Home With Sarah: Reflections on Enabling Israel's Elderly to Live on Their Own

"I remember as a girl, back in the orphanage in France, there was this yellow cheese that we all loved to eat," says Sarah, who was born in Paris and made aliyah in 1967. "It was donated by the Joint."

Nearly half a century after leaving the orphanage, now living in Jerusalem, Sarah's life is still being impacted by the Joint – the JDC. Sarah's neighborhood is one of 112 areas designated as a JDC-ESHEL Supportive Community, of which she is a member.

The JDC-ESHEL Supportive Community program – which was created in 1989 in partnership with the Ministry of Social Affairs and local associations for the aged as well as municipalities – provides the necessary infrastructure and support to enable the neighborhood's elderly to continue living at home rather than in institutions.

Sarah's case is severe: she suffers from myriad illnesses – including heart problems, severe diabetes, high blood pressure, and asthma – that in theory make living on her own both a challenge and a risk. Her condition could require medical attention at a moment's notice. And among other problems, when Sarah needs medicines, severe asthma makes it virtually impossible for her to walk the narrow, cobblestone streets from her apartment to the nearest main road to hail a taxi to the pharmacy.

Despite her health complications, Sarah is youthful, vivacious, and engaged in the community; she looks out for her neighbors and her poodle, Bonnie. "Ever since I adopted him, I've had much better luck," she says as the dog laps his tongue on her cheek.

Through the project, Rivkah, Sarah's Supportive Community "mother", or caretaker, arranges for Sarah's prescriptions to be brought to her home and coordinates transportation for her to reach other medical facilities. Rivkah is also assisting Sarah in her search for a new apartment, since the dampness in the walls of her current home greatly aggravates her breathing condition. The community "father", or handyman, Shaike, tends to all of the repairs: he changes light bulbs, fixes broken appliances, and rides on his motorcycle through the winding streets with tools and other essentials.

Since loneliness is also a frequent side effect for elderly living on their own, a social worker visits with the community members and evaluates them periodically. Community "mothers" also spend time with each member. "I also gain a lot from this project…it enriches me," says Rivkah. "I sit and listen to their stories and learn quite a lot. I call it the University of Life."

In addition to the personal attention that she receives from the community "parents", Sarah is hooked into a 24-hour emergency communication center. As is the case with all members of JDC-ESHEL Supportive Communities throughout Israel, Sarah wears a bracelet with an emergency button that she can press in case she falls, feels ill, or needs help of any sort. A similar button and intercom system are installed in her home – and in 158 other residences in her neighborhood. When either button is pressed, a signal alerts the communication center and within 30 seconds an attendant responds through the intercom – personally addressing the caller – prepared to dispatch the necessary assistance. This system gives elderly who may otherwise not be able to live unattended the security to continue living independently in their own homes.

"This neighborhood is something special," says Sarah, her French accent slightly detectable. "Everybody helps with something. One neighbor took care of my dog while I was in the hospital. And just a few weeks ago I mentioned to the [Supportive Community] social worker that I wanted to fix my teeth. They know I can't afford much. Without having to say another word, they called me and said they had arranged a very low price at the dentist so I could have it done."

To maintain the dignity of its beneficiaries and to help make the Supportive Communities self-sustaining, a small sliding fee is charged to members (individuals with the greatest need for subsidies pay only $10 per month). Among the services included is no-fee transport by ambulance, irrespective of the patient's condition; this is essential in Israel which has a unique policy that if you are not admitted overnight to the hospital insurance does not cover the cost of the ambulance. This cost– approximately $100 – is exorbitant for Sarah and other elderly, who may live on a pension of $400. Therefore, elderly outside of Supportive Communities often hesitate to seek help when they need it for fear they will end up with an ambulance bill they cannot afford.

Recently Sarah saved the life of one of her neighbors, who she heard screaming from a nearby apartment. "He had cut himself and blood was spurting out," she explains. A veteran nurse of Tel Hashomer, one of Israel's most respected hospitals, Sarah was able to stop the bleeding and also get assistance for him by pressing the button on her emergency bracelet. "He used to be stubborn about becoming involved in the Supportive Community," says Sarah. Now he has become a member and benefits greatly from the program. "When you have something so good, it is only natural to want to share it."