January/February 2013 Issue

Supporting Elder Holocaust Survivors
By Jennifer Van Pelt, MA
Social Work Today
Vol. 13 No. 1 P. 8

International and National Holocaust Remembrance days have been established as a memorial to deceased victims and living survivors of Nazi persecution. On these days, media often cover efforts to return property and valuables confiscated from Jewish families, pensions for survivors, and Holocaust educational programs, such as concentration camp survivors visiting school history classes. A less publicized effort is helping aging Jewish Holocaust survivors every day.

Since 1951, the Conference on Jewish Material Claims Against Germany, or the Claims Conference, has worked to obtain justice for Jewish victims of Nazi persecution during the 1930s and 1940s in a variety of ways. The organization negotiates with the German government for direct payments to Holocaust survivors as well as for a majority of the funding for allocations to social welfare agencies that service Holocaust survivors. In 2012, approximately $285 million was allocated for elder survivors in 47 countries worldwide, of which the majority came from the German government and proceeds from German properties of Holocaust victims that were recovered by the Claims Conference.

In 1995, the Claims Conference and the Alpert Jewish Family & Children’s Service (AJFCS) started the first social services program for Holocaust survivors, bringing attention to the plight of survivors after years of silence. Now, the Claims Conference funds approximately 100 social welfare agencies, reaching about 18,000 survivors across the United States every week with home care visits.

A primary goal of the organization is to keep aging survivors living independently in their own homes for as long as possible. “We want to ensure that in their final years, Holocaust survivors live with dignity,” says Greg Schneider, executive vice president of the Claims Conference.

As a result of the extreme physical and psychological suffering endured under Nazi occupation and persecution, elder Jewish Holocaust survivors have additional issues above and beyond the normal stresses of aging compared with the overall older adult population, including the following:

• higher rates of physical and emotional distress;

• greater likelihood of osteoporosis, dental problems, impaired vision, and heart issues from prolonged malnutrition in childhood and early adulthood;

• higher incidence of all cancers, especially breast and colorectal;

• higher rates of anxiety disorders and sleep disturbances, and higher use of psychiatric medications;

• greater difficulty performing daily living activities; and

• more poverty, as 22% of Jewish immigrants were at or below the poverty level vs. 4% of other Jewish Americans of similar age, according to a 2003 United Jewish Communities report.

Need for Cultural Competence
While these physical and mental health issues may be similar to American elders who grew up in poverty or experienced a rape or assault when younger, the mental trauma experienced by Holocaust survivors is unique and horrific. Living through genocide and then reliving that trauma for one’s entire life is very different from other types of trauma that social workers encounter, according to Jenni Frumer, MSEd, LCSW, LMHC, NCG, associate executive director at AJFCS. “Cultural competence is absolutely essential for anyone working with Holocaust survivors,” she emphasizes.

Supported through allocations by the Claims Conference, Frumer and colleague Eva Weiss, MEd, EdS, a certified gerontologist and lead coordinator of the Holocaust survivor assistance program at AJFCS, train healthcare providers, home health workers, social workers, and others involved in supporting aging Holocaust survivors to identify, understand, and handle the many physical, emotional, and environmental/situational triggers that have resulted from Holocaust trauma. Weiss, the daughter of Polish Holocaust survivors, currently serves as a case manager and provides supportive counseling and assistance with reparations and compensations, and coordinates socialization programs for the more than 9,000 Holocaust survivors in Palm Beach County, Florida.

Holocaust survivors are experiencing the same aging-related issues as other elder adults, such as declining physical functioning and health issues. “However, the overlay of Holocaust survival creates a special situation,” Weiss notes. Support services to help survivors deal with aging-related issues actually may create fear and distress because they trigger memories of Holocaust horrors, evoking strong psychoemotional responses. Simple tasks, such as filling out a family history questionnaire during a social services or healthcare visit, bring back trauma. Common questions such as “How old were your mother and father when they died?” and “Do you have any siblings?” evoke memories of the last time they saw their mother and younger sister—when they were yanked from the client’s arms at a concentration camp or shot by German soldiers. A home health worker asking the client to shower may trigger memories of concentration camp prisoners being told they were taking a shower and instead were taken to the gas chamber. Becoming aware of triggers will help a social worker better understand such situational reactions, Weiss says. 

When clinicians misinterpret psychoemotional reactions to traumatic triggers, aging Holocaust survivors can be incorrectly diagnosed as having a behavioral or medical condition. Weiss describes a powerful example of how traumatic Holocaust memories can create psychological and behavioral issues that may be misinterpreted by caregivers. When a previously independent older Jewish woman fell and broke her hip, she underwent rehabilitation in an institutional setting. Her physical therapy was not progressing well, and the doctors concluded that she would never be able to live independently again. Weiss determined that the institutional setting triggered a fear rooted in the Holocaust experience: being on a meal schedule evoked fears of starvation. Once given some control over her meals, snacks, and food portions, the woman successfully completed her physical therapy and could return home. 

“Institutional settings are particularly problematic,” Schneider says, which is why social services focus on keeping aging survivors in their homes as long as possible. Staff uniforms, railings on bed, daily routines, janitors walking with jangling keys—things that other elder residents may ignore—take aging Holocaust survivors back to their traumatic days. “Physically, they are here in the 21st century. Emotionally, psychologically, they are back in the Holocaust,” Schneider explains.

Triggers vary depending on the survivor’s experience. Schneider and Frumer note that survivors may have fled their homes and hid in a forest, been imprisoned in concentration camps, or been subjected to medical experimentation. “[So] for someone who survived in a forest every night, nightfall takes them back to that fear,” Frumer says.

Barking neighborhood dogs may trigger fear, bringing back memories of being hunted. For a survivor of medical experiments, even a routine doctor’s visit or a minor medical procedure may trigger extreme emotional and psychological distress, she adds.

Even though they may have had 60 years of a good life with a spouse, children, and grandchildren, Holocaust survivors always go back to the horror. For example, it is common for elders to reminisce about childhood as they acknowledge aging and approach the end of life. “For the Holocaust survivor, what was their childhood? Days without food, soldiers killing, concentration camps, [and] losing family are their memories. They are taken back to the darkest part of the 20th century, not a happy childhood,” Schneider notes.

Therefore, it’s crucial that social workers understand Holocaust trauma and learn how to identify triggers, according to Schneider, Frumer, and Weiss. “Don’t be afraid to ask questions, though,” Weiss advises social workers caring for this population. “Holocaust survivors have dealt with far worse than a social worker talking to them. But you must be prepared for what you might hear when they answer your questions.”

— Jennifer Van Pelt, MA, is a freelance writer based in Reading, PA, and a frequent contributor to Social Work Today.

Resources
• Keinan-Boker, L., Vin-Raviv, N., Liphshitz, I., Linn, S., & Barchana, M. (2009). Cancer incidence in Israeli Jewish survivors of World War II. Journal of the National Cancer Institute, 101(21), 1489-1500.

• Paratz, E. D., & Katz, B. (2011). Ageing Holocaust survivors in Australia. Medical Journal of Australia, 194(4), 194-197. 

• Sharon, A., Levav, I., Brodsky, J., Shemesh, A. A., & Kohn, R. (2009). Psychiatric disorders and other health dimensions among Holocaust survivors 6 decades later. British Journal of Psychiatry, 195(4), 331-335.

• Stessman, J., Cohen, A., Hammerman-Rozenberg, R., et al. (2008). Holocaust survivors in old age: the Jerusalem Longitudinal Study. Journal of the American Geriatrics Society, 56(3), 470-477.