MONTREAL — A candid explanation of why many Orthodox Jewish seniors are suspicious or even fearful of providers of health and personal care is offered in a newly published handbook titled Bridging Worlds.

Written by Ahavas Chesed, a grassroots social service agency in the Orthodox community, the handbook contains practical advice for professionals and workers on how to overcome the resistance and phobias they may encounter among their religious Jewish clients. The publication also serves as a primer on the Orthodox community’s history, religious customs and lifestyles.

This type of straightforward information and guidance is needed, according to Ahavas Chesed director Carol Polter, because of the increasing reliance of Orthodox seniors in Montreal on “outside” help.

About 80 per cent of these elderly Jews are Holocaust survivors, a fact that compounds the community’s traditional reluctance to accept assistance from those not their own.

Admitting “foreign” service providers into their homes and letting them give them intimate care does not come easily for these seniors, and often their family as well.

At the same time, the often strange practices (to non-Jews) of Orthodox Jews and the seemingly irrational reaction of the elderly to benign situations can be a challenge for even the most well-intentioned caregiver.

Turning to help outside the community has become a necessity for the Orthodox, with more of the younger generation living outside Montreal or otherwise unable to assume responsibility for all of their elderly parents’ needs.

Home care is not the only issue. Regular medical or hospital treatment can also provoke anxiety among vulnerable Orthodox seniors, the handbook points out. The result is that situations often reach a crisis before they or their families turn for help.

“Survivors remember a world that betrayed their trust in humanity,” the handbook states. “For some, coming in contact with hospitals, nurses, social workers and so on, elicits difficult reactions and behaviours, reminiscent of their earlier life of pain and loss.” Even those with cognitive loss may still retain a sense of what happened to them during the war years, the book notes.

Ahavas Chesed (Hebrew for loving kindness), founded 13 years ago by Polter, offers crisis management, advocacy, information and referral. Perhaps most importantly, it acts as a cultural interpreter between the Orthodox communities and health care and service providers, both in the public and private sectors. Last year, it held a daylong symposium, also titled Bridging Worlds, attended by about 140 people, from the helping professions, as well as police and other public agencies, to sensitize them to the culture of Orthodox Jews.

Far from being critical of those working with Orthodox seniors, Polter congratulates the great deal of goodwill they show and their genuine desire to better understand and gain the confidence of their clients.

The handbook opens with a sketch of the Jewish community in general in Canada, the Holocaust and Orthodox life today. It explains the nuanced differences between the four major Orthodox populations in Montreal: the Yiddish-speaking “downtown” Outremont Chassidim; the English-speaking “uptown” yeshiva community; the Lubavitch community; and the estimated 35,000 other Jews living mainly in Côte St. Luc, St. Laurent and Dollard des Ormeaux, who follow the Jewish laws strictly but are more integrated into general society.

Bridging Worlds itemizes some of the triggers that can evoke painful memories for survivors, including such everyday occurrences as taking a shower, shots or needles, being shaved, orders to go right or left, or small spaces, such as elevators.

The handbook cites a 2003 survey conducted by Ahavas Chesed and FEDERATION CJA that found that close to one-third of Orthodox seniors have children outside Montreal and are living here alone.

The relationship between Orthodox adult children and their elderly parents can be complex. The children can carry enormous guilt about not doing enough for their parents. Now between 55 and 65 themselves, they are dealing with the demands of their own large families and a growing number of grandchildren.

The picture can get even more complicated if the spouse, usually the wife, elderly herself, has been the caregiver until now of the senior needing help.

“It is this picture into which a worker steps… She will sense, almost hear, ‘I need help urgently, but don’t even think of helping me,’” the handbook says.

“This worker needs to be well informed about history, about family dynamics, about what is accepted into this home and about how the home is managed.”

Workers, whether in the home or an institution, have a responsibility to learn about the Orthodox Holocaust survivor’s history to understand what sort of care would be comfortable and what could trigger resistance, Polter said. “They need to understand how the Orthodox survivor’s faith will colour all behaviours, how, ultimately, this faith sustains and directs life’s decisions.”

The handbook says the Orthodox should be offered the choice of a male or female worker, that home-care workers should not dress in an immodest way that might offend their clients, and should not bring non-kosher food into the home. While requests like that became issues of contention during Quebec’s “reasonable accommodation” debate, Polter said asking for such considerations is not different from not allowing people to smoke in your home.

Bridging Worlds, which has been published with private donations, may be purchased at a cost of $35 by calling Ahavas Chesed at 737-3029 or sending an e-mail to [email protected]. Include “Holocaust Handbook Request” in the subject line. Excerpts from the handbook can be found at www.ahavaschesed.ca.