The imperatives to honor and revere parents are truly weighty positive commandments. They are demanding even when ageing parents have clear minds and are essentially healthy. These precepts are even more challenging if a parent suffers a physical disability or dementia. It is not for naught that the third century amora, Rabbi Yohanan ben Nappaha, whose teachings comprise a major portion of the Jerusalem Talmud, stated, “Fortunate is the one who never saw his parents.”(TB, Kiddushin 31b) While his statement is formulated as clearly hyperbole, it does convey the enormous challenge of properly fulfilling the commandments to honor and revere a parent. His statement also provides a positive spin to his tragic personal history; he was raised by a grandfather (TJ, Ma’asrot 1:2) as his father died before he was born and his mother died in childbirth.
Maimonides (h. Mamrim 6:7) describes the length to which the duty of honoring a parent goes. “Even were they to take his purse, full of gold, and cast it in his presence in the sea, he must not shame them, manifest grief in their presence, or display any anger, but accept the divine decree without demur.” The same is true regarding the demands of reverence as the Jewish law requires the son/daughter, even if publicly humiliated, to remain silent and revere the King of Kings, who has thus decreed.
The Talmud (TB, Kiddushin 31b) tells us about the late third and early fourth century Amora, Rav Assi, who came to the realization that his elderly mother suffered dementia and made numerous demands of him. He initially honored her requests but when they became totally unreasonable and inappropriate (i.e., she said that she wanted to marry someone like her son), he turned her care over to others and supervised her care from afar. Maimonides (h. Mamrim 6:10) and Rabbi Yosef Karo (ShA, YD 240:10) formulate a halacha based on Rav Assi’s conduct and codify the following, “If one’s father or mother has become mentally disordered, he should make an effort to behave towards them according to their state of mind until they will be shown mercy. But if it becomes impossible because they have become utterly deranged, he may charge others to take care of them, while he supervises the care from a distance.” Clearly Rav Assi assigned others to care for his mother because of the inappropriate nature of her demands; otherwise he would have attended to his mother.
Above and beyond the halacha as outlined above, there are options for caring for a parent with dementia. The best option is to have the parent, with an aide, live with family. The parent will feel comfortable seeing familiar and loving faces of children and grandchildren throughout the week. This may not always be possible if the home does not have a bedroom and bath on the main floor. I know that this is an ideal situation because my wife and I took my mother, z”l, into our home where she lived with two aides for three years. She expressed in her limited way that she was grateful to be with family. This was possible because my wife was in full agreement and my brother, Rabbi Levi Meier, z”l, and his wife, Marcie, were very supportive from their home in California.
The second option would be a kosher facility with full time aides. Such a facility would provide the parent with a familiar environment featuring other people of a similar religious orientation, kosher meals and Shabbat services. When a parent has maintained a religious and observant practice their entire life, not honoring that standard during the parent’s final years certainly is a breach of a child’s obligation to honor and respect the parent. This is particularly true in a case of dementia where there is no concern of pikuach nefesh (saving a life). The aides are indispensable for the dignity of the parent; they can assure the cleanliness and hygienic state of the parent. Without aides, most facilities do not have the human resources to address the parent’s bodily functions in a timely and regular basis.
I should add that the cost of such care should, according to halacha, come from the parent’s estate. If and when that is exhausted, it can come from the children’s tzedakah funds.
While I mention the dignity of the parent, I should add that we really do not know what a dementia parent processes. Therefore one should always speak respectfully of the parent in their presence. One should speak to the parent with respect, even if the latter cannot respond appropriately. It is estimated that there were 5.8 million Alzheimer’s dementia patients in the United States in 2018 with the number on the rise throughout the world. These people are still living human beings who were created in the image of God and, while not the same as their former selves, are still worthy of dignified and respectful human contact.
May the Almighty help researchers find a cure for Alzheimer’s dementia, and if not a cure, at least the means to arrest it when diagnosed. May He also grant those with the challenge of dealing with such a parent the wisdom to recognize the unique opportunity of honoring and revering a parent, even one diagnosed with dementia.
By Menahem Meier
Menahem Meier served as the founding principal of The Frisch School (1971-1997) and lives in Teaneck with his wife, Tzipora.