Ida Shtulman laughs from behind the wacky, oversized glasses.
Her white hair is in a neat bob. Always fashionable, she wears a new red blouse and black sweater for the occasion, although the clothes swallow her now-small frame. There is a clown nearby, a cake ablaze with candles, and sparkling juice.
In these photos of her 90th birthday party in March, Ida is smiling as she is hugged by family members.
She died less than four months later.
For her daughter, Rita Shtulman of Waltham, the photos are a reminder that her mother’s last days were spent not only battling pneumonia and other illnesses, but were also filled with moments of joy, in large part because of a novel hospice program.
Newton-based Hospice of the Good Shepherd has been working with Royal Braintree Nursing & Rehabilitation Center, where Ida lived, for the past year to meet the needs of Russian-speaking elderly patients.
Shtulman, who emigrated with her parents and her son from the Ukraine more than 20 years ago, said she was initially reluctant to accept hospice care for her mother, thinking that “with hospice, death is going to sit there.” But after talking with her mother’s doctor and caregivers, and researching end-of-life care, Shtulman said, she realized that hospice would provide her mother with additional help.
“Because of them she was alive for 11 months,” Shtulman said of the team of hospice and nursing home workers. “She was happy in her own way. And I was happy.”
When Hospice of the Good Shepherd began Krug Zaboty, its comprehensive Russian program (which translates to “circle of caring”), a year and half ago, agency officials knew they faced a challenge.
How do you convince Russian families — many of whom are brought up to fight for their last breath, avoid handshakes at funerals, and are likely to opt for aggressive life-saving measures — that another operation is unnecessary and unhelpful, and that reducing a dying family member’s pain is more important?
But the need was there for the region’s growing Russian-speaking elderly population, who in many cases had immigrated with their children decades ago or moved to the United States to be closer to their families, said Artur Micolisin, nursing care coordinator for the Hospice of the Good Shepherd. He emigrated from Moldova in 2000 and speaks Russian.
“In Western culture, terminal patients accept the outcome,” said Micolisin, and they may spend their last remaining months grieving or settling matters with family members.
“The vast majority of Russians,” on the other hand, “were in panicking mode, trying to jump from one medical solution to another medical solution, when there wasn’t one,” Micolisin said.
Since modern hospice services were introduced in the United States in the mid-1970s, the movement has expanded and become more specialized. According to a study by the National Hospice and Palliative Care Organization, nearly 1.6 million patients received hospice care in 2010, up from 1.3 million in 2006.
Hospice agencies are developing programs aimed at specific communities. Many have end-of-life care for veterans and Holocaust survivors. Organizations are reaching out to Latinos and African-Americans, who overall use hospice less frequently. In the Washington, D.C., area, there is a hospice program for Korean families, said Jon Radulovic, a spokesman for the National Hospice and Palliative Care Organization.
With increased competition and more regulatory requirements and demand for resources, hospice agencies are trying to meet as many needs in their communities as possible.
“Hospices are having to be smarter, more efficient, and still provide interdisciplinary care,” Radulovic said. His organization instructs hospice programs “to make sure you’re not putting resources to what you don’t need, and not missing out on communities that need service.”
Newton’s Hospice of the Good Shepherd had a Russian nurse for several years, but the nonprofit realized that it wasn’t enough, said Timothy Boon, the organization’s president.
Good Shepherd has developed a Russian-speaking team, with a nurse, social worker, home health aides, and an art therapist.
The workers help explain medical terms to patients and their families in Russian, manage pain with medications, and even go out to get ethnic food.
About 100 patients have used the hospice’s Russian program since it began, Boon said, and about 10 percent of the agency’s current patients are Russian.
Some of the patients are in their homes, but many others are residents of nursing homes, such as the Royal Braintree Nursing & Rehabilitation Center, which has a Russian-speaking unit.
Cambridge resident Olga Dadasheva said that having caregivers and hospice workers who spoke Russian was a comfort to her mother, and helped her understand what was happening medically. Dadasheva’s mother had been a resident of the Braintree nursing home for a few months before her death in January at age 87.
For her mother, “the English-speaking environment was frightening, especially in the hospitals,” she said.
Dadasheva moved her mother, who suffered from dementia, to the nursing home and asked for hospice services after she suffered a fall and stopped eating. Her mother had grown up in Siberia and had always been strong, Dadasheva said, but in the last few weeks couldn’t get out of bed. Dadasheva said she was pleased with the extra help and support they received from hospice.
“I feel like we did everything we could,” Dadasheva said.
While Hospice of the Good Shepherd is expanding its outreach to the local Russian community, the organization is also trying to build ties internationally. Micolisin returned to his hometown of Chisinau, Moldova, this summer to learn about the country’s hospice program, which started soon after he moved away more than a decade ago.
Hospice of the Good Shepherd is raising money to help Hospice Angelus, the Moldovan organization, purchase equipment for its patients, and hopes eventually to conduct exchanges and training.
Micolisin said he was impressed by the extent to which hospice is growing in the former Soviet state. And he realized that the local Russian-speaking program and Hospice Angelus are facing similar challenges, such as how to draw more volunteers, which is a cornerstone of the hospice movement.
The visit signaled that if the views of end-of-life care are changing for communities that were once part of the Soviet Union, they may change for Russian-speakers in the United States.
“I was amazed at how many things changed,” Micolisin said.