Trauma-sensitive approach for aiding Holocaust survivors transforms how care is delivered

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Larry Luxner | JTA

Picture this scenario: An 89-year-old Holocaust survivor lies on his back while a white-coated dentist with pliers approaches, preparing to pull an infected tooth. Feeling frail, helpless and a little confused, the survivor flashes back to Nazi medical experiments, panics, and is unable to undergo the procedure.


(bedya/iStock / Getty Images Plus/Getty Images)

Or this one: An attorney asks a Holocaust survivor about preferences for burial or cremation, then hands her a form to list all her financial assets. The questions and subject matter remind her of watching her parents surrender all their worldly possessions before ultimately being forced into the crematoria. She leaves the meeting anxious and never returns to complete the advanced planning.

Even something as innocuous as a buffet in a synagogue hall can be difficult for a Holocaust survivor who once had to wait in line for meals, not knowing if any food would remain by the time their turn arrived.

This is why professionals who work with survivors have been adopting a new approach called person-centered, trauma-informed (PCTI) care. The idea is to offer services in a way that takes into account a person’s history of trauma and avoids triggering that trauma anew. The PCTI framework is meant to empower survivors and other older adults to make choices about the care they receive.

Jewish agencies are at the forefront of this movement thanks to significant support from the Jewish Federations of North America, which recognized the efficacy of the new approach early on and is funding efforts to spread it widely. Now other institutions that work with once-traumatized populations are adopting these protocols, too.

“PCTI speaks to the sensitivity and awareness of individual clients’ needs,” said Adeena Horowitz, managing director of the Holocaust Survivor Program at New York’s Selfhelp Community Services Inc., one of the Jewish Federations-funded agencies using this new approach. “Our staff is specifically trained on how the impact of their earlier life trauma manifests itself today. It’s extremely important that we not retraumatize them. We have to be aware of those triggers.”

For example, Horowitz said, “if a survivor was in a concentration camp and has dementia, trying to get them to take a shower may upset them because everyone knew that meant you would be gassed.”

Using the person-centered, trauma-informed framework, staff or family caregivers would be sensitive to this and arrange activities such as showering, dental procedures, or attorney visits in ways that minimize triggers and make the individual feel safe.

Much of the work is carried out through the Jewish social service agency infrastructure supported by the Jewish Federations. The federations’ work with survivors is part and parcel of their mission to serve as the backbone — often unseen — of the North American Jewish community.

Earlier this year, the Jewish Federations’ Center on Holocaust Survivor Care and Institute on Aging and Trauma awarded 55 grants totaling $5.3 million to organizations across the United States. The money funds social services for thousands of Holocaust survivors, diverse older adults with a history of trauma, and their family caregivers. In turn, the local service providers spread the PCTI approach to other populations.

Shelley Rood Wernick, managing director of the Center on Holocaust Survivor Care, said Jewish Federations are working with the federal government and generous philanthropists to make PCTI care the universal strategy when interacting with anyone over 65. It’s one of the areas where Jewish Federations are reshaping how the community engages with people in their older years.

“We know that as people age, trauma from the past impacts them differently,” Wernick said. “If you have to use a walker or a wheelchair, you know you’re vulnerable, and you can no longer run away from a threat.”

That’s why, for example, when planning a community meal for people who may have experienced extreme hunger, she said, “a PCTI approach would have plated meals and to-go boxes on the table so there’s an expectation that there will be an abundance of food. That’s a low-cost example of systemic change.”

The center has trained 16,000 professionals and volunteers on PCTI care.

For some Holocaust survivors who immigrated to the United States from Ukraine, watching the scenes of devastation from the current war in Ukraine has been triggering. Steve Zakusilo, a program manager and social worker who grew up in Ukraine, said anxiety over the war has affected survivors’ sleep schedules and mental health.

“For people who grew up in Ukraine, it’s a triple trauma, because not only is it happening to their country right now, but it reminds them of what happened in their time. It’s in their face 24/7. For some of them, it’s very hard to switch that button off,” Zakusilo said. “But when you speak their language, and when you’re familiar with the culture of the former Soviet Union they grew up with, you take the anxiety away.”

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