Even with dementia, life can still be worth living

Leah Abramowitz, a veteran social worker and specialist in caring for Alzheimer’s patients, is retiring at 78.

By JUDY SIEGEL-ITZKOVICH
leah aBRAMOWITZ 370 (photo credit: Judy Siegel-Itzkovich)
leah aBRAMOWITZ 370
(photo credit: Judy Siegel-Itzkovich)
Many people regard Alzheimer’s disease – the most common cause of dementia – as a hopeless death sentence. Yet, although it is a progressive, fatal disorder that affects two percent of those over age 65 and 20% of those over 80, there are numerous things that can be done to ease the suffering of those with the condition and that of their families. There are currently 100,000 families in Israel caring for a relative with Alzheimer’s symptoms. With increased longevity, these numbers will continue to rise.
Near the end of 1980, Shaare Zedek Medical Center (SZMC) social worker Leah Abramowitz, geriatrician Prof. Arnold Rosin and colleagues – having witnessed the problems faced by patients and their families after the diagnosis who lacked advice and facilities for coping – established Melabev (the Hebrew acronym for Center for Treatment of the Elderly in the Community). In a long, evolutionary process, Abramowitz and her team studied the field here and abroad, discovered ways to slow the development of dementia and cheer the victims, developed programs and set up memory clubs, day care centers, home care projects and accredited courses for professional and lay caregivers.
Next year, a spacious new home for Melabev will open in Jerusalem’s Givat Masua quarter (not far from the Kiryat Menahem neighborhood) to provide at one address a variety of services and support to Alzheimer’s victims and their loved ones.
Now, after 33 years in Melabev and the receipt of the Jerusalem Municipality’s Yakir Yerushalayim award, the religiously observant social worker has announced her retirement, but says she will continue to be involved in various Alzheimer’s activities – and give even more attention to her and her husband Abe’s tribe of 13 children and their spouses and scores of grandchildren and greatgrandchildren.
Melabev CEO Motti Zelikovich has taken over responsibility for the organization.
Leah says she will continue to give courses and run seminars and retreats, run support groups and give personal counselling on aging. In addition, she is a member of the pensioners’ council of the municipality and supervises social work students at various universities.
She was born Lotte Froelich in Germany in 1935, daughter to a religious family who sensed the Nazi danger at the rise of Hitler and fled to St. Louis, Missouri. They were active in the local Young Israel synagogue and Zionist activists. When the State of Israel was established, she joined the Bnei Akiva youth movement and first arrived here in 1954 with a religious Zionist group.
It wasn’t long after her return to her family that she was chosen a representative of the Bnei Akiva movement and sent to Montreal, at the same time earning her bachelor’s degree in sociology and psychology at Sir George Williams College. By 1957, she came on aliya and worked in the Social Welfare Ministry as an examination officer and an occupational adviser.
Leah met her husband Abe Abramowitz, a South African immigrant and accountant, and they married in Jerusalem. But after a short while, the idealistic couple decided to settle in the new southern development town of Netivot, where Leah worked as a communal social worker. Two years later, the couple – now raising their first three children – decided to return to Jerusalem after the Six Day War and became pioneers in the resettlement of the Old City’s Jewish Quarter, where they have lived ever since.
LEAH BEGAN work at SZMC as a medical social worker and completed her first and second degrees in her profession. The only solution for dementia patients she encountered there was to refer them to old-age homes, but that was usually not the right solution, because just being there shortened their lives.
Asked whether she had any personal family experience with Alzheimer’s, Abramowitz said no, but her mother contracted “poststroke dementia.” The disease she deals with daily does not scare her, because even though there is no cure yet, “there are things you can do to help patients and their caregivers.”
She had found it “frustrating that when their hospitalization ended and they had to be taken home, there was nothing to offer. People after a heart attack, stroke or hip fracture can be sent for rehabilitation, but not people with dementia. We started by trial and error until we understood what could help.”
Abramowitz recalls the day one patient wandered off from a day care center in the Kiryat Hayovel neighborhood, and a search had to be carried out. “After that,” she said, “we learned to lock the doors. We also learned to place people with early-stage dementia together and not mix them with late-stage Alzheimer’s. We learned how to get into the patients’ and caregivers’ shoes, to cope with wandering, repetition of sentences and their agitation. The good thing about Alzheimer’s is that if they fight something, they forget so one can start again.”
Many Israeli social welfare organizations, such as Yad Sarah, were established around 1980. “People with dementia deserved something better than what they had been given,” Abramowitz said in an interview with The Jerusalem Post. “They thought they had no more present and no future. The memory clubs to help preserve the memory that patients retained were the first in the country. We also established day care centers, support groups and other institutions. We used music for Alzheimer’s patients unable to speak who could nevertheless sing. Their memories as children and young people came reappeared.”
Families paid what they could afford, and then the Jerusalem Municipality under mayor Teddy Kollek and the ESHEL organization gave funds.
“We saw we needed professional people, not only amateur caregivers. From the first 10 employees, Melabev now has 250 volunteers and a smaller number of paid staff. We became an official voluntary organization, servicing Jerusalem and Beit Shemesh.”
Most families are referred to Melabev after their loved one is diagnosed by their health fund clinic doctor or at hospitals. Melabev has an assessment clinic at SZMC with a neurologist, occupation therapist, social worker and psychiatrist. The youngest-ever person to be diagnosed there was only 45. The interdisciplinary team reach their conclusion about each case. Patients are also advised about medications that can slow the development of dementia.
It is not the dementia itself that proves terminal, but complications such as pneumonia that bring the end, about 10 or 15 years after the first symptoms appear. However, they can survive longer as medical research and technology improve.
Among the activities in centers are gardening, art, music, animal-assisted therapy, yoga, massage and Snoezlen rooms that can be both soothing and stimulate the senses.
There are 10 centers in the capital alone. In other places around the country, there are municipal services for the elderly.
In 1989, the Melabev staff realized that some patients weren’t well enough to be bused to day care centers and memory clubs, so they launched home care services as well.
“Many couldn’t make their way up and down the stairs to the van. So we went to them, evaluating needs, giving counseling and then offering activities at home through ‘Melabev Ad Habayit.’” This expanded beyond Jerusalem and reached Tel Aviv, the Sharon region and the north as well. “We try to organize groups according to languages in which patients feel comfortable. We have some for Russian speakers, three for English speakers and one for speakers of Arabic. The Arab group is small, as many women in the community do not go out to work, so they usually take responsibility for demented elders, but we supply Arabic-speaking counsellors. We hope to have a French-speaking group in the near future.”
Finally, more knowledgeable about the disorder and more systematic, Melabev launched training for professionals, with retreats in Jerusalem or in a kibbutz.
“There are outpatient facilities for Alzheimer’s patients in other cities and towns, Abramowitz said, either through municipalities or the Joint Distribution Committee, but we feel our level of care is higher because we insist on using many professionals.”
Abramowitz established the Institute for the Study of Aging at SZMC, which offers courses, seminars and workshops for in-service training accredited by three government ministries to teach professionals. She also participated in a 200-page, soft cover Hebrew-language book published by ESHEL and called Alzheimer Ve’dementiot Aheirot (Alzheimer’s and Other Diseases) edited by Rahel Birnbaum, that serves as a textbook for those interested in the subject.
A free “telephone reassurance service,” reached by dialing 109, uses over 109 volunteers to call lone dementia patients at home and ask daily how they’re feeling, coordinate home visits, help out with buying groceries and medications, arrange for home repairs and do haircuts, manicures and medical pedicures (for a nominal fee).
Savion, a unique, mind-stimulating computer program developed by Melabev specially to help dementia patients is available to Melabev centers to challenge the patients in math, language, shapes and memory cognition.
Most of the users have never touched a computer before, said Abramowitz.
“The software uses big letters, terminology familiar to the elderly and shapes combined with words. It can be used even in private homes and adapted to each person’s level of competence and interests. It increases the user’s self-esteem by letting them feel that they can use a computer. From our experience, we see that even people with significant dementia can and want to use the computer.
A Ben-Gurion University Health Sciences Faculty pilot research study has shown that the use of Savion for as little as 20 minutes, twice a week, had positive aspects on some aspects of memory.
“People who work in Melabev have a special personality attracted to working with the elderly. They know how to relate to them and giving them dignity and respect,” said Abramowitz. “They know how to draw out the best, even from those with advanced dementia.”
NUMEROUS RESEARCH groups on Alzheimer’s have come to Melabev to learn.
They have shown that going to Melabev day care is as effective as preventing further deterioration as medication is, Abramowitz said.
“Often, the demented act like babies. We can’t reverse dementia, but we can improve their quality of life, improve their self image and draw out more acceptance from their family members. They have a new way of looking at their parents. Their mothers can suddenly serve them tea, while their fathers can lead prayers.”
Israel is still a family-oriented society, concludes Abramowitz.
“Ninety-give percent of Alzheimer’s patients live at home and have help from family or a paid caregiver. In Europe, most are institutionalized. Caregivers from the Philippines have saved the day here; they are extraordinarily devoted. We give courses for the caregivers in English, and it serves as a support group for them.”
Melabev can be reached at 1-700-70-4533 or www.melabev.org