Religious Life Department.  She conducts two weekly worship services (one for those who are cognitively able, and one for those who are cognitively impaired), makes pastoral visits, and counsels with families and staff.   In addition, she makes sure that our Catholic residents are visited and cared for by clergy and lay pastors from the local parish.

In this way, all of our residents have opportunities to continue to have meaningful religious and/or spiritual experiences according to the traditions with which they are familiar and comfortable.  Residents are not automatically taken to a religious program "just to give them something to do," nor are they assisted to any worship service unless they wish to attend.  Moreover, staff members are careful not to bring Jewish residents to Christian worship, or vice-versa.    It has been our experience, however, that non-Jewish residents often appreciate the opportunity to attend-and participate in-Jewish worship services and other specifically Jewish religious programs.  Indeed, over the years there have been several who have been more faithful attendees than their fellow Jewish residents!

It should be noted that when it comes to welcoming and acclimating non-Jewish residents into Jewish LTCs, the challenges are certainly not all on "the Jewish side".  Moving into a Jewish LTC with a robustly Jewish ethos, non-Jewish residents and their families frequently have a lot with which to become acquainted, particularly if their experience with Jews and Judaism has been limited.

For this reason, our Admissions Department includes a discussion of a few of the "basics" with new residents and their families, Jewish and non-Jewish alike.  They are careful to remind them that our facility is a Jewish "faith-based" institution, that Jewish religious practice and culture is a major part of life in the facility, and that certain aspects with which they will come into regular contact, i.e. the Jewish dietary laws (kashrut) need to be remembered and respected.  Materials are included in our Admission Packet explaining kashrut: 1) that all food served to residents is prepared according to the Jewish dietary laws 2) that all public areas in the building are "kosher" areas, and 3) that food brought into the facility is permitted ONLY in residents' private rooms, or in the staff dining room.

Because keeping the Sabbath and observing biblical holidays is a staple of Jewish religious life, new residents and their families are also made aware of those Sabbath/holiday restrictions which are part of Jewish life at WHV.  They are informed that on these days, regularly scheduled occurrences-i.e. baths, therapies, etc.-will be shifted away from those times when worship is scheduled; they are informed that on these sacred days regular admissions and discharges do not take place (except in unavoidable circumstances), and that Administrative offices are closed and regular business is suspended.  In addition, they are informed that our responses to end-of-life issues is grounded in the belief that every person is created in the image of God, no matter what his/her physical condition, and that our care for persons at the end of their lives will reflect that belief, regardless of the resident's religion.

There may be those who assume that so many of these "unusual" conditions or limitations which are not a part of the culture of other LTCs, would lead to complaints from many non-Jewish residents and their families.  On the contrary, with the exception of some residents who may have some difficulty getting used to certain ethnic Jewish foods (gefilte fish is indeed an acquired taste), or perhaps not fully understanding some of the restrictions of kashrut (i.e. the restriction regarding outside food in the public areas), our experience has generally been that non-Jewish residents and their families usually understand and respect the need to preserve our Home's Jewish religious and cultural integrity.  And not only do they understand and respect the need, but they also very much appreciate it.  They appreciate it because they know that the excellent care for which our facility is known is a manifestation of a commitment to our Jewish religious teachings.  They understand that our commitment to properly caring for those who are frail and vulnerable is intertwined with our commitments to observing certain days as sacred and watching what we put or do not put into our mouths: that these are all part of our religious obligations to God, and that they all come from the same Source.

With this understanding, non-Jewish residents and families also appreciate our helping them to increase their own awareness and understanding of Jewish traditions, rituals and celebrations.  They know that they are always welcome to attend any and all Jewish worship services and religious programs if they so choose-and many do!  Furthermore, in such an atmosphere, our non-Jewish residents soon learn that their respect of Jewish traditions and religious life will be reciprocated.  They come to learn that with a Christian chaplain on staff, and regularly scheduled worship and Scripture study, they also will be able to continue to practice their own faith traditions.

Thus, while our non-Jewish residents may be "in the minority", numerically speaking, all efforts are made to make them feel that they are indeed part of our community. Observances of American holidays such as July 4 and Thanksgiving are planned with all residents in mind, as is our resident memorial service, which includes Scriptural selections and poetry with which everyone can resonate. The experience of feeling part of the community is nowhere more affirmed than in this monthly gathering.  Over and over again, family members of non-Jewish residents have expressed their appreciation for how we cared for their loved ones, but also how we continued to demonstrate that care by honoring their memories after they had died.

"The December Dilemma"

To be sure, there is one sensitive issue that annually presents a potential challenge to maintaining that fine balance between our commitment to tolerance and our commitment to an authentic Jewish ambience: the observance of Christmas.  Every December our Jewish facility provides opportunities for those residents and their families who celebrate the holiday, without compromising our Jewish identity and sense of authenticity.  Over the years, we have succeeded in nipping any problems in the bud with the following policy:

--During the December holiday season, all residents have the right to enhance/decorate their rooms however they wish to-as long as the decorations (particularly if they are religious in nature) are in their rooms, which are considered private domains (all our rooms are all "single occupancy").

--Because the front side of residents' room doors face the public areas, residents are also respectfully requested (and expected) to refrain from putting holiday decorations on the front of their doors.

This policy is similar to the one governing the observance of the Jewish dietary laws: private rooms and private offices are not under kosher restrictions, while food served and eaten in all public areas (resident dining areas, living areas, etc.) must be kosher.  In addition, our staff dining room is an "open" area with no kosher restrictions.   In both situations, these solutions have worked for all concerned, primarily because they are based on mutual respect and a serious concern and understanding for everyone's needs.

And yet, even as we navigate every December through potentially troubled waters, a tremendous source of pride for Wexner Heritage House as a Jewish facility is our annual resident/family Christmas worship service and party that we have hosted for almost a decade.  The pride we feel is rooted not only in the knowledge that we are providing for the religious needs of our Christian residents and their families, but more in the fact that the  party and reception following the worship service, which is prepared in our kitchen,  is kosher!   A kosher Christmas party! What better way to realize both our ritual obligations as well as our ethical obligation to make "the stranger" feel welcome.    With this in mind, I am always pleased to begin this particular program every year with a word of welcome and appreciation for the spirit of tolerance and diversity that this program represents.

Preserving the Chaplain's Religious Integrity

Occasionally, there are other situations that arise which may present other sorts of challenges, not necessarily to the religious integrity of the institution, but to my own religious integrity as a rabbi and a Jew.  As a trained chaplain, I am prepared to meet people "where they are"-to listen to their concerns and situation, while respecting and trying to understand the particular spirituality or belief system with which they live in the world.  Yet, as a rabbi I am grounded in my own spirituality and belief system, and these provide the spiritual and religious resources from which I draw as both a rabbi and a chaplain.

To be sure, there are those who believe that chaplains should be prepared to do whatever is necessary to meet the religious and spiritual needs of the people they encounter, even if the chaplain  must compromise or violate his/her own religious principles and beliefs.  In this approach to chaplaincy, Jewish chaplains should be prepared to pray "in the name of Jesus" with believing Christians, and  Christian chaplains who believe every prayer must be offered "in the name of Jesus" should be prepared to forego this requirement if necessary.

I am not one of those advocates. While I am committed to flexibility (most of this essay has focused on flexibility in action), I believe that to be an effective rabbi and chaplain, one has to be authentic, both personally and professionally.  I believe that my chaplaincy is based on my rabbinic calling-and to practice chaplaincy any other way would, for me, be inauthentic. Yes, as a rabbi I am able to offer much to folks who are not Jewish.  When I meet with a non-Jewish resident or family member and the opportunity for a pastoral encounter occurs, I will listen to, pray and counsel with, teach and explain, or just offer a "ministry of presence".

And such a presence must be one that is totally authentic-to what and who I am-for that is the only way I as a rabbi and chaplain can hope to represent God's authentic presence. In this way, authenticity can be more important than which faith I represent.  It also means that I recognize the same need for, and right to, authenticity in others.  So, when someone needs or requests prayer and pastoral care that is specifically out of the Christian tradition, I will connect them with our Protestant chaplain, or contact their own clergy. This is always appreciated, even when there are acknowledged our religious differences.  It is appreciated because people in need and who are hurting usually appreciate an empathy born out of authenticity that reaches across religious differences.  In my experience, authenticity eclipsing religious differences has manifested itself in at least two ways:  the fact that we always have non-Jewish residents regularly attending our Jewish worship services and Torah study, and the fact that the families of non-Jewish residents feel comfortable asking me to conduct, or participate in, the funeral service of their loved ones.

But the truth of this phenomenon was really shown to me several years ago after a High Holiday service at which Hattie was present. Hattie is an African American lady who is a regular attendee at our Sabbath and Holiday services.  A student of Scripture and church-going lady all her life, Hattie knew, and resonated to, good preaching.  She knew what it means to be truly inspired and uplifted by a well-delivered sermon.  After that service she came up to me, looked me in straight in the eye and said, "Raaabi (sic) ...your sermon...that was RIGHTEOUS!!"  In my thirty-plus years as a member of the clergy, I have never felt so complimented.  Moreover, I was pleased that our connection was so close-- that, even though she was a believing Christian and I am a believing Jew, I was truly "her rabbi", and she wanted me to know that.

Experiences such as these remind me that while there will always be religious and spiritual differences among residents that must be acknowledged and boundaries that must be respected, the words of the prophet Malachi continue to be a touchstone: Have we not all one Father? Has not one God created us?

In our facility, we continue to address the religious spiritual needs of all of our residents because for us the answer to both of these questions is "yes".

Rabbi Cary Kozberg

Rabbi Cary Kozberg, MAHL, DD, BCC,  has been Director of Spiritual Life at the Wexner Heritage Village since 1989. His responsibilities include overseeing the religious and spiritual nurturing of residents, family members and staff throughout the Wexner Heritage Village family of services.  He believes that spirituality is the base that supports our ability to serve others and states that “by promoting an ethos of sanctity, spirituality gives meaning and purpose to our mission to honor the elderly, affirm the dignity of every person, and bring healing to those who need it.”

See Exodus 12.48, 23.9 and 23.20; Deuteronomy 10.19 among others.

Talmud Gittin 61a; see also Maimonides, Mishneh Torah, Hilchot Melakhim, chapter 10 (end).

Genesis 1.27.

Genesis 18.19; Isaiah 43.10.

See Deuteronomy 11.22, 28.9 and Isaiah 42.6 ff.

As of this writing, all non-Jewish residents of WHV who list a religious preference have, with one exception, identified as Christians (either Roman Catholic or belonging to a Protestant denomination).

My co-editor James Michaels is proud that the Hebrew Home of Greater Washington offers the world's only kosher-for-Passover Easter dinner.

For more on authenticity in chaplaincy, see "The Chaplain as an Authentic and Ethical Presence" by David Zucker, T. Patrick Bradley, and Bonita Taylor, in Chaplaincy Today, Vol. 23. No. 2.

Malachi 2.10.

As our communities become more ethnically and religiously diverse, it is likely that we will have residents who are Muslims, Buddhists, or other Eastern religions. We will owe them the same accommodations and respect we give to Christians including, if possible, bringing in clergy from local mosques or temples. At the very least, they and their families should be given ample opportunity and space for prayer and celebration.

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