Bio׳s of Presenters: Dale Shagrin, BSW Dr./Rabbi Elisheva Diaz

18520 Burbank Blvd #103
(866) 952-2734 Office
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Tarzana, CA 91356
(866) 861-2455 Fax
Bio’s of Presenters:
Dale Shagrin, BSW
Dale Shagrin is the Director of Community Education at Care One Hospice. Dale has over thirty years of experience in
healthcare, most of which are with seniors. After graduating from Ohio State University, he worked as a Social Worker
for a geriatric service organization and then moved to California, where he began three decades of work with seniors,
specifically in the healthcare professions of clinical lab, home health, and ultimately in hospice. Hospice proved to be
more than a career; it became a passionate mission to ensure that patients and families received the kind of loving
care that could sustain them through this emotional period in their lives. Having the privilege of being a part of this
highly personal, forever memorable, period is the most important professional endeavor he has pursued.
Dr./Rabbi Elisheva Diaz
Rabbi Elisheva is a first generation Jewish Latina born in East Los Angeles who was reared in a quasi Jewish and
Catholic family by way of both parents. Her Mother’s Spanish/Mexican family came from the Spanish Canary Islands
with their recent origins in Mexico. Her father’s family is Ashkenazi/Mexican with a very common thread into
Guadalajara, Jalisco. Dr./Rabbi Diaz was educated in Catholic private schools as a child and grew up exposed to
Judaism through her Mother’s family members. Her tenure into a 25+year career in National politics began at a
grassroots level in Los Angeles and moved her up in the ranks where she worked with two white house
administrations. She was later recruited by some the most powerful National leaders to build National Special Interest
Coalition groups throughout the country.
Here in Los Angeles she was one of the movers and shakers that helped spearhead “Navidad en el Barrio” (Christmas
in the Barrio) an annual effort to provide warm and meaningful holidays for Latino families throughout and
surrounding the city. It was through Spanish Television (KMEX 34) that she helped produce annual National Celebrity
Telethons to raise money for under-privileged children in Los Angeles and special projects such as “Mexico estamos
con tigo” for Mexico’s earthquake victims in 1985. In the early 90s she was asked to assist the Los Angeles Police
Department in combating Child abuse and Child Pornography through the National “Enough is Enough” Campaign. It
was through this effort that she worked closely with Angelino Latino leaders to help educate the community on the
issues directly impacting Latinos as a family unit.
She traveled annually for 14 years to South America to address Government Leaders that included distinguished
members of the United Nations. After 10 years of consistent work, Dr./Rabbi Diaz was honored by the Brazilian
Government for her endeavors in their slum areas (Favelas) and orphanages throughout parts of Brazil. She served on
the board for the USC Mexican American Scholarship Foundation, Haggard School of Theology Women’s Interfaith
Council for Azusa Pacific University, the Task force for Ethical Charities for the Los Angeles Police Department, and
was appointed by Governor Pete Wilson on The Commission on Improving Life through Service. Her expertise on
world religions, Pastoral (Jewish and interfaith) Spiritual care reaches back to the early 90’s. Her knowledge of the
Latino culture/tradition, which is her own as well, will bring realistic learning and dialogue to our session. She is the
President and Founder of the Coalition for Sephardic Ladino Legacy and works closely with the Latino community in
Los Angeles. She is the resident Rabbi and Interfaith Chaplain for Care One Hospice located in Tarzana, California.
Addressing the Palliative and Hospice Needs of the Underserved
Hispanic Population in California
Introduction:
Hospice and Palliative services have been available in the United States since the early 1970’s, yet these services
are not being utilized equally across many cultural segments.
Our goal here today is to, first, shed more light on what the issues and challenges hospice and palliative
professionals have in attempting to broaden our availability to those underserved, and then to offer solutions to
these challenges.
For the purposes of clarity and specificity we have chosen to focus on California’s largest and fastest growing
population….The Hispanic/Latino community.
In order to move forward we must ask ourselves some questions:
a.) Generally, why are Latinos not using Palliative and Hospice Care?
b.) Is the Palliative Care we are offering Culturally Competent?
c.) What are the patterns of the Latino Family, their bond and,
d.) Who are the decision-makers when caring for the terminally ill Latino patient?
e.) How does the Hispanic/Latino view Life and death and what do they affiliate with when this tragedy hits
their homes?
The Hispanic Community (formerly a minority) is one of the largest in California, with numbers growing
exponentially each year. Hispanics/Latinos currently make up the majority in California; 38.6% of the
population. However, out of the 1,542,737 people served by hospice in 2013, only 6.8% of them
were of Hispanic/Latino origin.
To successfully grapple with the above as Palliative Care Professionals, we must find the key mediator in
palliative care; the issue of identity and pride (Self- Identify vs. Social identity and Social Comparison becomes
a key).
a.) Self-Identity
As humans, we all have a need to develop a personal identity that distinguishes us from others. How does
this family in need describe themselves?
Although it sounds like a simple question, it can be complex when dealing with multi-cultures and
religions. Self-identity is a very complex idea; so complex, in fact, that even those who actively work on
understanding themselves and their self-identity still have difficulty knowing how to define themselves.
This we know for sure, one cannot deem to know this answer about another.
b.) Social identity Hispanic or Latino?
Terminology: Hispanic refers to language. If you and/or your ancestry come from a country where they
speak Spanish. (Hispano originated in Iberian Peninsula then for a Spaniard)
Latino refers to geography. Specifically, to Latin America, to people from the Caribbean (Puerto Rico,
Cuba, Dominican Republic), South America (Ecuador, Bolivia, Colombia, Peru, etc.) and Central America
(Honduras, Costa Rica, etc.)
A Latino refers more exclusively to persons or communities of Latin American origin. While there is a
significant overlap between the groups, Brazilians are a good example of Latinos who are not Hispanic.
Both terms were meant to refer to ethnicity, not race; however, in the U.S., they are often used
haphazardly to refer to race as well.
NOTE: It is imperative that one does not clump together all Latino identity and geography and can be
very offensive to a Latino/Hispanic family.
Differences
There is a very well known theory in psychology and certainly not limited to the Latino population. It is
known as in-group (us) and out-group (them). It is important to acknowledge that Social identity theory
states that the in- group will in many cases subconsciously discriminate against the out-group to
enhance their self-image and strengthen their identity. What does this mean?
1. As Health Care professionals, we must learn how to recognize the groups, acknowledge them and
realize how they blend with each other.
2. The family must understand that geography and borders are important.
C.) The final stage is social comparison.
Once we have categorized ourselves as part of a group and/or identified with that group, we then tend to
compare that group to all others that are different. If self-esteem is to be maintained, we must own the idea
that we are different and depending on where we are, our group needs to compare favorably with other
groups.
Does the Latino Community generally operate within this methodology? Why is it important to know
and understand this?
Are there any pros to stereotyping?
America continues to struggle with cultural ignorance. Our focus today is on the Latino and Palliative Care
and the issue of Life and Death.
These issues cannot be effectively addressed
without the reality of:






Family
Language
Religion/Faith
Gender issue
Culture/tradition
Immigration – documented or not
Generational differences in the Hispanic/Latino community:
When looking at Generational differences here in America we break it down as follows:
 Baby Boomers (born 1946–1961)
 Gen/X'ers (born 1962–1981)
 Millennials (born after 1982)
How do we break down Generational differences in the Latino/Hispanic
Community and why?

Family Decision Makers:
 the
Hispanic/Latino American children learn early
importance of:

(1) A deep sense of family responsibility,
(2) The rigid definitions of sex roles,
(3) Respectful and reverent treatment of the

elderly, and
 in
(4) The male's position of respect and authority
the family. (Although some of the male's authority
appears to be relaxing as the woman's roleis
redefined, women in the Hispanic/Latino American
culture generally continue to occupy a subordinate
position. Fathers have prestige and authority and
sons have more and earlier independence than do
daughters.)
(5) The extended Family Members
(6) Religion and psychological distress (Spiritual
assessment and care)
Example:
End of Life Bill (LA TIMES PoliticalCal, October 5, 2015)
After struggling, Jerry Brown makes assisted suicide legal in California:
Caught between conflicting moral arguments, Gov. Jerry Brown, a former Jesuit seminary student, signed a
measure Monday allowing physicians to prescribe lethal doses of drugs to terminally ill patients who want
to hasten their deaths. Brown appeared to struggle in deciding whether to approve the bill, whose
opponents included the Catholic Church. How does a Latino Family feel about this?
Why?
-ConclusionSTRATEGY FOR SUCCESS
Patient
← Process of Education for Palliative and Hospice Care
Hospice
Staff
Immediate
Family
When dealing with individual families regarding Palliative and Hospice Care, the need for education
must be assessed. There are family members (3rd and sometimes 2nd generation) that may be able
to help with this. Assessment of the complexion of the family must be made.
When dealing with the Hispanic/Latino community, the syllabus should be structured by someone
that understands the community, the culture and traditions, i.e., preferably a (bi-lingual) Latino
educator that can communicate with all the family and/or assembly.
Church
&
The Greatest Influence for Education →
Extended
Family
Memebers
Head of
Household/
Pillars
Church
Children's
School
God
Physician
Latino
Family
Media
Media
Latino
Family
Social
Service
Locations
← Best Venues for Education on Health Care