The age-gap peril we'll all have to face
Anglo-Jewry in the 21st century: Part four, ageing
In Nightingale's South London care home, you'll see Singer sewing machines, old family photographs and other trinkets associated with the past.
With about two-thirds of Nightingale's 200 residents suffering from dementia, the intention is to trigger memories, acknowledging that the needs of today's elderly people are different from their predecessors'.
"Nightingale has concerts and discussion groups, which help us to keep mentally alert," said resident Sylvia Berman, 96, praising it as "the top" home.
"It's a wonderful place," agreed Miriam Samuels, 97. "You have the physio, the doctor and all the activities you need."
But as Leon Smith, Nightingale's chief executive, is well aware, providing such services - streamlined to individual needs - does not come cheap. He and many other care experts believe that, in the future, families must prepare to contribute more towards care of elderly relatives. As in many western countries, Britain's population is ageing; people are living longer and expecting a better standard of care, putting more pressure on existing services.
Only the sickest of the sick and the frailest of the frail may be entitled to residential care
For the Jewish community, the situation is even more pressing. Overall, "life expectancy among Jews will be higher than the general population," said David Graham, a demographer at the Institute for Jewish Policy Research. At the last Census, 12.4 per cent of Britain's Jewish community was over 75, compared with 7.5 per cent in the population at large.
Further, people who have lived their lives outside the community often return to the fold as they age. "It can be really important that, when they go into a care home, it's a Jewish care home," said Neil Taylor, director of community services for Jewish Care, which offers services for the elderly ranging from residential care to support groups in London, Southend and Brighton.
For charities and local authorities, the traditional means of helping families meet the costs of care are no longer sustainable. "There is increased competition for the same pot," said Karen Phillips, chief executive of Manchester's Federation of Jewish Services, adding that at Heathlands Care Village, which MFJS administers, they absorb losses of £300 per week per resident.
Leon Smith agreed: "We are fortunate in the number of bequests we get but I'm not sure that there is a future in them, because more people are going to be spending on care, or their pensions. Families could be doing an awful lot more, even if it means seeing their inheritance going on care fees".
"Even if the economy improves, it will never be the same," said Neil Taylor. Future fundraising would have to be targeted at those who really cannot pay.
The shortfall is worse because, compared to 30 years ago, far more old and immobile people require costly full-time nursing or one-on-one care, not to mention the need for highly trained staff and volunteers. Meanwhile, criteria for local authority funding have become stricter. Mr Smith said that, unless people could pay for private care, only "the sickest of the sick and the frailest of the frail, people that need pretty much everything done for them, would have residential care".
All others will be encouraged to stay in their homes. While this is often seen as preferable, it presents a challenge to their families. And it heightens the risk of isolation. Today's 70-to-90-year-olds may be in better physical health than their parents were at the same age, but they are still vulnerable to loneliness.
Among Jews, there is an above-average number of one-person units, many of them single older people and particularly women living alone.
Across the community, families are more spread out. In smaller communities, where the next generation has often moved away, "it has a huge impact," said Rebecca Weinberg, chief executive of the Leeds Jewish Welfare Board. "Less family support can influence mental well-being [and mean] increased unplanned hospital admissions because their health needs are not so well monitored."
"Older people in good health do lots of travelling to see their children. As they become less able, they can become more isolated," added Suzanne Neville, chief executive of Jewish Care Scotland. She and others stressed the wider Jewish community's responsibility to help fill the gap, and the need to build on the existing networks provided by shuls, charities and community centres, of bereavement groups, home-care visits and befriending programmes.
"We need people of all ages to contribute - financially and also volunteer," said Ms Phillips, who felt that the commitment of those in their 30s and 40s was not as strong as it used to be.
Many want to see a change in how retired Jews are perceived by the rest of the community - for example, encouraging organisations to consult them over new strategies. "Older people being given a voice in the Jewish community is very important," said Sylvia Berman.
Many of these difficulties are not unique to the Jewish community, but Jewish organisations face additional challenges from, for example, halachic rules at the end of life, keeping kashrut in residential homes, providing separate facilities for more Orthodox men and women, and educating non-Jewish staff about customs and traditions. In Manchester, where there is a growing Charedi community, services must be accessible to everybody. Likewise, with higher rates of intermarriage, organisations must decide if they will provide for non-Jewish spouses.
"Heathlands does have non-Jewish residents," said Ms Phillips. "It's a small number and because it is a charity for Jewish people, they have to pay privately but they can be with their partners. In future, it will be something we have to consider. It wouldn't change the nature of the organisation - people do gravitate back to the community as they get older, and it's right and proper to accept partners who are not Jewish. But it throws up lots of challenges."
As regional communities shrink, the viability of culturally specific care is called into question. "I hope we will always have provision," said Leeds's Rebecca Weinberg. "But we will have to look at more collaborative working and offer services to non-Jewish service users. It will be important to retain the identity of the service as fundamentally Jewish."
There is plenty here to address and, with demographic and financial pressures piling up, we need to do so fast. But, as Ms Weinberg points out, "we've been doing this for centuries".