Updated on May 19
When the health of Les Burger’s father began declining in 2021, the family knew they wanted hospice care that would honor not only his medical needs, but also his Jewish values and life experiences.
Burger’s father, Henry, was a devout and proud Jew who escaped Nazi Germany as a child in 1938.
“It was important to us, based on his upbringing and his wishes, that it be a hospice that, if at all possible, had Jewish values and Jewish people,” Burger said.
Their search led them to Angel Palliative Care and Hospice, a Bay Area agency founded and operated by two Jewish women. The hospice has long sought to offer culturally sensitive care to Jewish patients but in May became the first locally owned agency certified through the nonprofit National Institute for Jewish Hospice.
The institute, founded in 1985, trains hospice agencies on Jewish culture, religion and customs so they can better serve Jewish patients. There are 51 accredited agencies across the country whose staff have been trained on Jewish heritage, holidays, medical ethics and practices related to death, burial and mourning.
Palliative care and hospice are both focused on comfort and quality of life for people facing serious or terminal illness — palliative care for those still undergoing treatment, hospice for those expected to live six months or less. Both are typically covered by Medicare, Medi-Cal and private insurance, with no extra cost for choosing an institute-certified agency. Services are usually provided at home by a team of doctors, nurses, social workers, spiritual counselors and other caregivers.
Although there are an estimated 36,500 Jewish seniors in the Bay Area who may need such care, both palliative and hospice services are available for people of any age who are facing a terminal condition.
While every hospice agency provides the same core medical services, staff at a certified Jewish hospice may better understand Jewish family dynamics, Holocaust trauma, kosher needs, language preferences, holiday observances and mourning practices, according to Rabbi Yitzchak Young, director of education at the National Institute for Jewish Hospice.
“Most people never think about hospice before they need it. And then once they need it, there’s the tremendous pressure of time and they don’t always end up making the right decisions,” Young said. “Our goal is that the hospice’s interaction with the Jewish patients and the Jewish family takes on a much more positive [tone] because they’re very aware of all the cultural issues.”
For families like the Burgers, ensuring Henry received culturally sensitive care in the comfort of home was crucial. Les’ parents, Henry and Lottie, lived at the Moldaw Residences, the retirement community located at the Taube Koret Campus for Jewish Life in Palo Alto, for 16 years. The married couple was heavily involved in the community there, and Henry served as president of the residents association.
Both of their families had known each other in Germany and were reunited in the United States when Lottie’s mother catered Henry’s bar mitzvah. Lottie and Henry had been together since then, for nearly 70 years.
Angel Care worked with Henry for several months before he died in 2021. When Lottie’s health began to decline in February, the Burgers once again turned to Angel Care. She began receiving hospice care, which continued until she died in March, just weeks before what would have been her 96th birthday.
The experiences reinforced for the Burgers what culturally sensitive hospice care can mean for Jewish families, particularly those shaped by immigration and trauma.
“The compassion that they showed, keeping the family connected and informed and understanding, was really important to us,” said Nancy Burger, Les’ wife. “The family-centric respect and care was really always evident.”
That understanding is part of what motivated the team behind Angel Care to pursue Jewish hospice certification.
Yelena Asadov, an occupational therapist who emigrated from Ukraine as a child is one of the agency’s two founders. She said Angel Care has become well known among Russian-speaking Jews and Holocaust survivors in the Bay Area thanks to its specialized care. She added that the agency wants to become a trusted resource for the entire Jewish community, regardless of background or traditions.
“We’re committed to providing compassionate, personalized care to every culture and community we have the privilege to serve,” Asadov said. “But having Jewish roots myself, I always felt deeply connected to serving Jewish patients and families.”
Asadov arrived in San Francisco, with its significant concentration of Russian-speaking Jews, in 1995 at age 10 and attended Hebrew Academy, an Orthodox Jewish day school that has since shuttered.
She said that growing up in the former Soviet Union and within San Francisco’s emigre community shaped her understanding of many older people’s fears and hesitations around healthcare.
“In the former Soviet Union, it was taboo to be Jewish,” Asadov said. “When families learn that you are also Jewish and understand Jewish traditions, culture and values, it immediately creates a sense of comfort and trust. They feel understood on a deeper level, which helps them open their hearts and feel more at ease allowing you to care for their loved one.”
Many Jewish emigre families remain unfamiliar with hospice services and often believe receiving care from an agency means losing hope or abandoning their elders, Asadov said. Outsourcing elder care can feel like going against their cultural values of resilience, emotional strength and self-reliance, she explained.
“The Russian-speaking Jewish community is definitely tough,” she said. “A lot of people think that hospice is you giving up, and they don’t accept it.”
Asadov said that by offering culturally competent care, her clinicians are able to connect with these families and offer a deeper level of comfort and care to the patients.
“As well meaning as all hospice professionals are, coming into a Jewish home, which might keep kosher or Shabbos — and the person coming in doesn’t know or understand anything about that — can just create uncomfortableness and sometimes difficult situations,” Young said.
Through the certification program, Angel Care staff received training on Jewish traditions surrounding illness, end-of-life care, death and mourning.
One of the most compelling parts of the training, Asadov said, was learning about the Jewish custom of not leaving a body unattended after death.
“I didn’t know that once a Jewish person passes, the body should not be left alone,” she said. “That really stuck with me.”
The agency has since implemented new protocols to ensure families can fulfill this custom, including arranging for staff members to remain with the deceased.
The training also addressed modesty, gender sensitivity and religious customs that can affect how patients experience intimate medical care. The agency’s staff also now receives ongoing education tied to Jewish holidays and traditions throughout the year, not just during the initial certification process.
“When we enter someone’s home, we’re entering a sacred space,” Asadov said. “Patients are vulnerable. Sometimes they need wound care or help bathing. Understanding modesty in Jewish culture can make the difference between someone accepting care or refusing it.”
Marlene Rosales is a registered nurse at Angel Care who completed a training program in Jewish hospice care as part of the agency’s accreditation. Originally from Mexico City, Rosales said she previously had little exposure to Judaism. She said the coursework expanded her understanding of Jewish customs and reinforced the importance of dignity in hospice work.
“I didn’t understand before some of the traditions, such as [Passover], and how my actions, like just bringing, for example, a bagel in my bag or something, could jeopardize all the work they did to clean the house for the holiday,” she said.
Rosales said learning about Jewish mourning practices and beliefs surrounding the soul after death particularly resonated with her.
“That belief that the soul is still present and can still hear you was very meaningful to me,” she said. “I always talk to my patients after they pass and thank them for everything they did in their lives.”
Rosales said the training also made her reflect on previous Jewish patients she had cared for, including a woman who was a Holocaust survivor.
“She had the tattoo with the number that they gave her back at that time, and she would tell me all the time how it was for her as a little girl, to go through all of this, and how hard it was to not have their dignity,” she said. “I feel like I understand better.”
The Burgers said the emotional support Angel Care provided extended beyond direct medical aid.
“She was really a guiding light to us,” Nancy Burger said of Asadov. “Even when she wasn’t officially engaged as the hospice provider, she was willing to answer questions and help us make informed decisions.”
For Asadov, that kind of trust is central to hospice care.
“I always tell families hospice is not the end,” she said. “It’s a different way of thinking about life — focusing on comfort, dignity and quality time together.”