Social welfare for jewish nazi victims



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HOLOCAUST ERA ASSETS CONFERENCE

Prague, June 2009

A REVIEW:

SOCIAL WELFARE FOR JEWISH NAZI VICTIMS

The personal history of every victim of Nazi persecution, as well as the story of each victim’s struggle to adjust to normal society after enduring hell on earth, is unique. Nonetheless, trends and patterns describing the circumstances facing Holocaust victims as a group can and need to be made detailing the assistance many of them require. This report will describe the growing challenges Holocaust victims face and what has been – and might be – done to address them.


This report has three parts. The first describes the general social circumstances of Holocaust victims worldwide – many are currently experiencing, and almost all can anticipate, the need for supportive services, including long-term care and health care, to ease the difficulties that accompany aging. The second reviews the social welfare services that the Conference on Jewish Material Claims Against Germany (“Claims Conference”) has been and continues to be involved with in assisting Holocaust victims. The final part – mindful that current funding sources are diminishing and already are proving inadequate – focuses on the collective obligation of all countries to support victims in response to their increasing needs.


I. GENERAL SOCIAL CIRCUMSTANCES
In the 64 years since the end of the Holocaust, the number of Nazi victims worldwide has declined and continues to decline as part of the human condition. Currently, it is estimated that there are approximately 600,0001 Jewish victims of Nazi persecution dispersed around the world, with the largest number living in Israel, the United States, and the countries of the former Soviet Union (“FSU”).
The resilience, refusal to succumb to tragedy, and profound commitment of Holocaust victims to rebuilding their lives and making sure that what happened to them and their families is remembered, in perpetuity, is truly remarkable and reflects an extraordinary strength. Nonetheless, all victims of Nazism are now elderly, their median age is 79,2 and many increasingly suffer from illness and are in urgent need of continual assistance.
Jewish Nazi victims are both part of, but distinct from, other elderly in their countries of residence. The personal history of each individual survivor as a victim of Nazi persecution, combined with memories of Nazi persecution and post-war adjustment, has created a group that has aged differently and has different, more acute, needs than other elderly. Holocaust victims are not merely a subset of the frail elderly. They are more likely than other elderly to be socially isolated and, as a result, are more likely to live in poverty and to be in poorer health.3 Indeed, the Holocaust victim’s poverty is often aggravated by non-existent or weakened familial and social support networks, as often there is no spouse or adult children nearby to provide financial and emotional support. Many victims who live on their own never married (or remarried) after the war. Among those who did marry, many are childless. Certainly, extended family networks such as siblings, in-laws, and cousins are dramatically reduced in this population. Thus, the Nazi victim population, for the most part, is more socially isolated than other older adults. 4
The majority of Holocaust victims are women, who have longer life expectancy than their male counterparts and face a higher risk of poverty.5 Indeed, income for older women between the ages of 67 and 80, in general, declines at rates two to three times greater than it does for older men (13-15% vs. 4-7%). This is largely due to the lower pensions that they receive, due to life-time earnings and lower rates of victims’ benefits.6
Many victims live alone as a result of having lost their entire family during the Holocaust, particularly those in the FSU.7 Nazi victims are more likely than other elderly to suffer from certain illnesses that result in functional limitations and disability, such as osteroporosis, as well as cognitive impairments (see discussion below), and, as a result, sink further into poverty.8 This combination of poverty and isolation results in Holocaust victims being in poorer physical and mental health than their contemporaries without comparative wartime experiences. Health researchers have found that both immediate and long-term health problems for survivors of the Holocaust and other genocides include disease, injuries and trauma all of which are chronic, lifelong and difficult to treat, and confer an increased burden on victims.9
Older adults with strong social supports report the fewest health complaints and more of their needs being met regarding their care.10 In comparison, Holocaust victims – in both self-assessments and health surveys – present with higher rates of chronic co-morbidities and acute conditions than both other elderly Jews and other elderly in general.11 These chronic co-morbidities and acute conditions are exacerbated by the survivors’ social isolation. Survivors are also more likely than other older adults to suffer from chronic pain syndrome.12 Among the most noticeable differences are the following: Holocaust victims have higher rates of osteoporosis and hip fractures than other elderly;13 higher cancer rates;14 higher rates of functional limitations and disability;15 and higher rates of cognitive impairments and mental health problems, exacerbated by “trigger” events.
Cognitive impairments and mental health problems are particularly troubling among Holocaust victims. Cognitive impairment has been documented to be more prevalent in groups who have survived genocide than in the general population.16 As a natural part of the aging process, memories change over time and are reinterpreted to the present social context. For Nazi victims, however, cognitive impairment may change the impact of war trauma by confusing events of the past in time and place. In the case of Alzheimer’s Disease and other forms of senile dementia, the loss of short-term memory—and the reliance on long-term memory—can be especially painful and can place victims particularly at risk. Loss of short-term memory may, for example, mean a loss of recognition of post-war accomplishments, such as success in building new lives in new countries, raising and educating responsible and caring children, and living to see and enjoy their grandchildren. As their minds deteriorate, Holocaust victims may be unable to control the intrusion of painful, long-term memories, and traumas of years past may become their only reality.17
Wartime experience also places Nazi victims at risk to suffer more from post-traumatic stress disorder, anxiety disorders and long-standing adjustment disorders than other older adults.18 Research on the Holocaust victim population has shown that their behavioral and cognitive functions are affected in both particular and more acute ways than that of the average aged population who did not have similar life experiences.19 For example, rates of clinical depression among Holocaust victims are higher than in the general population.20 Concentration camp survivors under psychiatric care are almost twice as likely to exhibit suicidal “ideation,” i.e., “the wish for death or the passive or active thinking and planning of ending one’s life,” than other older Jewish adults under psychiatric care who are not Nazi victims. Among Holocaust victims who have been admitted to a psychiatric facility, actual suicide attempt rates are higher than for the elderly population in general.21
Moreover, as victims grow older, they are confronted by events that trigger, or bring back, difficult memories which, in turn, provoke adverse emotional or physical reactions. These “trigger events” are more likely to occur when someone is ill, cognitively or physically impaired or just feeling vulnerable.22 They can even result from normal day-to-day activities or situations. For example, even food and nutrition programs combined with a socialization element geared for victims – which seem innocuous – may unwittingly create uncomfortable food-related situations. As a result, several U.S. communities have replaced the “soup kitchen” model, which requires that victims queue up for food, with a congregate meal model, in which victims are served their food.23 Similarly, long-term care in a skilled nursing facility is the least preferred option for Holocaust victims, by both the victims themselves and the professionals involved in their care. A female Nazi victim reported to her psychiatrist that she felt that the small daily indignities she faced in the nursing home were worse than her experiences in a labor camp—she could not bear feeling like a victim again, even in small measure.24 A wide range of seemingly standard scenarios in institutionalization settings may serve as triggers for vulnerable Holocaust victims. These often include institutional/hospital beds with bars/railings on the side, uniformed staff (guards), showering facilities in institutional settings, etc.
For Nazi victims, unfortunately, time does not heal all wounds. Too often, their wartime injuries and horrific memories are aggravated with the passage of time and become increasingly stressful.
Moreover, demographic studies indicate that, while the absolute number of living Nazi victims will decrease, the percentage of those still living and requiring aid will increase. As such, we will certainly continue to see for the next 4-5 years an increase in their needs. Simply put, the assistance Holocaust victims will require will grow in the next few years.
Based on a study by the Brookdale Institute in Israel,25 the chart below shows the absolute number of Nazi victims living (not in institutions) in Israel. Each year, as expected, the number decreases.


Year

N
Decrease in number of Nazi victims
umber of Nazi Victims in Community

2007

228,400

2008

215,000

2009

201,700

2010

188,600

2011

175,700

2012

163,200

2013

150,700

However, during that same period, within the same population, the percentage of those severely disabled increases. As a result, the total number of severely disabled Nazi victims is projected to increase through 2013.




Year

Number of Nazi Victims in Community

N
Increase in number of Nazi victims with severe

disability


umber of Nazi Victims in Community with severe disability

2007

228,400

14,300

2008

215,000

14,600

2009

201,700

14,600

2010

188,600

15,000

2011

175,700

15,400

2012

163,200

15,500

2013

150,700

15,600

Further, even after the projected peak of need is reached in 2013, there will be substantial numbers of poor Holocaust victims who will have substantial social welfare and medical needs for several years beyond 2013. In fact, projections show that in 2022 the number of Holocaust victims from among the non-institutionalized Holocaust victims in Israel with the same level of poverty and disability will be 75% of what it will be in 2013. However, three years later, in 2025, the figure drops to 58%, illustrating the sharp drop anticipated thereafter. (See Appendix A.)


Notwithstanding the vast disparities among Holocaust victims in income, medical care and long-term care services in the countries in which Nazi victims reside, broadly speaking, as victims grow older, they will become increasingly frail and disabled and, wherever they reside, in greater need of ongoing medical care and other attention owing to their wartime experiences.26 Further, as the demand for ongoing social services intensifies among those who are disabled, home-and community based services represent the survivors’ “best chance” to avoid feeling like victims again.27 In a cruel irony, the very population that is most unable to bear institutionalization is the same population with the least amount of family support to delay or avoid institutionalization. On a practical level, it is more cost effective for society to maintain Holocaust victims at home. On a moral level, society has an obligation to compensate these survivors for the paucity of familial structure which was destroyed by the hands of these very societies.
These factors, combined with the unique characteristics of Jewish victims of the Holocaust, point to the need for a wider discussion concerning the current and future needs of the Jewish victims of Nazi persecution worldwide. Holocaust victims suffer from multiple problems and needs associated with aging. They are poorer, more socially isolated and more likely to suffer from certain illnesses than other elderly, which are exacerbated because of their Holocaust-related experiences. As they age, even normal day to day activities or situations may conjure up lingering traumatic wartime memories. While the total number of Nazi victims is diminishing, as the remaining victims grow older, their need for social welfare and health care services, especially home care, is dramatically increasing.
The next section summarizes certain activities of the Claims Conference and its almost six decade battle to secure the rights of and assistance for Holocaust victims.

II. CLAIMS CONFERENCE
From its early days, the Claims Conference has vigorously pressed for the establishment and expansion of Holocaust-related compensation and other benefits programs for Jewish Holocaust victims. (A summary of the compensation programs is provided in Appendix B, attached to this report.) Over the course of its activities over the years, the priorities of the Claims Conference have evolved from rehabilitating victims in the immediate post-war period to caring for needy, vulnerable victims in the past decade, seeking to help ease the burdens they face to allow them to live out their days with a measure of dignity.
While there are many Holocaust victims who recovered fully from the trauma of the Shoah, rebuilding their lives and establishing financial independence, there are literally hundreds of thousands of Holocaust victims who today live in poverty. Many Holocaust victims are forced to choose among food, rent, and medicine, as surely all three are unattainable. In addition, there is a tier in society of near-poor, those who meagerly eek out an existence just above abject poverty but for whom economic disaster is one or two bad months away. For these victims, the funeral expenses of a spouse, unanticipated medical expenses from the sudden onset of a new condition, or changes in economics, such as increased fuel prices or a sharp drop in governmental subsidies for basic necessities, wreak havoc. Further, for those Holocaust victims with families, such as children or nieces and nephews, the economy can change the situation of the near poor survivor, who is getting small but important aid from the family member, to a source of funding for the recently unemployed family member. Any of these events can send near poor Holocaust victims spiraling downward into financial disaster, necessitating reliance on communal sources. The goal of the Claims Conference programs is to partner with agencies to provide assistance to achieve and maintain a dignified quality of life for victims. For those who suffered beyond compare, surely this is the least that we must provide.
The bulk of services provided to Holocaust victims, as is the case with all older adults, comes from government support. However, government entitlement programs contain significant gaps that condemn many Holocaust victims to live choosing between food and medicine. Simply put, there are hundreds of thousands of Jews who survived the Shoah and today are old, alone, poor, and sick.
In this light, the Claims Conference funds organizations and institutions around the world that provide essential social welfare services for Holocaust victims. The Claims Conference currently funds social service programs, with an emphasis on home- and community-based services, in 43 countries. The Claims Conference and its partner agencies have designed long-term care programs based on home- and community-based services to ensure quality of care in an environment that will ensure that Holocaust victims live out the rest of their days in dignity and comfort. Using a “Continuum of Care” model, in which the Claims Conference works with local agencies to create and sustain services that take into account the particular conditions and needs of victims in their communities, criteria have been established that seek to ensure that the needs of Holocaust victims will be met. Continuum of Care includes case management, and continues with home care, health care, psychological services, food programs, emergency assistance, supportive communities, senior day centers, and housing security, shelter, and institutionalization.
Case Management: The starting point for quality of care in home- and community-based services is case management. Surely, in many countries in North America, Western Europe and in Israel, Nazi victims can draw upon services provided by public assistance and non-government organizations (NGOs). However, all too often, Holocaust victims do not – in fact, cannot – fully benefit from these programs. There are many reasons for this. First, it may be that they are unaware of such help. Additionally, Holocaust victims may be resistant to it for a whole range of reasons (many stemming from formative years’ experiences with being known by authorities and/or psychological perception of needing to be strong and never being able to admit frailty, knowing that it would lead to death in the camps). For some, as they become increasingly isolated because of frailty and impairment, they are physically or mentally unable to access assistance. Finally, for others, the process is overwhelming and can engender frustrating barriers such as extraordinary complexity in navigating bureaucracy, forms and delays. For poor and near-poor victims who are aging, often vulnerable and devoid of strong familial support, managing the tasks of daily living can be daunting, never mind facing the complex web of assistance programs that may keep them from living in severe privation. The reality is that in most societies public benefits, when available, are delivered in an overburdened, overly complex system. Aging elderly and frail victims often require professional guidance to understand and access the public and NGO assistance that is available to them. In professional case management, case workers are available to vulnerable clients to help guide them.
Case management consists of ongoing interaction between a social worker and a client. It begins with a comprehensive assessment of the client’s environmental, health, financial, social and physical situation. Case workers monitor the overall conditions of their clients and respond quickly to changes in their clients’ physical, psychological, medical and financial condition. In addition, the case worker connects clients with public and private programs and family resources. Even in countries and U.S. states that provide publicly-funded home- and community-based services that ensure a dignified level of in-home care,28 it is essential that the case managers arranging for such care understand the particularities of Holocaust victims.29 Case workers strive to provide seamless delivery service. For example, the care of a Nazi victim receiving 12 hours of home care per week may be funded by different Claims Conference sources, other private philanthropic funds and public sources (e.g., Medicaid in the United States or Bituach Leumi/National Insurance Institute in Israel). It is incumbent upon the case worker to ensure that service is continuous and ideally from the same home health care agency. Further, case workers are trained to handle the special sensitivities of Holocaust victims.30


Case managers also ensure that all elements in the continuum of care model are integrated. For example, a case worker at the Cummings Jewish Centre for Seniors in Montreal, Canada, ensured that a 79-year-old client with a broken arm would receive assistance with medical care, medical equipment, transportation, home-delivered meals, clothing and other services. Before the intervention of the agency’s case manager, the victim did not receive any services that would enable her to remain in her home.


Home Care: Studies indicate that the largest area of unmet needs for Nazi victims continues to be home care services.31 As victims age, they, like general older adult populations, will experience significant limitations in their physical, mental and social functions. However, there are two differences between the general adult populations and Holocaust victims. First, as we have shown in Section I of this paper, Holocaust victims, as a result of what they endured, are more infirm, more isolated, poorer and more vulnerable to psychological distress than their counterparts who did not undergo the trauma of the Shoah. Second, nursing home and other forms of institutionalized long-term care are particularly traumatic for many victims, who often experience such care as a recurrence of their treatment at the hands of the Nazis.32 Home care services, on the other hand, allow Holocaust victims to remain in their homes as long as possible, even after they are disabled, by providing them assistance with activities of daily living, including bathing, dressing, eating and housekeeping and personal nursing care for those who need assistance with medication or medical equipment. Further, home care workers ensure that minor home modifications, such as guard rails in or near toilets and in bath tubs, ramps for the wheel-chair bound and special telephones for the hearing-impaired, are properly installed and maintained.
The provision of even minimal home care, such as a few hours of chore/housekeeping services per week, allows Holocaust victims to remain among familiar surroundings, significantly improving the quality of their daily life.33
Health Care: As previously mentioned, the physical and mental health needs of Holocaust victims differ significantly from other elderly. In general, their physical and mental health tends to be poorer than their contemporaries, including other elderly living in poverty. Subjective assessments of personal health by Jewish Nazi victims in Israel and the United States reflect similar disparity between Holocaust victims and non-victims. In Israel, nearly two-thirds of Jewish Nazi victims have reported that their health is “not so good” or “bad,”34 whereas in the United States, just over 60 per cent per cent of Jewish Nazi victims described their health as “fair” or “poor.”35 Particularly troubling are the general health conditions of Holocaust victims who have either remained in the FSU or have emigrated from the FSU to Israel, the United States, Germany and other countries. When compared to other Holocaust victims, regardless of where they currently live, their general health measures are worse.36
While a number of the countries where Holocaust victims reside have universal health care for the elderly, many of these health care schemes require some cost-sharing for medical services, hospitalization, prescription drugs and durable medical equipment. These costs can add up for individuals on fixed incomes with chronic medical conditions. Further, there are many goods and services – either excluded from public coverage or with high cost-sharing requirements – that victims desperately need, such as eyeglasses, hearing aids, orthodics, prosthetic devices, incontinence pads, bed pans, wheel chairs and orthopedic beds, chairs and shoes. The Claims Conference has worked with local Jewish communities to develop health programs through its grants to help provide such critical additional assistance. However, despite these efforts, skyrocketing costs for medicines and co-pays, supplemental insurance, and items not covered under national programs make proper health care unattainable for hundreds of thousands of Holocaust victims.
Claims Conference grants also emphasize preventative medicine: Many Holocaust victims living on their own have personal emergency alert systems and have received home modifications, such as installation of safety devices and prophylactic, or non-slip aids, such as handrails in bathrooms and toilets, as discussed above, in the section on in-home services (at p. 10). Further, many agencies have begun to provide subsidies for medical treatment or have established clinics that rely on the pro bono medical services of professionals who are sensitive to the needs of Holocaust victims.37
Dental Services: Even when universal health care is available for the elderly, dental care, which is a key component of maintaining physical health, is often overlooked. Dental disease is a prime example of the disease, injuries and trauma discussed above, which victims of the Holocaust endure as a result of their substantial malnutrition during war-time years. Poor dental care leads to bacterial infections, which in turn exacerbate the co-morbidities that older adults have, such as cardio-vascular disease. At the same time, other co-morbidities, such as diabetes, affect oral health.
Poor dental health is particularly acute for victims who spent the post-war years in Eastern Europe or the FSU, regardless of where they live today. Moreover, other poor and near-poor victims in countries with significant health care for older adults often suffer from a gap in entitlements. In the United States, for example, the Medicare program does not include dental care and dental care under Medicaid is severely limited.
Hence, the Claims Conference has worked with its partner agencies to establish dental services that address the needs of Holocaust victims. For example, the Jewish Family and Children’s Service of Greater Boston established a dental clinic that provided extensive services to 90 Holocaust victims in 2008. Such dental care programs include emergency treatment for relief of pain and infection, x-rays to assess state of oral health, and provide for the cost of dentures and denture repairs. Through the Foundation for the Benefit of Holocaust Victims in Israel, the Claims Conference has subsidized dentures for thousands of Holocaust victims. The Claims Conference also assists victims who cannot afford the high cost-sharing requirements of many public dental care programs.

Psychological Services: Holocaust victims’ special psychological needs have been known for many years. As mentioned above, loss of cognitive function, particularly short-term memory, regardless of degree, is particularly traumatic for survivors and post-war accomplishments are often overshadowed by wartime experiences.38 Moreover, the “natural” decline of social and familial supports—the loss of a spouse, the high level of international geographical mobility of adult children of survivors resulting in a split of networks across different countries,39 declining income as a result of both smaller household size and declining health, is often debilitating both physically (manifest in increased loss of mobility) and psychologically (presented as clinical depression) for victims. After a lifetime of pursuing activities and making decisions in concert with others, whether they were family members or friends in the best of times, or other concentration camp inmates in the worst of times, victims suddenly find themselves painfully alone. Elderly persons have the highest rates of suicide among any age group, but aging Holocaust victims are at increased risk of attempting suicide.40
Many of the Claims Conference’s partner agencies serving this population have also provided therapeutic interventions including counseling and Jewish spiritual care, support groups for Holocaust victims, and support programs for family members and caregivers. Through Claims Conference support, 9,000 Holocaust victims in Israel receive psychological counseling through the organization Amcha, and 3,000 are members of Amcha’s day clubs.
Food Programs: Food programs are an essential component of home- and community-based services. Many Holocaust victims are at risk of food insecurity – that is, limited or uncertain availability of, or ability to acquire, adequate and safe foods – and hunger.41 Inadequate diets may contribute to or exacerbate disease.42 Moreover, food programs decrease the isolation of victims, either by combining a home-delivered hot meal to a client (meals-on-wheels) with a friendly visit from a case worker or trained volunteer, or by inviting clients to congregate meals, with victims and others, which are frequently held at local Jewish communal centers.43 In addition, in the “warm home” model, small groups of Holocaust victims gather at one victim’s house for a meal. Beyond the nutritional value, socialization occurs as warm home participants are usually clustered (organized by social welfare agency) around common war time experiences and locations. Other food programs include food vouchers/cash grants that enable victims to purchase groceries and the provision of food packages, which are particularly important for those living in areas in the FSU and other parts of Central and Eastern Europe, as well as the homebound.
For example, throughout the FSU, a network of Jewish social service agencies called Hesed organizations ( Hesed is Hebrew term for acts of loving kindness) are providing, with Claims Conference funding in 2009, more than 353,000 hot meals in communal settings, more than 508,000 meals-on-wheels, 169,000 fresh foods sets, and 148,000 food packages. In addition, the Claims Conference is working with Jewish communal organizations in many other countries that provide hunger relief, including dozens of communal meal settings (soup kitchens) in Israel and even food delivery programs in Western countries such as the United States, Australia, Canada and the United Kingdom.44
Emergency Assistance: Emergency Assistance programs provide short- term financial assistance to victims in acute or crisis situations. Funds are applied toward housing costs to prevent eviction, utility payments to prevent shut-offs, emergency relocation, dental care, medical care, home care, client transportation and other services such as winter clothing and funeral expenses. Emergency funds are used as a stop-gap measure until a victim can receive public funds or a long term solution can be found. For example, emergency home care would include short-term nursing hours, as opposed to long-term care, after a hospital stay. The goal of the program is to be flexible enough to respond to whatever the problem is.
Client Transportation: In order for Holocaust victims to avail themselves of many of the various services described, they must have access to reliable transportation. Client transportation programs enable victims to obtain social services outside of the home, such as respite care and Café Europa programs, as well as participate in other social, recreational and cultural events, congregate meals, religious services, medical appointments, shopping and other errands. 45 By helping Holocaust victims get out and about, particularly those with vision and hearing difficulties who are afraid to go out on their own, the client transportation programs relieve victims’ feelings of isolation and enable them to feel more independent.
Socialization Programs: An Israeli study46 found that Holocaust victims expressed a strong desire to participate in social activities and to receive emotional and social support. The need to find meaning and feel connected, especially with other victims who can understand and share experiences from the past and present, is critical. Surprisingly, only 19 per cent of the victims surveyed reported attending social clubs, though many others expressed interest. To counter this trend, most agencies serving Holocaust victims, and in many instances victims themselves, have formed socialization programs, commonly known as Café Europa. Café Europa programs provide Jewish Nazi victims with an opportunity to socialize within a support network. Further, speakers provide information on a range of topics from compensation and restitution issues to older adult health care issues to general interest topics. Such groups are meeting in virtually every place that Holocaust victims live from Buenos Aires to Budapest. In Los Angeles, for example, Holocaust victims and college students meet to discuss victims’ lives before, during and after the war. These programs provide victims with a social framework and comfortable environment where they can be entertained and make friends among their peers. The sense of doing things collectively is extremely important to the Holocaust victim population and the isolation many feel now is in complete contrast to how they felt when they were younger, even in the worst of circumstances. As one Holocaust victim noted, “When we had to stand at attention for hours, we stood together, propping up one another when weak. When we dug ditches we did it together, one holding and moving the arms and shovel for another who didn’t have strength that day. We were desperate, but never alone.”47
Community-Based Programs (Supportive Communities and Senior Day Centers): Supportive Communities Community-based efforts to maintain Holocaust victims in their homes and add dignity to their lives are important pieces in the continuum of care. In neighborhoods with substantial numbers of Nazi victims, the supportive communities model helps to address the needs of aging and increasingly frail victims. Through joining a neighborhood association, members are provided with services such as personal emergency alert systems, home modifications, counseling, security and socialization programs. For elderly living alone the knowledge that someone will check in on them on a regular basis is a comfort and can be life-saving. In Israel, the Claims Conference is providing subventions for any low-income Holocaust victim who wishes to participate in one of the several hundred supportive communities throughout the country.
Senior Day Centers Similarly, senior day centers provide activities to combat loneliness and isolation associated with old age. Programs are combinations of health and social services designed to help prevent the premature placement into long term care facilities, offer participants opportunities to socialize, enjoy peer support, and receive medical and social services in a stimulating environment while sustaining independence and provide assistance to families and caregivers (often spouses who themselves may be Holocaust victims) who are responsible for an impaired older adult. The support given at the senior day center allows participants to preserve their precious independence while providing beneficial respite to family members and caregivers. The Claims Conference offers subventions toward the cost of participation for thousands of low-income Holocaust victims who attend one of 140 senior day centers across Israel.48
Housing Security, Shelter, and Institutionalization: Notwithstanding these home- and community-based efforts, the Claims Conference recognizes that, despite efforts to keep Holocaust victims at home as long as possible, as this population gets older and more infirm, many will no longer be able to remain in their homes, particularly if they live alone. In Israel, the Claims Conference funds capital projects that shelter and/or provide institutional settings for Holocaust victims. This includes support for old age homes, psychiatric hospitals, senior day care centers, geriatric centers and hospitals, sheltered housing, and nursing units on kibbutzim. The lack of affordable stable housing for many elderly further exacerbates the economic pressure felt by Holocaust victims. As housing costs drain individual savings and inflate the cost of living, the struggle of the near poor is intensified. Understanding the enormity of the finances required to address these issues, the Claims Conference’s only possible response has been to provide emergency cash assistance to help alleviate a crisis situation while case managers help to develop a care plan. Additional facilities for congregate living and sheltered housing are required.
Despite the Continuum of Care that these services are geared to provide, there remain many unmet needs. In the past decade, Holocaust victims have seen the average public pension benefit decline in the majority of countries in which they live, raising the risk of more of them falling into poverty. Even in Western Europe, there has been a notable drop in the generosity of pension benefits in several countries, including Belgium, Denmark, Greece and the United Kingdom. In Israel, the value of the old-age pension benefit has declined as well and the government introduced higher eligibility standards for elder care programs. These phenomena have also occurred in Central and East European countries as they transitioned to market systems. The net result has been massive changes to public pension systems, hurting most those who were already living close to poverty.
Most of the activities of the Claims Conference have been funded by Successor Organization funds (proceeds from restituted unclaimed property in the former East Germany) as well as other sources (see discussion below). Since 2005, the Federal Republic of Germany also began to address these needs (see fn. 33 above). Claims Conference funding for social welfare programs has had a huge impact on Holocaust victims; however, the needs are beyond current Claims Conference resources. Further, the funding sources that, for example, support current Claims Conference allocations for social services will not last nearly as long as Holocaust victims are in need. Substantial, additional funding sources will have to be developed.

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