SERVING A BROADER RANGE OF SENIORS; SUSTAINING THE MISSION
A commitment to excellence in service to others and providing exceptional care to frail vulnerable seniors, including charitable support, is the Jewish Home’s founding focus and remains key to the Home’s mission – to enhance and enrich the quality of life for older adults. In general, the Jewish Home serves the most medically/cognitively frail, as well as financially compromised elders (94 percent of Jewish Home are Medi-Cal recipients or without the ability to pay the full cost of care), with an average age of 86.
To accommodate seniors’ diverse and changing needs, interests and wishes, the Jewish Home is actively engaged in a forward-thinking transformation and expansion of its campus so that it will serve a broader range of the Bay Area’s growing older adult population (as well as their families and caregivers) than it does currently – either on its campus or in individuals’ own homes and the community; revitalize the surrounding neighborhood and populace, thus benefiting San Francisco as a whole; and be financially sustainable, relevant, and viable for generations to come.
PROVIDING CARE FOR ALZHEIMER’S DISEASES AND OTHER DEMENTIAS
Innovations on the Jewish Home’s Alzheimer’s Garden Unit include an enclosed garden accessible only to this living environment and the creation of a more homelike setting in order to better serve these individuals. The careful, selective use of the WanderGuard (a signaling device that alerts when a person wearing one is about to exit the facility) enables the Home to care for many more residents with Alzheimer’s, as they may then safely reside on other living environments located on the campus. This also affords these individuals greater freedom to enjoy a variety of secure areas and outdoor spaces.
COMMUNITY HEALTH EDUCATION AND PROMOTION
The Jewish Home aims to promote and protect the community’s health by advancing and sharing knowledge and understanding of the factors that affect well-being. The following are some of the endeavors undertaken during fiscal year ending June 30, 2016.
Early in 2016, a number of Jewish Home senior staff joined a contingent of elder care experts from San Francisco on a fact-finding visit to Holland (specifically Amsterdam), a country that is known for its pioneering approach to senior care. In addition, and as part of the Seniors Quality Leap Initiative (SQLI), the Jewish Home has joined leading United States and Canadian organizations working toward a goal of reaching higher performance levels in quality and safety as they relate to seniors’ quality of life in long-term care facilities. Planning to provide the Jewish Home’s transformed campus as living and learning laboratories for entrepreneurs who are at various stages of creating new products describes the Jewish Home’s involvement with the Canadian Center for Aging and Brain Health Innovation (CCABHI). CCABHI is helping to accelerate the development, validation, commercialization, dissemination, and adoption of innovative products and services that are designed to support brain health and aging. By affiliating with these collaborative consortiums, and sharing staff expertise, organizational knowledge and best practices, the Jewish Home will be able to provide a better quality of life for Bay Area older adults as they age.
The Jewish Home-based UCSF Harris Fishbon Distinguished Professor serves as the director of Tideswell at UCSF (advancing community-centered care for the aging). The program serves as a catalyst for transforming the care of frail older adults through education, discovery, rapid testing, and the improvement of clinical care delivery models. In addition, it has facilitated the development and evaluation of an array of clinical care innovation projects, including home-based video care, home-based palliative care, complex care coordination, and an initiative to bring palliative care services to long-term care facilities. The program’s efforts contributed to the securing of two prestigious grant awards at UCSF: Claude D. Pepper Older American Independence Center and the Donald W. Reynolds Comprehensive Program to Strengthen Physicians’ Training in Interprofessional Care. Both these awards will ultimately positively impact the Jewish Home’s older adults’ quality of life and care.
The Fishbon professor co-directs the National Home-based Primary Care and Palliative Care Network and the Palliative Care Research Cooperative. This work will become even more relevant as the Jewish Home expands its care, services, and programs to support an increasingly broader range of older adults in the community.
As a result of the fostering of relationships with a range of Bay Area universities, a greater number of professional volunteers, masters of social work interns, and geriatric psychiatry fellows (from the University of San Francisco, in particular) are rotating through the Home’s acute geriatric psychiatry hospital. Also in the process of development is a proctor program with USF’s psychiatric nursing program. The aim is to inspire more professionals to pursue a career in the geriatric field and to provide a positive experience for all involved.
COMMUNITY ADULT EDUCATION
The Jewish Home recognizes that providing and collaborating in educational opportunities for adults foster personal and professional development, enhance a sense of community, and promote cross-cultural understanding, cooperation, and support. Below are a few examples of the learning programs and information-sharing made available over the fiscal year ending June 30, 2016.
Over the past 43 years, the Jewish Home has partnered with San Francisco City College in offering several adult education classes to the general community. Approximately 20 to 25 students enrolled in the Fall 2015 Creative Arts class at the Jewish Home, a weekly all-day endeavor of nine months’ duration. As this class includes Jewish Home resident artists, a spirit of collaboration and participation between the Home and the community is fostered and strengthened. Tai-chi Chia® Mind/Body/Spirit/Health is another course provided through City College that meets weekly at the Home. It is also open to the general community and has an enrollment of 40 to 60 students. Four separate classes were held this past fiscal year, so as to accommodate English-speaking residents as well as those for whom Russian is their primary language. The Home does not receive compensation for the space made available for these community classes.
The Accessible Theater Arts program, run under the auspices of the Department of Disabled Students, is now enjoying its second year of collaboration with the Jewish Home and San Francisco City College. For a period of six weeks, with two separate classes per designated day, a complement of 30 to 40 students (including Jewish Home residents) call on their improvisational skills to act, move, use voice, and convey emotion. Armed with props, texts or music, participants increase their self-confidence, explore their imaginations, and engage in meaningful fun.
The Jewish Home’s rabbi and director of Jewish Life regularly teaches in the Jewish community and participates in both educational and leadership development programs with other agencies. Organizations include the Bay Area Jewish Healing Center (this involves joint training and supervision of spiritual care partners for the collaborative end-of-life/hospice volunteer program Kol Haneshama) and Bay Area congregations. He is often invited to make presentations to chaplains, Jewish professionals, and lay people on the use of poetry and sacred texts in pastoral care, and on spiritual issues related to aging, illness, dementia and death.
SERVICES TO RUSSIAN ÉMIGRÉS
The influx of elderly Russian émigrés to the Bay Area had a significant impact upon San Francisco’s Jewish community. The Jewish Home continues to address this population’s need for residential care, programs, and services. With the assistance of full-time Russian-speaking staff in a range of disciplines and departments, approximately 122 Russian-speaking residents benefit from the robust Russian services program offered by the Home.
INFORMATION AND REFERRAL SERVICES
The Jewish Home’s director of Admissions & Marketing, associated team members, and colleagues continue to inform, provide community outreach, and establish strategic partnerships with Bay Area professionals and entities with respect to the Home’s on-site short-stay programs, namely STARS and its acute geriatric psychiatry hospital. The following reflect the range of this past year’s undertakings:
The Jewish Home’s partnership with teams from the University of California, San Francisco (UCSF) results in referrals from various areas. For example, UCSF’s congestive heart failure team works with STARS to diminish the need for post-operative re-admission by following patients during their STARS stay and thereafter at home.
Participation in UCSF’s Model 2 Bundled Payment Initiative. This initiative is part of healthcare reform – a direct result of the Affordable Care Act. This bundled payment is the first of such initiatives; the Jewish Home was chosen as one of three post-acute providers.
The Jewish Home initiated a data-sharing, dashboard agreement with UCSF, so as to better inform their management team of the outcome of patients admitted to the Home.
Partnerships with the Bay Area’s assisted living and life plan communities with respect to their utilization of the Jewish Home’s acute geriatric psychiatry hospital have become more focused. Residents at these facilities who are dealing with psychiatric issues benefit from improved levels of care and are therefore either able to return to or remain in their current living situations.
All case managers have been informed that the Jewish Home is a member of the Health Net alliance. It is noteworthy that Health Net’s medical management director has established STARS as their preferred provider (“first choice”) for seniors requiring such services.
COMMUNITY SERVICE AND LEARNING
The Jewish Home partners with local high schools that aim to involve youth in their community by encouraging them to fulfill needs in their respective milieus. Mutual goals include the promotion of civic responsibility and the development of leadership skills. By volunteering at the Home, students gain valuable life experiences and acquire volunteer time required for college admissions. During this past fiscal year, students from Abraham Lincoln High School, Archbishop Riordan High School, Immaculate Conception Academy, June Jordan High School, Lowell High School, Mercy High School, Phillip & Sala Burton High School, Sacred Heart, Saint Ignatius, and University High School completed their community service requirements at the Home.
The Home also partners with local colleges to host service-learning programs, which combine experiential learning with community service. The purpose of service-learning is to enhance classroom instruction by providing students with practical field experience while, at the same time, meeting the needs of the community partner. This past year, students from City College of San Francisco, San Francisco State University, University of California at San Francisco, and the University of San Francisco were placed at the Home.
The Jewish Home is an approved work site for the Mayor’s Youth Employment and Education Program, a city-wide program that provides after-school and summer employment to youth, with the goal of developing job skills and providing work experience that increases career awareness and future employability.
Achieve, a year-round, four-year high school scholarship and enrichment program for underserved, low-income minority students, opens a world of possibilities by providing students with access to quality education – including cultural, career, and community service experiences. A total of 22 Achieve students from Archbishop Riordan High School and Mercy High School participated in an academic-year program at the Jewish Home, where they assisted residents of the Home with a variety of activities, ranging from Oneg Shabbat (post-Sabbath) services to acting as companions. Partnerships and interactions such as these result in a deeper understanding and appreciation of both generations’ perspectives, life experiences, and challenges.
COUNSELING AND SUPPORT
November 2015 heralded the San Francisco Jewish Community Center’s first annual “Embracing the Journey: End-of-Life Resource Fair.” The Jewish Home was honored to be this event’s co-partner and, in the spirit of the fair, took to heart the opportunity to present its nationally recognized and numerous award-winning Kol Haneshama: Jewish End of Life/Hospice Volunteer Program.
The Jewish Home opened its doors to Family Caregiver Alliance (FCA) and a four-week training in February 2016. Funded in part by the San Francisco County Department of Aging and Adult Services and Jewish Senior Living Group, the program offered new skills and tools for family caregivers who care for a loved one with Alzheimer’s disease or related dementias.
DONATED SPACE AND SUPPLIES
The Jewish Home regularly opens its doors to civic causes, professional organizations and community groups, offering them free meeting space, continuing education credits when appropriate, refreshments or more elaborate fare.
In partnership with Mission Bay Community Church, the Jewish Home participated in a support program that provided three neighborhood/community families – including a number of residents of a men’s group home – with essential items. Conducted over the holiday period, and in the season’s spirit of generosity and thoughtfulness, many of the items included winter coats and shoes.
MEDICAL CARE SERVICES
SHORT-TERM AND REHABILITATION SERVICES
STARS, the Jewish Home’s short-term and rehabilitation services program, is designed for those who require temporary skilled oversight – including medical rehabilitation and management by on-site physicians, nursing care, physical, occupational and speech therapies, and psychosocial services – usually following discharge from an acute hospital or an acute illness, with the goal of returning to the community. In response to the greater need for short-term and rehabilitation services, the Home has significantly expanded the number of beds initially allotted to this type of care.
Of benefit to high-risk patients, family members who are unable to take care of their loved ones, hospitals that are relieved from readmitting patients, and a number of homecare agencies is Peace of Mind – an innovative and multidisciplinary discharge program developed at the Jewish Home. Members of the STARS team partner with a community homecare agency to assist patients as they transition back to their homes. Peace of Mind offers a safe and individualized discharge plan; escorted transportation service from the Jewish Home to the individual’s home; pharmacy pick-up and medication set-up; personal home arrangements (including meal preparation, light housekeeping, and grooming); grocery shopping and errands; and the organizing and/or confirmation of medical appointments.
ACUTE PSYCHIATRIC CARE SERVICE
The Jewish Home is one of the only enterprises in 14 Bay Area counties that ensures the emotional and mental health of seniors through its on-site acute geriatric psychiatry hospital. In fact, it is an imperative service to the greater Bay Area community, as many other similar services are no longer in operation. Licensed by the Department of Public Health, acute short-term stays are available to both voluntary and involuntary patients, thus serving a greater number of elders in their time of psychiatric crisis.
The fact that the hospital regularly has a near-full census solidifies that there is a need for this unique program that addresses older adults’ combined emotional, physical, medical, and medicinal requirements. The older age population is especially underserved in the realm of mental health services. The Home’s psychiatry program provides a valuable community service by addressing the requirements of this population group; treating illness; relieving suffering and excess disability; and reducing the need for institutionalization.
A PARTNER FOR VULNERABLE POPULATIONS
Employment Plus, a nonprofit agency, seeks both paid and voluntary employment for adults with developmental disabilities and provides on-the-job support through job coaching. The long-term goal of the program is to have individuals become fully integrated, participatory, and contributing members of the community in which they work and live. The short-term goal is to maximize each individual’s self-reliance, independence, and productivity. The Home serves as a work site for four adult participants in this program who perform duties in the Home’s Environmental Services department one and a half hours per day, four days a week, accompanied by a job coach.
Activities, socialization, and a good time for all concerned were on the program when the Jewish Home hosted an outing for members of the Memory Care Café in June 2016. This nonprofit entity organizes informal meetings and social outings for people with early-stage Alzheimer’s/dementia and their care partners at various locations throughout the Bay Area. The visitors were informed by a tour of the Jewish Home, inspired by a talk on Judaism given by the Home’s rabbi, and happily satisfied with the tasty and convivial luncheon.
BENEFITS TO THE BROADER COMMUNITY
The Jewish Home is a mid-size employer in the city of San Francisco and provides employment to over 650 employees each year, ranging from skilled labor to executive-level positions. The average length of tenure is 9.98 years of service.
Promoting health, wellness, and safety
A number of wellness seminars, covering topics such as dealing with stress and guides to healthy eating, and run by the entity that also provides staff with access to an employee assistance program, are on the calendar throughout the year, with the goal of boosting employees’ physical and emotional health and well-being.
The Jewish Home’s security personnel conduct patrols of the facility’s perimeter and abutting neighborhood area as a regular part of their 24-hours, seven-days-a-week security measures and safety protocols. By working in concert with the local police department, being vigilant about tracking unusual occurrences, and maintaining open lines of communication with the SFPD, the Home’s security team plays a significant role in deterring some neighborhood crime, while continuing to secure the safety of its residents, patients, staff, visitors, and nearby dwellers.
Neighborhood and Local Vicinity Involvement
The Jewish Home successfully partners with local organizations, fostering dialogue, collaborations, and ongoing communications with its neighbors.
Every Saturday morning, a parking lot on the Jewish Home’s campus is transformed into a colorful marketplace. Fresh fruits and vegetables, canned goods and other miscellaneous groceries, courtesy of the S.F.-Marin Food Bank, fill tables, and low-income neighbors are invited to receive free foodstuffs. This is the Excelsior Community Food Pantry – a partnership of the Jewish Home of San Francisco and Mission Bay Community Church (MBCC). In 2014, when the pantry’s former space in the area was no longer available, the Home stepped up and became the pantry’s new site. As a result, several hundred Excelsior neighborhood adults and children are continuing to enjoy healthy meals. This partnership reflects the common goal of giving time, resources and beneficence, and is in accordance with one of the tenets of the Jewish faith: we are all responsible to help each other.
Medical social workers, hospital discharge planners, and other geriatric specialists gathered in October 2015 for the Jewish Home’s hosting of the Bay Area Social Workers In Health Care (BASWHC) event. Attendees socialized and networked at the reception, enjoyed a delicious dinner, and learned as an expert pair made up of an elder law attorney/registered nurse and psychologist/gerontologist discussed the extent of the U.S.’s current financial elder abuse problem.
The Jewish Home was pleased to partner with local residents and the Excelsior Action Group by being a top-level contributor to the Kenny Alley Beautification Project. This multiphased effort is designed to renew and revitalize the neighborhood’s Kenny Alley Steps, a heretofore graffiti-marked, littered, and unsafe area. The Jewish Home’s inscribed donor tile will form part of a handmade mosaic art installation.
Since the inception of the Excelsior Street Festival 14 years ago, the Jewish Home has served as a major sponsor of this annual family-friendly art and musical community event that has grown into a citywide attraction aimed at building civic pride and showcasing all that the Excelsior community has to offer.
HEALTH RESEARCH, EDUCATION AND TRAINING PROGRAMS
Enriching the quality of life of older adults is the Jewish Home’s mission – and also an accelerated scientific imperative. The Jewish Home-based Harris Fishbon Distinguished Professorship in Clinical Translational Research in Aging is advancing this urgent need for more geriatric research and furthering the Jewish Home’s mission of ensuring that people enjoy quality of life. With one in four older adults living with four or more co-occurring chronic conditions – many of them serious and thus contributing to high illness burden – the Fishbon appointee is leading the development of a research program to improve the care and health of older adults, including very old persons, by translating research findings into clinical benefits and therapies.
A care model that combines team-based patient care with home visits was recently completed by the Fishbon professor. Such a team-based model – when pharmacists, nurses, therapists and physicians work collaboratively – is enormously beneficial, helping to uncover vital information about patients’ unique needs and specific circumstances. The professor anticipates increasing her work with the Jewish Home in implementation research, and accelerating efforts on how to best integrate research and quality improvement into the fabric of the Jewish Home.
Acute Psychiatry Hospital Training
The Home’s psychiatry hospital began serving as a training site for future geriatric psychiatrists in September 2012. The Jewish Home’s geriatric psychiatry department and the University of California, San Francisco’s department of psychiatry continue their program of training and medical education for geriatric psychiatry physicians.
Learning opportunities are not limited to the field of geriatric psychiatry, however. The expertise and experience of staff of the acute geriatric psychiatry hospital lends itself to the training of students (from multiple community and regional educational institutions) in the areas of social work and recreational therapy as well.
Clinical Training and Internships
First- and second-year medical students from UCSF gain and build upon knowledge of geriatrics and patient care through regular attendance at the Home, as do students from multiple Bay Area facilities who are studying to be physicians’ assistants and nurse practitioners.
Throughout the academic year, the Jewish Home offers internship opportunities for recreation therapy students to take their academic knowledge and, under the supervision of state and nationally certified recreation therapists, apply it to gaining clinical experience.
Approximately eight massage therapy students from the National Holistic Institute fulfilled their internship and community hour requirements at the Jewish Home by providing massage services to Jewish Home’s staff. It is worth noting that the benefits derived from massage therapy are in concert with the Home’s focus on the well-being of its employees.
As a complement to traditional medical care, Healing Touch – a therapeutic approach that uses gentle, non-invasive hands-on touch and energy techniques – has proven to be a particularly good tool for decreasing agitation in residents with dementia or Alzheimer’s disease. This award-winning program has been enthusiastically embraced by the Home’s culture, by the medical community, and beyond.
End-of-Life and Hospice Care
At the initiative of the Jewish Home’s rabbi and director of Jewish Life, the Home implemented Kol Haneshama: Jewish End-of-Life/Hospice Volunteer Program – a program of volunteer and staff training that the Jewish Home co-sponsors with the Bay Area Jewish Healing Center. The Home and the Healing Center enjoyed an early collaboration with the Zen Hospice Project, a nationally recognized innovator in the training of volunteers for spiritual/end-of-life care. Spiritual care partners (volunteers), which include Jewish Home employees and community members, receive more than 40 hours of initial training in end-of-life care. Instruction runs the gamut from an inward focus on the volunteers’ personal experiences of loss and grief to acquiring concrete tools for spiritual care, such as active listening, Jewish teachings, prayer, music, poetry, and non-verbal communication.
Congruent with the Jewish Home’s philosophy that no one who is actively dying should be going through this process alone, the Home collaborates with two Bay Area home care agencies, scheduling sitters (caregivers) for the times that staff may not be available, when family members live at a distance, or in those cases where the resident/patient does not have loved ones.