My Last Survivor
Preface: Ever since moving to Florida in 2005, I have been involved in the assisted living industry. In every retirement home I have operated, there has been at least one Holocaust Survivor who was a resident. That was until my last assisted living facility, or so I thought.
"Eli, your sister has got to stop calling my staff racial slurs and stop calling me a k**e*."
All I can hear is a snicker on the other side of the telephone line.
I ran a fifty bed assisted living facility (ALF) with a limited mental health license. Many of the residents were diagnosed with major mental illnesses such as Schizophrenia or other psychotic disorders. However, most of the residents understood, through their personal experiences, that racial and antisemitic name calling was not acceptable. Miriam1 understood that what she was doing was wrong and understood that there were consequences for her conduct.
She did not care.
No matter what intervention we used to reduce Miriam's behavior, nothing worked. In fact, the behavior just elevated. It reached a point that it affected her roommates as well as the residents of the community.
I asked Eli about his reaction and why he was laughing. He responded that this behavior was so unlike Miriam. His older sister understood and experienced antisemitism firsthand.
He went on to explain that his sister was born in 1943 Poland. I was astounded.
"You mean to tell me that your sister was born in Poland, in the middle of the Holocaust?"
"Yes."
That meant she was almost two years old when the war ended."
Miriam grew up in a displaced persons camp. Eli told me that even though she was a toddler then, her only memory was playing on top of the brick rubble at the displaced persons camp.
By official and clinical definition, Miriam was considered a Holocaust survivor. Studies have shown that children who experienced severe trauma, even at two years of age, still have vivid memories of their experiences.
During the last few years of my career while operating and correcting assisted living facilities, I decided to switch from facilities that cared for the elderly to those that were licensed to care for the mentally ill. Prior to that I worked on a limited capacity with this population. They were younger in age and I felt I could make a difference2. Plus, I wanted a change.
When I switched to a mental health setting, I realized that there was a strong probability there would not be any more survivors among the residents. Throughout my career, there was always at least one survivor among the residents I cared for. In one ALF that I ran, there were eight survivors. Survivors were always given special recognition. Those who were able, helped plan for Yom HaShoah, Holocaust Remembrance Day. Their history needed to be retold, and it was.
But here I was, in 2019, at a new assisted living facility with no more survivors. That was, until I spoke to Eli. Miriam was my last survivor. I was determined to do right by her, even though her behavior warranted issuing a letter of eviction to find another ALF.
Her behavior was demoralizing to my staff. They understood that she had mental health issues and always conducted themselves professionally. I was proud of them. However, it was time to take this moment a step further, to create a teaching moment. I conducted a workshop for them about Miriam, the Shoah, her childhood background and its effects on her behavior. They were able to work with her with more understanding and compassion resulting in incremental, positive, behavioral changes by Miriam.
Then came Covid. All residents, on orders of the governor and enforced by the Department of Health, had to shelter in place and not leave their room. The residents’ meals were served to them in their rooms, and their medications were administered to them in the same manner.
A mental health crisis was about to ensue, and I wrote to the Department of Health regarding my concerns. Imagine being cooped with your roommates for weeks on end. It would affect anyone, as it had in our society.
My biggest concern was Miriam. She and her two roommates were always at odds with each other.
To reduce the possibility of a crisis, we did two things:
We had a large yard at the facility and twice a day, initially under the observation of the Department of Health3, we conducted dances or exercises with residents having them maintain the required six-foot distance from each other.
Every day, without exception, I, with my Director of Nursing, and at times with our psychiatrist, would go to every room to check up on the mental health status of every resident.
Miriam and her roommates were our biggest surprise. There was a lovefest going on in her room. They really got along with each other and laughed together. In fact, Miriam shared her snacks that her brother sent her on a weekly basis with her roommates. I attribute the success to the change of dealing with Miriam as a result of how we worked on her shortly before the pandemic.
There was one problem, Miriam would always stay in bed. We begged her to walk around. Those were the days when elective therapists, or visitors of any kind were not allowed on campus because of Covid. I had my staff accompany and support her on walks. Initially she would only walk thirty feet and then insist she be taken back to her room. As time went on, she was adamant about staying in bed. No one could convince her otherwise.
She declined to such a degree that she had to be taken to the hospital and then rehab. We did not want this to happen because hospitals were packed with Covid cases, but we did not have a choice to the matter.
After two weeks, we received a call from the discharge social worker of the rehab unit saying Miriam was ready to return. I did not believe her. Knowing Miriam's condition, I knew she would not be able to regain strength within fourteen days. There might have been two reasons for that call: Miriam's medical insurance refused to cover anything after 14 days, or the rehab center was overwhelmed with Covid cases and was short in staff.
Unfortunately, even before Covid, whenever a rehab center would say a resident was ready to be discharged, I, or a member of my staff, would travel there to make sure they were telling the truth. I could not do that this time since visitors were not allowed on premises. Instead, I was firm with the discharge planner and said the ambulette would not be leaving until we checked Miriam out. Plus, a Covid test had to be administered to her, which bought us another 48 hours.
Miriam arrived. She was so thrilled, as were her roommates and all of us. There was one problem. She was in worse shape now than when she left us.
The survivor in her came to the forefront. She was determined not to return to the rehab center. She tried getting up from her wheelchair. Even our staff tried to assist her. All I needed was for her to stand on her own two feet, which was less than what qualifies one to live in an assisted living facility. Her legs were shaking severely. She was so desperate to remain, but sadly she needed to return to the rehab. We were so devastated. I lost my last survivor. The rehab did a huge injustice by her.
In time, Miriam was transferred to an LTAC4. I was not allowed to visit her. During those days, health care centers were prohibited from allowing any visitors to visit their patients due to Covid.
On August 29, 2021, the thirteenth of Elul 5781, Miriam’s brother informed me that she passed away. I was bereft. Again, no one was allowed to attend the funeral due to Covid. It was televised on ZOOM.
I had so many questions yet to ask Miriam about her memories. The Displaced Persons Camps had their own place during the Postwar years. I think of Miriam often and do miss her.
May Her Memory be a Blessing. יהי זכרה ברוך
Postscript: After Miriam passed away, I told her brother I was going to write about her. As with many of my articles, it could take weeks, months, or even years to put it in writing after formulating it in my mind. To Eli, please accept my apologies. I was determined, this year, to post an article before Yom HaShoah, Holocaust Memorial Day.
For reasons of confidentiality, Eli and Miriam are not their real names.
To give the reader perspective, the mean age of a retirement home at the time was 86 years old, while the mean age of my limited health assisted living facility was much younger at 68 years old.
The Department of Health did not observe us to see whether we were in compliance. They came as a result of my letter to them. They were taking notes to pass on to other assisted living facilities.
Long-Term Acute Care (LTAC), refers to specialized hospital facilities that provide intensive, ongoing care for patients with complex medical conditions who require extended acute care.
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