An article (in the Science & Health section of the Feb. 14, 2012 edition of the New York Times) stated that a senior residence facility passed an edict that residents in the assisted living and nursing facility can not eat in the same dining room as the independent living residents. (I recommend you read the article). Some couples and friends can no longer dine together. Various reasons were cited for the decision, including space, mobility, safety and concern about depressing the independent residents. This is screaming out to me as a great discussion topic in Jewish values. I can point to the values of caring for the sick and disabled, treating your neighbor as you would like to be treated, honoring the elderly, etc., but I am looking for specific sources and quotes to use as a teaching lesson. Thanks.
The New York Times article, “The New Old Age: Tables Reserved for Only the Fittest”, (http://newoldage.blogs.nytimes.com/2012/02/09/tables-reserved-for-the-healthiest/) describes a phenomenon that is taking place in a number of senior citizen facilities across the country. These settings have been purposefully designed to provide structure and care on a graduated basis so that as the individual becomes increasingly infirm, he does not have to completely relocate, but rather can move from section to section of the facility, from independent living, to assisted living to nursing care, so that he will have available the appropriate level of supervision and assistance that he requires at that point in his life. An attractive feature of these senior communities is their restaurants and dining halls which accommodate not only residents but also guests, friends and family members. While it appears that almost all of the facilities originally allowed residents who lived independently as well as those in assisted-living (nursing patients, because of their intensive needs have not been included) to eat together, several of the institutions of late have adopted policies that deliberately separate these groups from one another.
One critical variable that has to be explored is the degree to which such a policy is necessary for the health and safety—dimensions of Pikuach Nefesh (lit. oversight of life—Leviticus 18:5)—of particular residents, i.e., those in need of greater support than those who require less. If by eating together it will be impossible to regulate people’s diets, accommodate their special equipment and monitor their taking necessary medicines, then the social benefits of being part of a larger group and maintaining one’s sense of personal dignity—a function of Kavod HaBriyot (lit. honor of people—Avot 4:1; Berachot 19b)—are offset by the real dangers to individual life to which those in need of assistance are susceptible.
However, it would not appear that an either/or choice necessarily has to be made. Such a perspective entails a cost/benefit calculus, i.e., if extra staff and accommodations would be required in order to allow for a greater range of individuals to spend quality time with one another, at what point, if ever, does the cost become counter-productive? Does a dimension of Bal Tashchit (the obligation not to be wasteful—Devarim 20:19-20) preclude incurring costs beyond a certain point monetarily, even if a valuable social and psychological dimension would have to be sacrificed? Furthermore, if certain residents would be able to afford the extra personnel that would allow them more social flexibility, would it be ethical to allow them to “buy” such an opportunity, in the face of those who did not possess the wherewithal to do so? An additional consideration would be the recognition that one’s immune system is affected positively or negatively by your state of mind; feeling depressed at being excluded from the larger group might actually be counter-indicated in the interests of healing the sick (Exodus 21:19; Bava Kamma 85a).
Another constructive suggestion would provide for individual residents in assisted-living to be regularly evaluated with respect to their ability to participate in larger group activities such as eating together in the facility’s restaurants and dining halls. This would create a system similar to where at least three individuals would be placed in charge of Tzedaka distribution in order to try to make the process as fair as possible and allow for deliberation regarding individual cases (Pe’ah 8:7). While such determinations might prove disturbing to those who will be subject to them, perhaps such risks and possible short-term disruptions are worth the long-term achievement of more equitable treatment and advancing personal self-esteem, a sense of possessing Tzelem Elokim (the quality of having been created in the Image of God—Genesis 1:26-7)).
While the discussion to this point considers the sensibilities of those who will suffer exclusion from their desired setting and relegation to one that is less pleasant and amenable, there is also the concern of the residents who, at least for the time being, are living independently. Unless these individuals are spiritual and even traditional in their religious observances to the point where one could invoke the need to be considerate of others (Proverbs 3:4) , putting oneself in their shoes (Avot 2:4), realizing that we are all responsible for one another (Sanhedrin 27b) as well as attempting to manifest Hillel’s rule, “What is hateful to you, do not do to others” (Shabbat 31a), it will be difficult to insist that they demonstrate sensitivity towards their less-fortunate co-residents. Perhaps to counter this reality, the healthier residents should also be given the choice to either sit with the more infirm residents, or opt not to. In this manner the settings can be sufficiently personalized to satisfy a larger constituency of the residents. But unfortunately, it is clear that one “can’t keep all the people happy all the time.”
Judaism places great value on caring for the elderly. The Ten Commandants contain the admonition to “Honor your Father and Mother” which is interpreted to mean that you must care for them when they become aged. Several sources provide quotes to use for teaching:
·“You shall honor the old.” - Leviticus 19:32
·“Abandon me not when I grow old.” - Proverbs 71:9
·“He who learns from the old, to what can he be compared? To one who
·“Whoever greets the old... it is as if he greets the Divine Presence.” -
Midrash Tanchuma, Ki Tisa 27
·“Gauge a country’s prosperity by its treatment of the aged.” - Rabbi
Nachman of Breslav
·“ A test of a people is how it behaves toward the old. It is easy to love children. Even tyrants and dictators make a point of being fond of children. But the affection and care for the old, the incurable, and the helpless are the true gold mines of a culture.” Abraham Joshua Heschel
Caring for the sick is an equally great value, and there are many, many texts you can use to teach, here is a small sampling:
I.“These are the commandments, the fruits of which a person enjoys in this life, while the principle endures for him to all eternity: honoring one’s father and mother, performing deeds of lovingkindness, hospitality to wayfarers, visiting the sick, dowering the bride, accompanying the dead to the grave, devotion in prayer, making peace between man and his fellow, and the study of Torah is equivalent to them all.” - Mishnah Peah 1:1
II.“Visiting the sick is a mitzvah which everyone is obligated to perform. Even someone who is great (who has high status) should visit someone who is not. One should visit several times in one day. The more one visits, the more praiseworthy it is, so long as this does not bother the patient. When one visits the ill, it is as if he takes away a portion of the illness and lifts the burden of the illness. When one does not visit (the sick), it is as if he has shed blood." - Moses Maimonides, Mishneh Torah, Laws of Bikkur Cholim
III.Rabbi Hiyya ben Abba fell ill and Rabbi Yochanan went in to visit him. He (Rabbi
Yochanan) said to him: “Are your sufferings welcome to you?” He replied: “Neither them nor their reward.” Rabbi Yochanan said to him, “Give me your hand.” He gave him his hand and he raised (healed) him.
Rabbi Yochanan once fell ill and Rabbi Hanina went to visit him. Rabbi Hanina said to him: “Are your sufferings welcome to you?” He replied: “Neither them nor their reward.” Rabbi Hanina said to him; “Give me your hand.” He gave him his hand and he raised him. Why could not Rabbi Yochanan heal himself? They replied: “The prisoner cannot free himself from jail.”
- Brachot 5b
Given the clear messages of these texts we are all commanded to take care of the elderly, visit the sick, and respect each person’s divine individuality. The retirement communities described in the New York Times article need to carefully balance the needs of all of their residents and take care of each of them with dignity and respect. These texts will lead to a rich discusion of values.
Question: “RE: article in NYT Feb.14 2012 Science/Health section about a Senior Residence Facility passing an edict that residents in the Assisted Living and Nursing facility can not eat in the same dining room as the independent living residents. (I recommend you read the article). Some couples and friends can no longer dine together. Various reasons were cited for the decision. Space, mobility, safety, and concern about depressing the independent residents, among other reasons. This is screaming out to me as a great discussion topic in Jewish values. I can point to the values of caring for the sick and disabled, treating your neighbor as you would like to be treated, honoring the elderly, etc., but I am looking for specific sources and quotes to use as a teaching lesson. Thanks.”
The complicated situation that this article details (“Tables Reserved for the Healthiest” NYTimes for February 9, 2012, found online at http://newoldage.blogs.nytimes.com/2012/02/09/tables-reserved-for-the-healthiest/?ref=health) can easily break one’s heart. To hear that couples have been separated, or that seniors with disabilities were excluded because they seemed – by someone in authority – to be unable to care for themselves in the communal dining room, is shameful. And yet, when one reads this report, one begins to see the various sides of this issue.
As with many – if not all – ‘ethical matters’, selecting one particular course of action is not a choice between ‘good’ and ‘bad’, but rather between many competing ‘good’ values. We want to honor those who want to live independently and, at the same time, it’s vital to be concerned about the safety and health of all the residents. When we filter out the voices of exclusivity from that article (“I should be able to have what we call quiet enjoyment,” said one female resident. And “It’s a very upscale community,” said [the developer and current executive director of the Norfolk facility]. He continued, “When someone comes in wearing a coat and tie, with guests, they want an ambience of fine dining”.), I think we can find points of contention between competing values.
So it’s not a matter of one side being more correct than another. But using one specific Jewish value one might be able to see a pathway toward resolving the question.
I begin with a commandment from the book of Leviticus. In chapter 19, verse 32, we read, “Rise up in the presence of the hoary head, pay honor to the elderly. You shall fear your God: I am the Eternal.” This teaches that we are to ‘honor’ and ‘pay respect’ to the elderly; and the “fear” that this verse speaks about leads us to be mindful of the importance of this value: Our ancestors believed that a violation would lead to divine retribution, so we were instructed to watch our behavior toward and our words about very carefully.
So there is no question that the elderly have a special place in Jewish praxis. And since exclusion from certain activities or facilities is anathema to this value of honoring our elderly, we need to define this value for us and for those whom we are to honor. That may be all the prompting you need for a values-based discussion on this article.
What does it mean to honor? When someone becomes ill during dinner and ‘throws up,’ do we honor the sensibilities of those who can’t deal with someone becoming sick, or do we honor the ill and have compassion for their situation? Concerning the safety issue, do we honor the elderly who want to live completely independently, or do we honor the other residents who have legitimate safety concerns about wheelchairs that can pose safety risks, and find someone to accompany them through the buffet line, a place admittedly where there are safety issues?
These are the ethical questions that can form the basis for a properly guided discussion on what it means to honor the elderly.
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