The terrorist attacks on Oct. 7, 2023, in Israel devastated many people of all faiths and backgrounds in both the United States and Israel, destroying people’s sense of safety, and giving rise to a wave of antisemitism and Islamophobia. And for many older adults with a history of trauma, including Holocaust survivors, the attacks caused them to relive painful memories from decades past.
“My heart is broken witnessing the beastly acts perpetrated by Hamas in Israel. As a survivor, it has evoked fear and disbelief,” said Ada Gracin, a Holocaust survivor in New York.
These memories can permeate every aspect of life. Some Holocaust survivors may find it difficult to leave their homes to do their grocery shopping or to attend medical appointments. Others may feel increased depression, anxiety and social isolation as they experience intrusive memories of past loss. Those who seek connection may have an increased need to share their stories.
“The recent conflict in Israel has triggered painful memories of displacement, persecution, and the loss of loved ones for many survivors,” said Meredith Davis, a service provider at a Jewish Family Service of the Cincinnati Area.
This situation places unique demands upon aging service providers. With retraumatization can come isolation or fear, and as a result there are more Holocaust survivors who need services and support such as a friendly visitor program or free mental health counseling.
‘As many as 90% of older Americans will experience a traumatic event in their lifetime.’
Simultaneously, Holocaust survivors are particularly vulnerable to retraumatization through service delivery. For example, having to undress, put away personal items, say goodbye to loved ones, and being escorted to undergo an invasive procedure may trigger flashbacks of living in concentration camps or undergoing medical experiments. Providers must adjust their approach to services to ensure that survivors feel safe and empowered. This could mean better explaining of services, more welcoming questions, and building rapport before providing services.
Service providers must also take care of themselves to mitigate vicarious trauma.
Unfortunately, the risk of retraumatization is not unique to Holocaust survivors. Trauma exposure is widespread among the American population. As many as 90% of older Americans will experience a traumatic event in their lifetime, with exposure to multiple traumatic events being the norm. This can include experiencing war, crime, natural disasters, sexual violence, or systemic racial, economic, religious, and gender discrimination. Regardless of the specific event, trauma exposure can rupture one’s sense of safety, affecting health, well-being and resilience throughout the life course.
Person-centered, Trauma-informed Care
To provide the best care to older adults with a history of trauma and their family caregivers, it is essential to account for the role of trauma in aging and service delivery. The person-centered, trauma-informed (PCTI) approach can help. PCTI care is a holistic approach to service provision that promotes the dignity, strength and empowerment of individuals with a history of trauma by incorporating knowledge about the role of trauma into agency programs, policies and procedures.
PCTI care combines the principles of person-centered care (self-determination, choice, empowerment, and individual preference) with the six principles of trauma-informed care that have been disseminated by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). These six principles are:
- safety
- trust and transparency
- peer support
- collaboration and mutuality
- empowerment, voice, and choice
- cultural, historical, and gender issues
This approach to care delivery has been demonstrated to result in improved health and well-being for this population.
While PCTI care can improve health and well-being, a 2021 study showed that only 30% of respondent aging service organizations demonstrated capacity to provide PCTI care to clients. In response, The Jewish Federations of North America’s (JFNA) Center on Holocaust Survivor Care and Institute on Aging and Trauma (Center) published “Aging with a History of Trauma: Strategies to Provide Person-Centered, Trauma-Informed (PCTI) Care to Older Adults and Family Caregivers.”
This publication is an essential guide for anyone working or volunteering with older adults and family caregivers. It covers the role of trauma in aging, the PCTI approach, and recommendations on supporting diverse older adults and family caregivers.
‘Direct service providers can integrate PCTI approaches into intake forms, referrals, therapy, or food delivery.’
The recommendations in this guide can be implemented at all levels of aging services organizations. Direct service providers can integrate PCTI approaches into intake forms, referrals, therapy, or food delivery. Organizational leadership can dedicate resources to PCTI initiatives, to integrating PCTI principles into the organization’s mission, vision, and procedures, and to training staff in PCTI care. When successfully implemented, PCTI care not only helps service recipients but also staff and volunteers by creating environments where staff and volunteers are supported and accepted, and where vicarious trauma and burnout can be addressed.
Below is a sample of the ways in which PCTI care can be integrated into aging service organizations. Please see “Aging with a History of Trauma” for the full list.
- Safety
• Ensure spaces are welcoming, quiet, well-lit and accessible.
• Post resources and materials that acknowledge and welcome family caregivers.
• Allow family caregivers to accompany care recipients for services. - Trust and Transparency
• Explain services or procedures, who they involve and how they are conducted.
• Explain what personal information is collected, how it is used and how it is stored.
• Follow through on plans, clarify next steps and be prompt. - Peer Support
• Provide time and space for care recipients to get to know one another.
• Advertise information about peer support groups.
• Host social events such as holiday parties, communal meals or virtual programs. - Collaboration and Mutuality
• Create joint care plans that align provider recommendations to the care recipient’s priorities, strengths and support systems.
• Explain how providers will work with care recipients to meet their respective goals.
• Incorporate family caregivers into care plans according to their and their loved one’s preferences. - Empowerment, Voice, and Choice
• Ensure participation in services is optional and not linked to future service eligibility.
• If a service or procedure is required, explain why.
• Allow care recipients and family caregivers to ask questions to ensure comfort with services. - Cultural, Historical, and Gender Issues
• Address disparities in care by engaging underserved communities in program design.
• Ensure that organization leadership, direct care providers and volunteers are diverse and reflect the communities served.
• Ensure services and resources are conducted or written in the preferred language of care recipients and provide translation services wherever possible.
In the aftermath of Oct. 7, the PCTI approach has become essential in the direct care services provided to Holocaust survivors and older adults. Agencies have provided Holocaust survivors with peer support through support groups and organized events, empowerment through letter writing, and even cultural competency through food delivery services.
Any organization—from community-based service agencies, to hospitals, senior centers, or food pantries—can employ PCTI strategies. The aging services sector has the collective power to establish PCTI care as the standard approach to service delivery, resulting in better outcomes before, during and after traumatic events. Each step made toward expanding and improving PCTI care ensures that all people with a history of trauma receive safe, inclusive and empowering services that support their health and well-being.
To learn more visit AgingandTrauma.org and read “Aging with a History of Trauma.”
This work is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $5,922,000 with 75% funded by ACL/HHS and $1,974,000 and 25% funded by non-government source(s). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.
Vanessa Rubenstein is Assistant Manager, Research and Evaluation, Carmel Rabin is Director, Research and Evaluation, and Shelley Rood Wernick is Managing Director of the Center on Holocaust Survivor Care and Institute on Aging and Trauma, all with the Jewish Federations of North America.
Photo credit: Shutterstock/grandbrothers
