My family does not have a Holocaust story. As far as I know, all four sets of grandparents arrived here from Lithuania and Russia by 1910 to 1912. We were safe and had no knowledge of those left behind. The erroneous belief that we were secure allowed me to grow up in the 1950s seeing numbers on the arms of older neighbors and thinking that they belonged to a faraway time and place. It enabled me to watch documentaries of emaciated human beings being liberated and understand nothing about what had happened to them. It freed me to ride my bike, to roam and play on sandlots and railway tracks with nary a care of anyone targeting me. As a teen, I was much more of an “American Jewish Princess” than a young woman growing up with a sense of identity tied to a historical legacy, a legacy I now realize is impossible and callous to deny. Not only do I have to acknowledge my connecting cord to this central Jewish trauma, but I’ve come to realize that my insides reverberate deeply to the experience that others have shouldered for so long in their muscles, bones, and nerve fibers.

Our tradition obligates us to care for our parents until the end of life – personally, if possible, yet if not, then to employ caregivers for their assistance. The assumption is that the issue of providing appropriate care is now resolved. However, as someone who has been involved as a mental heath therapist, care advocate, and sometimes a relative with individuals and families approaching elder care both at home and in facilities, I can say that this is when the real watchdog effort needs to take place.

The phrase “nursing home” conjures up several images. One might be that of a caring environment where a level of healing can take place. Alternatively, one’s thoughts can go to media depictions of places where people are left towards the end of life with minimal – and sometimes adverse – treatment.

Nursing homes have their purpose. When hope of rehabilitation is gone, and close kin do not have the time, energy, or knowledge to meet their loved one’s daily needs – and hospice is not an immediate possibility – long-term facilities can provide a space for end-of-life care. The questions become: How long a period might “end-of-life” be, and what will be the quality of care? We live in an age where medications can keep us alive yet barely functioning. Is this providing quality care? Who gets to determine the criteria for quality care and then assess whether or not it is occurring?

Like everything else in our health care system, there are myriad regulations in long-term care provision. Nursing home administrators will tell you they do their best to comply with state, federal, and insurance codes. They claim that the care required is enormous and their profit margin is low. They say that families thrust their guilt and anxieties on staff and demand the impossible in caring for their relative. They assert that most of us are in such denial about our loved one’s inevitable demise that our inability to accept what is happening only makes their jobs harder and more frustrating. We want answers; we want cures; we want better outcomes. And the staff lumbers along putting in time and energy with little improvement to show for it.

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The excellent article interviewing Shlomo Schor in January’s issue, “Understanding Trauma and PTSD in Laymen’s Terms,” was an informative overview. Now I will attempt to give some general and anecdotal ways in which trauma therapy and the path to healing play out and to suggest caveats to prospective clients.

I am a licensed counselor who has been in practice for 25 years, with specific trauma training for the past six. I have met people who endured physical violence and other abuse, which, while no doubt horrific and distressing, did not traumatize them. I’ve known others who went through a more common experience, nowadays, like divorce of their parents when they were vulnerable children, who remain traumatized as adults.

So a working definition of trauma is not the actual event but, rather, the symptoms of stress, anxiety, PTSD, and somatic illness that one is experiencing. Of course, each person’s temperament and physical, emotional, and environmental sensitivities are also factors in their own suffering.

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As adults, we all hope to age in place and exit the world as gracefully and painlessly as possible. As children, we all vow to care for our parents lovingly in our own homes as they weaken and lose their independence. Unfortunately, these beautiful scenarios are not always possible. Medical realities, insurance considerations, and family dynamics often preclude being able to fulfill these dreams. Indeed, the current norm is that about one in ten older people will spend their ebbing time in a nursing home.