Melabev, a leader of Alzheimer’s care in Jerusalem, received the highly coveted Glickman Prize from ESHEL, the agency of the Joint that oversees eldercare services in Israel for its innovative Home Hospice Care program, which receives funding from the UJA-Federation of New York.

The Certificate states:

For Home Hospice Care of Demented Patients with a multi-profession staff.

For supporting the weakened abilities of the target population and their families in their hour of need, and protecting the patients’ dignity in their last stages of life.

For providing on-going practical and spiritual support for the families. And for improving the quality of life for the elderly living in the community.

The M. Family of Jerusalem would agree with all of the above. Mrs. M, whose mother-in-law has late stage Alzheimer’s disease, details the ways in which the Home Hospice team of Melabev has helped her family:

“They have always been there for us, they are always available.”

The patient was assessed by Yehudit Lange, the Occupational Therapist who has over-all responsibility for the activity worker who comes twice a week for the patient, and the physical therapist who has an additional session with her.

The Social Worker, Chaya Ben Yaacov, understands everything that’s going on in the family, says the daughter.-in-law.

Miriam Fried, R.N. and family therapist - “taught the foreign worker the best way to manage my mother-in-law in the shower,” says Mrs. M.

“This is a progressive disease,” Mrs. M. continues, “and none of us knew much about it before. It’s not just that there are three different stages to the disease [early, middle and late] but there are different levels within each phase, and the patient can swing back and forth. Every day is a different ballgame--even in the same day there can be changes. Everyone in the family reacts differently to the changes in the situation. Chaya can be reached practically any hour of the day. She irons things out and sees to it that everyone in the family is on the same page.”

Chaya Ben Yaacov adds, “It’s not commonly known what can be expected of the patient,” she says. She quotes one caregiver explaining, “Every time I think I found the ground under my feet, the floor moved again.”

In the end stage of the disease, in particular, where the Homecare / Home Hospice team is supplying palliative care for their patients (to relieve bed sores, and massage or music or aroma therapy to ease them) it’s particularly necessary to provide extra support for the family. “That means meeting them on their terms and as frequently as needed. There can be telephone calls daily,” Chaya says.

The Melabev Home Hospice project for Alzheimer’s patients, which was initiated with the support of UJA-Federation of New York, is the only one of its kind in all of Israel. The health funds provide both home care and home hospice – but most usually for cancer patients and not at all for dementia patients (unless the dementia is in addition to cancer or another physical illness).

Melabev has been running its unique home care program for over 15 years.

Chaya Ben Yaacov, MSW, coordinates the therapists, the nurse and family therapist who are on the Home Hospice team, working with end stage dementia patients. Three geriatricians provide the medical specialization needed, such as prescribing the best medication to help with patient management. The Melabev doctors are in continuous contact with the family physician.

Judy Montel, a music therapist, speaks of her emotions in connecting with an end-stage patient a few months before the mentally frail woman passed away. . . .. . .The therapist gained the insight to play music from the patient’s past that mattered to her and evoked a response. Even though a dementia patient may appear disconnected from reality, “Music could break down barriers and create an environment where connections could be made,” Judy says. “It’s even possible to form a new relationship.”

Judy agrees with the statement, “The disease is very unpredictable.” By this she means, “You mustn’t refrain from trying things because the ‘book’ says you can’t. . . .This patient opened the world to me that I hadn’t known before. I learned from her that no matter how decrepit we are, how severe our illness, or our cognitive loss, we’re still ‘us’. . . On Thursday [two days before her death] my patient was still trying to sing along, although she was very weak.”

“I should not have been surprised [by her passing], since I knew we could lose her at any moment. But routine makes us feel it will continue.”

Yet for many caregivers, “Alzheimer’s is a living death,” Chaya notes. “The family mourns for someone long before they’re gone. ‘That’s not my mother anymore. She no longer recognizes me,’ they say.” How can the social worker help them? “By being there with them. By letting them give testimony. Letting the family member say it aloud can be comforting.”

“One of the most important ways we help the family caregivers,” says Miriam Fried, “is by giving them permission to take care of themselves. It’s O.K. for the spouse of a late stage Alzheimer’s patient to go to a class or have cup of coffee out. You aren’t being disloyal to your mate by taking care of your needs.” She acknowledges there’s a fine line between taking care of oneself and neglecting the spouse. One should avoid doing anything that would cause guilt later on.

She also advises family members to let other people do the physical caregiving, when possible. And she gives them permission to talk about death and mourning.

Indeed, Mrs. M. values the ability to speak to Chaya about anything. “We can all open up to her and she helps us solve problems.” Although she says the patient has declined, the family has learned to work together to handle it. “We all work as a unit, along with the Melabev team.”

How do the professional caregivers handle so many heavy issues? At the end of the day, how do they take care of themselves? “I walk, I read, and I have a supervisor, with whom to discuss issues,” Miriam Fried says. Though the social work supervisor, Rivka Ish Shalom, functions behind the scene, she is another essential member of the team.

Together, the multi-professional team of Melabev’s Home Hospice fulfills the characteristics certified by the Glickman Award.