Introduction

Pesach is a time of familial joy and includes unique commandments and prohibitions with very significant meaning and various practical ramifications, more so than any other holiday. Participating in holiday events is important for each person, including a person with dementia or a person sick with severe, complex disease. From a fundamental perspective, a sick person is obligated in mitzvot. However, when the fulfillment of mitzvot adds tremendous burden and great difficulty on top of the struggle of illness, there are situations where the person is exempt from mitzvot; yet it is possible that his participation in their fulfillment will benefit him. Not only this, but a person with dementia or complex disease can suffer throughout the year with eating and swallowing difficulties, and a significant portion of the Seder night mitzvot are related to eating – matzah, maror, and the four cups – and perhaps this will lead to difficulty fulfilling them. The guidelines detailed here deal with all of the prohibitions, mitzvot, and customs of Pesach, including issues involving eating as well.¹

Halachic Principles

1. A person with dementia who understands what Pesach is and is aware of the mitzvot of the holiday (even if they require a reminder) – is obligated in all the mitzvot and prohibitions. When they are totally unaware of the significance of the day or the commandments – they are exempt from the mitzvot.²

2. When fulfilling these mitzvot involves great difficulty and is burdensome and distressing for the person with dementia or severe, complex disease, they are obligated to fulfill the most fundamental and limited form of the mitzvah, and at times are even exempt from it entirely.³

3. Even when a person with dementia or a patient with complex disease is exempt from mitzvot, it is possible that it is beneficial for their soul to fulfill the mitzvot of the holiday and its customs. For example, participating in the Seder night preserves their status within the family; Hearing the familiar tunes and participating in familiar customs brings forth pleasant memories from the past and improves their wellbeing. One is thus required to find the balance between placing burden on a person with dementia and helping and including him in the fulfillment of the holiday’s mitzvot – and one should act in the manner that would benefit his condition the most.⁴

4. A person with dementia that is entirely unaware that there is a prohibition is not liable for it. Despite this, one is obligated to distance him from sin, yet there is a difference between biblical and rabbinic prohibitions, as explained in the footnote and detailed later on.⁵

5. One who is taking care of a dementia patient or a patient who requires constant supervision is “engaged in a mitzvah”. When they are the sole caretaker, they are exempt from other mitzvot; and even when they are not directly taking care of the patient, if the illness carries with it risk, the caretaker is exempt from the mitzvah, and this ruling applies if there is a reasonable concern that fulfilling the mitzvah will impair the treatment of the patient.⁶ Practically, one can generally fulfill the mitzvot of the Seder night even when they are with a sick person, and of course when there is more than one caretaker.⁷ In times of need, it is possible to limit and fulfill only the fundamental obligations, as explained later on regarding the patient.

6. To download a file with an abridged Haggadah and practical advice for conversation and preparing a dementia patient for Pesach and the Seder night, go to the Tzohar Ad 120 Website.

The Burning (Biur Chametz) and Search for Chametz (Bedikat Chametz)

7. When necessary, one may scale back the house cleaning. One should clean and kasher the kitchen, dining area, and the places where food is stored.⁸

8. A person with dementia that cannot search for chametz themselves can have a family member search for them – even if they do not live in the house.⁹

9. Regarding a person with dementia that cannot exterminate their chametz themselves, it is a mitzvah to assist him in burning their chametz. One may sell the chametz for them, even if it is impossible to receive clear instructions or consent from him. If he has a legal guardian, they should sell the chametz for him.¹⁰

10. A non-Jewish worker can assist in Pesach cleaning and the preparations for the search for chametz. One should explain to him the severity of the prohibition of chametz and guide him in the cleaning process and removal of chametz from the home. The search for chametz can be done by a Jew only. Burning the chametz should ideally be performed by a Jew, but when necessary, one may burn it via a gentile.¹¹

Eating on the Eve of Pesach

11.A person with dementia who is not aware of the Firstborn Fast is not obligated in it. Even if he is aware of the fast but is weak or has difficulty arriving at a siyum, he is exempt from the fast and one should not burden him to participate in a siyum.¹²

12. Even though one should avoid eating a meal close to the beginning of the holiday, and on Seder night before eating the matzah, a dementia patient can eat and take medicine as they normally do on the eve of Pesach.¹³ They are permitted to eat even at the time of the recitation of the Haggadah, and it is best that they eat between kiddush and pouring the second cup.¹⁴

The Prohibition of Eating Chametz

13. One should not feed a dementia patient chametz, even if they are unaware of the prohibition.¹⁵ In a situation of vital need – it is permissible as explained in the following articles.

14. Regarding a person with dementia or a patient requiring assisted living that is fed with designated medical nutrition (such as Ensure) and this is their primary nutrition – one should use it. Granted that if there is no kosher alternative, it is permitted to feed it to him even if there are chametz ingredients in the food. If there are kitniyot ingredients, one may use it even for a patient who does not eat kitniyot on Pesach.¹⁶

15. One may nourish a dementia patient via a nasogastric tube or PEG even if the food is not kosher for Pesach, for this is not technically eating according to halacha.¹⁷

16. Medications and creams are not fit to be eaten, and changing the medication regimen is not medically recommended. Therefore, a person with dementia or complex disease should continue to take their regular medication with no deviations.¹⁸

17. A patient who uses medical cannabis and its derivatives – is permitted to use it, even by way of eating or drinking, and even if there are kitniyot ingredients in the product.¹⁹

The Seder Night

18. The time for Kiddush and the Haggadah is after the appearance of three stars (tzeit hakochavim). When necessary, one may say kiddush and the beginning of the seder a short time before tzeit hakochavim, however drinking the rest of the cups of wine, eating the matzah and maror, and saying Hallel must be done after tzeit hakochavim.²⁰

19. A dementia patient who is unable to sit for extended periods on Seder night or requires fixed sleeping routines and a patient with complex disease who is frail and fatigued should participate in a shortened Seder, including the things that are fundamentally required:²¹

a. Kiddush and the First Cup

b. (Eating Karpas)²²

c. Saying the primary sections of Maggid: The Four Questions (מה נשתנה), “We were slaves” (עבדים היינו), “Initially our forefathers were idol worshippers” (מתחילה עובדי עבודה זרה), (“an Aramite tried to destroy my father” – “ארמי אובד אבי”), and “anyone who does not say these three things” (“כל שלא אמר שלושה דברים אלו”, the chapters of Hallel at the end of Maggid, the blessing of redemption and the second cup.²³

d. Eating the matzah, maror, and meal.

e. Birkat HaMazon and the third cup.²⁴

f. Finishing Hallel and the fourth cup: from “not us” (“לא לנו”) until “You are my God, and I will give you thanks” (“אלי אתה ואודך”) and the blessing of “they will praise you” (“יהללוך”) with its final blessing (one may shorten this by saying only a few verses. It is not necessary to say “the Great Hallel” [Psalms 136] and the blessing of Nishmat and Yishtabach.²⁵

If necessary and based on the style of the participants, one can arrange an abridged and quick Seder for everyone, and afterwards continue the story of the Exodus from Egypt.

20. A dementia patient who must stop reciting the Haggadah, Hallel, or Birkat HaMazon in the middle in order to relieve themselves and the like may return to the location they stopped at and do not need to start from the beginning, even if a significant amount of time has passed or they spoke in the interim.²⁶

21. A person with dementia that has difficulty reading the Haggadah, berachot, or Hallel may hear it from another person and fulfill their obligation through listening. A man can hear from a woman and vice versa and fulfill their obligation.²⁷

22. A person with dementia who suffers from dysgraphia, has difficulty eating and swallowing, and has a complex eating regimen that involves great distress and suffering is exempt from the Seder night mitzvot involving food. If it is possible, they should eat a quarter of a matzah.²⁸

23. Eating Matzah: A person with dementia that is aware of the mitzvah of eating matzah and does not have difficulty eating should eat two thirds of a machine matzah during the first course, after HaMotzi. If they have difficulty eating yet are able to eat a small amount of matzah, they should eat a third or at the very least a quarter of a piece of matzah, thereby fulfilling the biblical commandment to eat matzah. Korech and Afikoman are rabbinic obligations, and it is enough to eat only a quarter of a piece of matzah for them. If they have difficulty eating, they are exempt from Korech and Afikoman.²⁹

24. A person who has difficulty eating matzah may crush it or soak it in water in order to soften it.³⁰ One may buy “soft matzot” for a person with dementia or a sick person who has difficulty eating, and even those who are stringent to prohibit eating soft matzah could be lenient for the sick.³¹

25. Maror: the obligation to eat maror is rabbinic in origin. Ideally, if a person can eat, they should eat a kezayit of maror (a medium-sized lettuce leaf), When the person has difficulty eating, they can eat a small portion of maror and hear the blessing from someone else. If this is still difficult, they are not obligated at all to eat.³²

26. The Four Cups: The obligation to drink four cups of wine is rabbinic in origin. If a person has no difficulty drinking, he should drink the majority of a cup of grape juice.³³

27. Drinking the four cups must be connected to the Seder: the first cup – at kiddush; the second cup – at the end of Maggid; third cup – at the end of Birkat HaMazon; fourth cup – at the end of Hallel. Even a person with dementia or a sick person who is reading the abridged version of the Haggadah should drink the cups at their proper times in the abridged Seder and should not drink two cups simultaneously.³⁴

28. The primary obligation of reclining exists during drinking the four cups and eating the mitzvah matza. A dementia patient who is in a wheelchair and the like – should lean on the armrest. If they have difficulty reclining, they should sit normally.³⁵

29. The songs after Hallel have no halachic status. Even the familiar tunes, such as VeHi SheAmda and Dayenu belong to sections with secondary halachic importance. However, these songs can especially improve one’s wellbeing and the familiar tunes of the Seder night songs can gladden a person with dementia and improve his mood. One can deviate from the set seder of the Haggadah and sing the songs at an earlier stage in the Seder.

30. Regarding a person with dementia that wishes to host the Seder for the whole family as he has done in previous years, if it is known that he will be able to do this, even if he requires help from someone else, one should do so. If it is reasonable to assume that he will not succeed – one should honor him and protect his station by finding a way that another person can facilitate the Seder in full while giving the person with dementia the ability to lead what they can, so that he should feel that he is orchestrating the Seder. Flexibility and facilitation towards the person with dementia are imperative in situations such as these and it is a great mitzvah.

31. For a person who takes painkillers affecting their alertness and a person who is very weak due to sickness and medical therapies, one has no obligation to wake them in order to fulfill mitzvot.³⁶ If the estimate is that fulfilling the mitzvah and participating in the Seder will comfort them while the suffering due to the decreased dosage is minimal – one may wake them.³⁷

The Joy of Yom Tov and Chol HaMoed and Hilchot Chol HaMoed

32. “And you shall be happy on my holidays” – a person is obligated to be joyous on holidays and gladden his family. A person with dementia or one who is sick and infirm is part of the family and one has an obligation to gladden them, even more than the rest of the year.³⁸

33. Included within the mitzvah of joy is also the concern for the joy of people who are distressed and overwhelmed, even those who are not family. Therefore, it is the obligation of the friends, neighbors, and community to pay attention to the needs of the sick and the caretaking families that are engaged all year and the holidays with taking care of their relatives – and gladden them.³⁹

34. It is customary to wear more festive clothes on Chol HaMoed. It is proper to ensure that a person with dementia is dressed appropriately if it is not difficult for him.⁴⁰

35. It is prohibited to launder clothes on Chol HaMoed so that a person will enter Yom Tov with clean clothes. Even a gentile cannot launder clothes for a Jew. However, a person with dementia or one with assisted living that constantly dirties their clothes is permitted to launder them, as well as laundering his sheets, towels, etc., when there is a need.⁴¹

36. In hospitals, assisted living, and medical facilities – it is permissible to launder as normal.⁴²

37. It is prohibited to get a haircut or shave on Chol HaMoed, and in many communities one does not put on tefillin on Chol HaMoed.⁴³

38. If a person with dementia requests to shave or put on tefillin during Chol HaMoed as they normally do, there is no need to prevent him from doing so and it is even possible to assist him in putting on tefillin or shaving. However, if one can easily convince him or distract him – one should do so.⁴⁴

Sefirat HaOmer and Customs of the Sefirah Days

39. A person with dementia who is aware of the mitzvah of Sefirah and can follow the Sefirah count – is obligated in Sefirat HaOmer. A person with dementia that is unaware of Sefirat HaOmer is exempt from it.

40. For a person with dementia that is unaware of Sefirah, who even when one mentions the day he should count is left confused, however wishes to count Sefirat HaOmer, it is best that he hears the blessing from someone else. If he asks to make the blessing, one should not prevent him from doing so.⁴⁵

41. It is a Jewish custom to avoid shaving and getting a haircut during a portion of the days of Sefirat HaOmer, and there are a number of different practices.⁴⁶ A person with dementia that is unaware of this obligation is not obligated in it, however it is beneficial for him to be part of the community and act in accordance with its customs, and therefore one should avoid shaving him.

42. If the very fact that he is unshaven influences his behavior and mood, or if the matter damages his care by looking neglected – one should do whatever action improves his wellbeing.⁴⁷

43. A person with dementia who listens to music to calm himself down– is permissible to listen to music during Sefirat HaOmer.⁴⁸Even those around him do not need to avoid listening to music or lower the volume.

1. We will soon be releasing a book dealing with the various aspects of taking care of a person with dementia. We have summarized for the majority of these footnotes, and we will, b’ezrat Hashem, expand on them there.
2. See what we have written in the document ‘Obligations of a Dementia Patient on Fast Days and in Mourning Rites of the Three Weeks’, endnote 3. Our conclusion there is that for a person with dementia, if they understand the mitzvah – they are obligated in the same way as a mentally competent individual; if they do not understand the mitzvah or are not aware of it – they are exempt. The precise definition is dependent on different factors, especially the condition of the person and their level of awareness, as well as the consciousness and capability required to fulfill the specific mitzvah. Rabbi Yitzchok Zilberstein, Shiurei Torah for Doctors, volume 3, article 208, page 481, writes that there is value to a dementia patient eating matzah on the Seder night, since they can fulfill this mitzvah without intent; and even if they are exempt, they will receive reward as if they were not commanded and fulfilled it regardless. However, it seems that when the lack of awareness includes difficulty and struggling with the act of eating itself, as explained in the next footnote, one should not overburden the patient.
3. See ibid., endnote 4. We discuss there the fulfillment of mitzvot when there is a general concern for sickness, and here we will elaborate on some of the authorities who are lenient in the commandments of Pesach when there is concern for sickness. The Mishneh Brura, article 472:35 writes that even though the Shulchan Aruch (472:10, all the general citations for the Shulchan Aruch, Beit Yosef, and Rema as well as the other commentaries on site refer to the section of Orach Chaim, unless stated otherwise) rules that one who experiences headache or pain while drinking wine must force himself to drink four cups, but if drinking wine will cause them to become sick and bedridden – they are exempt. However, in the Shaar HaTzion, subarticle 52, it is written that the reason for this is because this is not in the manner of freedom, yet the Mishneh Brura writes this also by maror – in article 473:43 and the Shaar HaTzion, ibid., subarticle 61. See also the Minchat Asher, volume 1 (Bereishit), article 39, who explains that the Mishneh Brura writes “the manner of freedom” is said is non-binding and written to sharpen understanding (see also The Pesach Haggadah: Minchat Asher, article 19). Rabbi Ovadiah Yosef writes similarly in two responsa in the Chazon Ovadiah Responsa (article 4, regarding drinking four cups; article 33, regarding eating matzah and maror) that if the eating will definitively bring him to sickness, he is exempt from the mitzvah and is not permitted to be stringent on himself; and if there is doubt as to whether this will bring him to sickness, he is permitted to be stringent when eating matzah, which is biblically ordained. Rabbi Asher Weiss, aside from his previously mentioned statement, discusses eating matzah for the mitzvah in situations of concern for sickness in The Pesach Haggadah: Minchat Asher, article 20 and writes that if there is a concern for irreversible injury they are exempt and not permitted to be stringent; and if the concern is that he will become bedridden or suffer from great pain, he is exempt but may be stringent as a matter of piety.
4. We have written this in prior documents involving the holidays: ‘Obligations of a Dementia Patient on Fast Days and in Mourning Rites of the Three Weeks’ (earlier footnote 2); ‘The Holiday Season for a Person with Dementia’; ‘Halachic Guidelines for Purim for a Person with Dementia, Those Sick with Complex Disease, and their Family Members’; Aside from the psychological advantage of participation, it is lofty for a person to additionally burden themselves in order to fulfill a mitzvah, even when exempt from it. However, it is important to verify that the will to burden oneself belongs to the person. If the will to be stringent is the family members’, there is no purpose.
5. Even when a person is exempt from fulfilling mitzvot, there is an obligation to distance them from prohibited acts and one should not actively feed them prohibited foods. Regarding the distancing from sin of a minor the Shulchan Aruch rules (343:1): “[Regarding] a minor who eats from the carcass of an animal, beit din is not commanded to distance them, but his father is commanded to rebuke him in order to distance him [from sin]”. The Achronim discuss the status of one who is not mentally competent. Rabbi Asher Weiss writes that when a sick person is mentally competent, one must prevent them from violating prohibitions, however family members are not obligated to overburden themselves for this (Teaching Methods – a Collection of Lessons, Responsa, and Halachic Rulings Regarding the Halachot of a Sick Person on Yom Kippur, Jerusalem 5769, article 2:2, page 8). Rabbi Yitzchok Zilberstein writes similarly (Vavei HaAmudim VeChashukeihem, 29, Ma’aseh Choshev, responsum 15) that any time a person sees someone with dementia about to violate a biblical prohibition, one should distance them, yet there is no obligation to follow him. It is also written there that all this is stated regarding biblical commandments, but rabbinic prohibitions do not carry an obligation to distance. Regarding the prohibition of chametz the idea of distancing is less relevant, since chametz is not found in the house at the time of the prohibition, and with proper preparation a dementia patient should not have access to the sold chametz. Later on, we will discuss this regarding other prohibitions as well, such as shaving on Chol HaMoed.
6. See ‘Halachic Guidelines for Purim for a Person with Dementia, Those Sick with Complex Disease, and their Family Members’ (earlier footnote 4), footnote 4.
7. When there is more than one caretaker and one can excuse themselves from work, the caretakers are obligated in the mitzvot. This is the opinion of the Mishneh Brura, article 640:10, see also what is brought in the previous footnote. Even when a person is engaged in a mitzvah and exempt from others, if they can nevertheless fulfill the commandment, they fulfill their obligation. This is written by the Mishneh Brura (Shaar HaTzion, article 475:39) regarding eating matzah, yet he debates whether one should make the blessing “that he has sanctified us with his mitzvot” and from his writings in the Mishneh Brura, article 640:33, it seems that one should not make a blessing. See also Rabbi Tzvi Pesach Frank, Mikraei Kodesh, Pesach, volume 2, article 33, who associates this with the argument regarding whether women make a blessing on a positive commandment that they are exempt from.
8. It is a Jewish custom to invest heavily in cleaning the house before Pesach. The intense cleaning regimen, the changes in household activities, and the stressful atmosphere can negatively impact the wellbeing of a person with dementia and even cause them anxiety. Therefore, when necessary, it is proper to lessen the amount of cleaning in order to conserve their health. The Rema (Shulchan Aruch, 433:11) and the Mishneh Brura (ibid., subarticle 46) write that the custom is to clean the house on the 13^th of Nissan before searching for chametz and this is enough.
9. Even if a dementia patient is exempt from a mitzvah that they cannot fulfill, there are other people living in the house or visiting, and therefore in any case one must search. One may search via a messenger even when there is no sick person present, as the Mishneh Brura writes (article 432:10) and the messenger should make a blessing on the search.
10. When the patient is unable to burn the chametz himself, he is considered physically unable to complete the mitzvah and exempt and doesn’t violate the commandments to see or find any chametz. Despite this, one can assume that the wishes of the patient are to burn their chametz and sell it, as they were accustomed to do in the years when they were healthy, and they are interested in us acting in their capacity. Regarding nullifying the chametz, the Shulchan Aruch (434:4) writes that a messenger may nullify their chametz for them. The Mishneh Brura (subarticle 15; Biur Halacha ד”ה יהא בטל) writes that there are those who prohibit this yet adds that when it is absolutely necessary one may be lenient. Regarding selling chametz, the Shulchan Aruch (443:2) rules that anyone who possesses chametz of another Jew on Erev Pesach must sell it to a gentile, and from his wording it is implied that the sale takes effect even if the owners are not aware of this. The opinion of the Achronim is that one may sell chametz for someone else based on “we perform beneficial transfers of property when the owner is not present”. See Rabbi Yitzchak Elchanan Spektor, Be’er Yitzchak Responsa, Orach Chaim, article 1; Rabbi Shlomo Zalman Auerbach, Minchat Shlomo Responsa, Tinyana, article 107. Therefore, one should act with a dementia patient’s chametz as they would in past years: what they normally would sell should be sold; and what they normally would burn should be burned, unless it is burdensome to burn it, and then one should sell it all. If there is a non-Jewish worker and the amount of chametz is small, it is proper to give him the chametz as a present, without any expectation to return or any tricks, and this will fulfill the basic wishes of the patient.
11. The search must be performed by a Jew, as the Mishneh Brura rules, article 432:10. The burning should ideally be done by a Jew, since it is possible that it is a mitzvah to burn chametz, however when necessary one can exterminate the remainder of the chametz, via fire or any other method, via a gentile, since the fundamental aspect of the mitzvah is that there should not be chametz – and not the act of burning. See Mishneh Brura, article 446:7; Rabbi Yosef Zvi Rimon, Eit Ziknah, Alon Shvut 5783, page 250.
12. The Shulchan Aruch (429:2) writes that the firstborn should fast on the Eve of Pesach. However, the accepted custom is to take part in the mitzvah feast celebrating the completion of a Talmudic tractate and thus exempt oneself from the fast. As we have written in ‘Obligations of a Dementia Patient on Fast Days and in Mourning Rites of the Three Weeks’ (earlier footnote 2), endnote 9, an elderly and infirm person is exempt from even the more stringent fast days, and are certainly exempt from this light fast. Therefore, he does not need to take part in a meal celebrating the end of a tractate, and all the more so if participation involves suffering or burden.
13. One should not eat bread from the tenth hour of the day and should not eat a large quantity of other foods in order to eat the mitzvah matzah with an appetite (Shulchan Aruch 471:1). A dementia patient requires fixed eating regimens and therefore one should not be stringent in the matter.
14. Biur Halacha, article 473, ד”ה הרשות בידו, writes that the Rishonim disagree regarding whether it is permissible to drink when reciting the Haggadah, after pouring the second cup until its drinking, and according to the him, the Shulchan Aruch rules in line with those who prohibit this. However, see He’arot Ish Matzliach to the Shulchan Aruch, 473:4, who explains these authorities differently. A person with dementia is permitted to eat after kiddush and before the pouring of the second cup even from the onset and it is proper to fit this with the time of eating the karpas (see later on footnote 22). If eating while the Haggadah is recited will be better for him and will enable him to participate in the Seder, he is permitted to rely on the lenient opinions and eat.
15. See earlier footnote 5.
16. A person with dementia has eating, chewing, and swallowing difficulties, and many are required to take food supplements in order to maintain a healthy, balanced diet. When one consistently uses these alternatives, this is his vital need and it is prohibited to withhold the nutrition from him. Even a patient with malnutrition, or one who would be malnourished if they do not take these supplements, is considered a critical patient and can even eat chametz. The food supplement Ensure found nowadays does not have chametz ingredients but does contain kitniyot and there exists Ensure that is kosher for Pesach for those who eat kitniyot. This supplement is permitted even to non-critical patients, even those who have the custom not to eat kitniyot (see later on footnote 19), If there is a need for a product that contains chametz and there is no alternative that does not contain chametz, it is permissible for a critical patient, and therefore a person who primarily subsists off of this may eat it. In borderline situations it is proper to consult with a physician and a rabbi. If one uses a product that has chametz, it is best if a Jew does not own the chametz, and therefore it is proper to give it as a present to a gentile caretaker or another person.
17. See Tzitz Eliezer Responsa, volume 14, article 70; Nishmat Avraham, Orach Chaim, article 612:7; ibid., Yoreh Deah, article 89:2.
18. Taking medication with a bitter taste is not considered eating and is permitted to a patient. This is written in the Igrot Moshe Responsa, Orach Chaim, volume 2, article 92; Yechave Da’at Responsa, volume 2, article 60 and many more authorities; see the Nishmat Avraham, article 466:1. One may even be lenient with a medication that tastes sweet and has chametz ingredients in the case of a dementia patient, since a sickness with loss of competency is considered a critical illness, and slowing the progression of the disease is considered a need with pikuach nefesh. See Rabbi Amit Kula (editor), And Beit Hillel Says: Halachic Rulings of Rabbis and Rabbaniot of Beit Hillel, 5778, pages 63-84; Rabbi Yoni Rosensweig and S. Harris, “I Ask For My Soul, Jerusalem 5782, appendix 5, pages 339-374.
19. CBD oil products are oftentimes mixed with kitniyot oil. Based on the explanations in the previous footnote, many medications that have chametz ingredients are permissible for use on Pesach even if the patient is not critically ill, and all the more so when they only contain kitniyot. The Mishneh Brura (article 453:7) writes that it is permissible for a non-critical patient who needs to may eat kitniyot, and therefore one should not be concerned for kitniyot ingredients found in the oils or other medications. This is not the place to expand on the issue of using cannabis on Shabbat and Yom Tov. When it is used by vaporizer that acts on a Shabbat timer the matter is permissible, and even genuine smoking is permitted to a critical patient who requires this. See Rabbi Avraham Resnikov, “Cannabis for Medical Purposes”, Techumin, 37 (5777), pages 110-111.
20. The Trumat HaDeshen (article 137) writes that one should make kiddush on Seder night after tzeit hakochavim, and this is the ruling of the Shulchan Aruch (472:1). Granted, the opinion of the Rashbatz (Yavin Shmua, Ma’amar Chametz, article 133) is that one may bring the kiddush forward like on all Shabbatot and holidays, and only drinking the rest of the cups of wine and eating the matzah must be done after tzeit hakochavim. This is also written by the Chatam Sofer in his Chiddushim on Mesechet Pesachim 99b. Rabbi Ovadiah Yosef also writes that this is permitted if necessary in Chazon Ovadiah Responsa, volume 1, article 1.
21. See earlier for the principles of this halacha, footnote 6, including a link to download the format of the abridged Haggadah. Compare this to The Passover Seder Haggadah for Times of Need that was published by the IDF Rabbinate, https://bit.ly/3uZhOEa; Rabbi Yosef Zvi Rimon, Seder Night – Kinor David, Jerusalem 5771, pages 97-102.
22. The obligation to eat karpas is rabbinic in origin, so that the children will ask. Practically it is ruled that one should eat less than a kezayit (Shulchan Aruch, 473:6) and despite the fact that ideally one should eat a vegetable called karpas (see Mishneh Brura, ibid., subarticle 19) and there are those who eat celery specific, one may fundamentally fulfill their obligation with any vegetable (Shulchan Aruch, ibid., 4). Therefore, even a dementia patient can fulfill this obligation easily, by eating a small amount of any vegetable. However, a dementia patient can have difficulty eating, and as explained in previous articles there are situations where one may be lenient with mitzvot involving eating. Of course, one should be lenient when eating karpas more than when eating matzah and maror and drinking the four cups – and therefore we write this in parentheses here. The Rishonim disagree regarding how much karpas one must eat. According to the Rambam (Mishneh Torah, Hilchot Chametz U’Matzah, chapter 8, halacha 2), one should eat a kezayit. According to the Rosh (Pesachim, chapter 10, article 25) it is enough to eat less than a kezayit. In the Maharal’s Responsa, articles 25 and 58, he writes that it is proper to eat less than a kezayit due to the doubt of whether it is necessary to make an afterbracha. The Shulchan Aruch (473:6) writes: “And he should take from the karpas less than a kezayit”. From the words of the Mishneh Brura (ibid, subarticle 53) it seems that the intent of the Shulchan Aruch is that it is enough to eat less than a kezayit and he did not intend to prohibit eating more than this. Regarding a dementia patient, we have already written earlier, footnote 14, that if they must eat before the matzah it is permitted. Therefore, it is possible for them to eat more than a kezayit if there is a need, however they should not make an afterbracha.
23. Shulchan Aruch HaRav, Orach Chaim, article 473:43 writes: “And the fundamental version of the Haggadah that the Sages instituted as an obligation for everyone is from the beginning of עבדים היינו until הרי זה משובח, afterwards מתחלה עובדי עבודה זרה היו אבותינו etc. until the end of the expounding of  the section of ארמי אובד אבי, afterwards פסח שהיו אוכלין וכו’ מרור זה וכו’ בכל דור ודור וכו’ ואותנו הוציא משם כו’ לפיכך כו’  until ברוך אתה ה’ גאל ישראל. And all other passages of the Haggadah are customs that all of Israel have practiced since the early generations”. The Mishnah (Pesachim 10:4) determines that “we begin with disgrace and finish with praise, and he expounds ‘an aramite tried to destroy my father’ until he finishes [expounding] the entire section”. In the Gemara (Pesachim 116a), the Amoraim disagree regarding what disgrace and what praise is, “עבדים היינו” or “מתחילה עובדי עבודה זרה”, and Rabbeinu Chananel (ibid) writes “and now we act according to both [opinions]” and this is the custom. Both sayings may be recited in a significantly shortened version without the expansions of the Haggadah, and therefore it is proper not to rely on just one of them. The expounding of “an aramite tried to destroy my father” is mentioned, as stated, in the Mishnah and should be said, however one can fundamentally fulfill their obligation by saying “we were slaves” and “initially”. The Mishnah (Pesachim 10:5) also teaches that “anyone who does not recite these three things on Pesach did not fulfill their obligation, and these are them: Pesach, Matzah, and Maror”, and its intent is that one must explicitly delineate and explain these things, as it is described in the Mishnah and Haggadah. However, the Ran (Pesachim 25b of the Rif, ד”ה כל) and the Rema (Darkei Moshe, article 473:19) writes that even though it is stated that ‘he does not fulfill his obligation’, the intent is that he does not fulfill the ideal mitzvah, but they have fulfilled their Haggadah obligation. See Halichot Shlomo, Holidays of the Year, Nissan-Av, chapter 9, article 32.
24. In the document that we have drafted, ‘Tefillah and Birkat HaMazon for an Infirm Patient’ https://bit.ly/32o9eju, we discuss the wording of the abridged Birkat HaMazon for a dementia patient. Based on this, we have determined the wording of the abridged blessing in the Haggadah.
25. The Mishnah (Pesachim 10:7) teaches: “Fourth – finish the Hallel with it, and say the blessing of song”. This is not the place to discuss Hallel and its blessings at length, however we will explain the fundamental matters relevant to our discussion. There is a Amoraic disagreement in the Gemara (Pesachim 118a) regarding what the ‘blessing of song’ is: “they will praise you” or Nishmat. The Rif (Pesachim 26b in the Rif’s pages) writes that the custom is to say “they will praise you”, and the Rambam (Mishneh Torah, Hilchot Chametz U’Matzah 8:10) writes that we say Hallel and “they will praise you”. The Rosh (Pesachim, chapter 10, article 32) writes that we act in according with both opinions and we finish with a double beracha. It is also implied from the Rambam that the fundamental part of Hallel is the “Egyptian Hallel” (Psalms 113-118) and saying “the Great Hallel” (Psalms 126) that is mentioned in the Mishnah and the discussion there is optional. Therefore, even though the Shulchan Aruch (480:1) rules that we say both the Egyptian and Great Hallel and finish with “they will praise you”, Nishmat, and Yishtabach (see ibid, and the opinions and customs of the authorities based on this), even according to him the fundamental aspect of Hallel is “Egyptian Hallel” and “they will praise you”, and when necessary this is enough. One should add that even though “Egyptian hallel” contains six complete psalms, even one who says a part of the praises expressed in them fulfills the fundamental obligation of praising and giving thanks. This is also written by Rabbi Shlomo Min HaHar in a letter printed at the end of Mikraei Kodesh (Harari), Hilchot Leil HaSeder, page 592, that the obligation is to praise God, and the Sages only instituted “Egyptian Hallel” as a recommendation, and therefore any mention of a few verses from Hallel, and potentially even other words of praise, can fulfill one’s obligation. In the Haggadah Service in Times of Need of the IDF Rabbinate (earlier footnote 21), all the sections of Egyptian Hallel are listed, but it is emphasized that in cases of great necessity, the first six verses of “All the nations shall praise God” “הללו את ה כל גוים” (117:1- 118:4), and this is how we have arrived at the Seder night service that is published here. One who reads the abridged version with a person with dementia and wishes to complete Hallel and the blessing of Nishmat afterwards – may do so, however he should not recite the concluding blessing a second time.
26. The Shulchan Aruch (422:5; 488:1; 644:1) rules that if they stopped during the recitation of Hallel, even if they delayed for long enough to recite the entire service, they may return to the place where they stopped. The Rema, despite disagreeing with him regarding reciting Shema when one is delayed due to extenuating circumstances (65:1), does not disagree with him explicitly regarding Hallel. According to the Mishneh Brura (article 422:25), the Rema was lenient with rabbinic commandments, and even though the Mishneh Brura is concerned for the opinion of those who say to start from the beginning, a person with dementia may rely on the simple understanding of the Rema’s opinion. When reciting the Haggadah, one fulfills their obligation to recount the exodus from Egypt with any recitation at all, and therefore halachot of interruptions do not apply. Regarding Birkat HaMazon, according to the Shulchan Aruch, if one pauses, they may return to the location where they stopped, and according to the Rema if it was due to extenuating circumstances one should return to the beginning of the blessing that they stopped in the middle of (see Mishneh Brura, article 183:25, and Biur Halacha, ibid, ד”ה אפילו אם), yet a person with dementia who has difficulty with this may be lenient in accordance with theShulchan Aruch. See the Biur Halacha, article 65, ד”ה קראה לסירוגין.
27. See ‘Channukah Guidelines for a Person with Dementia and their Family’, https://bit.ly/49cRsgz, footnote 10. There we have written that one may fulfill their obligation through the principle of “hearing is like answering” for Kiddush, Birkat HaMazon, Hallel, and other mitzvot. One who is having difficulty saying this may fulfill their obligation with listening even if the reader has already fulfilled their own obligation, and regarding Hallel one can fulfill their obligation by listening alone, even if they do not answer “Halleluyah” as one normally should. We also have written there, based on the Biur Halacha (article 422, ד”ה הלל), that even though generally a woman cannot fulfill a man’s obligation of Hallel, for the Seder night Hallel she can since women are also obligated in the same manner as men. Regarding reciting the Haggadha, see the Minchat Chinuch, mitzvah 21, who writes that it is clear that even for the Pesach Haggadah one may fulfill their obligation through the principle of “hearing is like answering”, and this is also written by Chazon Ovadiah, Pesach 2, Maggid, article 3, that one can fulfill their obligation through the recital of the head of the household, and disagree with the Ba’al Shevach Pesach who is doubtful about this. Rabbi Asher Weiss (Minchat Asher, Pesachim, article 84) writes that “hearing is like answering” does not apply at all to the recitation of the Haggadah because the mitzvah is to recount the exodus from Egypt, and the definition of recounting is that one person speaks and others listen and both fulfill their obligation. Rabbi Ovadiah Yosef adds (ibid,article 4) that a woman should not ideally recite for a man since it is possible that she is only rabbinically obligated, however as a last resort he fulfills his obligation. Therefore, a dementia patient who has difficulty reciting may fulfill his obligation through the recitation of his wife (and so too for Hallel on the Seder night, which women are obligated in), yet it is best that he says “Pesach, Matzah and Maror” and their reasons.
28. See earlier footnote 3. When possible, it is best to ensure eating a kezayit of matzah, since this is the biblical commandment, and all other mitzvot of eating are rabbinic.
29. The authorities heavily discuss the measurement of a kezayit, and this is not the place to discuss this at length. The Shulchan Aruch (486:1) writes that the a kezayit is half the size of an egg. The Mishneh Brura (ibid., subarticle 1) writes that for rabbinic obligations one may rely on the Rambam who holds that the requirement for matzah is a third of an egg, and one may also be lenient in biblical obligations for one who is sick and has difficulty eating a large amount (see more regarding the measurement of a kezayit in the Peninei Halacha, Berachot, 10:5-6; ibid., Pesach, 16, 23 regarding eating matzah). Rabbi A.A. Mendelboim (HaLayla HaZeh, Jerusalem 5764, pages 263-266) writes according to the opinion of Rabbi Shlomo Zalman Auerbach that one who has difficulty may use the measurement of a third of a machine matzah even as a biblical kezayit, and for rabbinic kezayit they fulfill their obligation with 11 grams, as the Chazon Ish was accustomed to believe (the size of the palm of the hand with fingers outstretched and together, not including the thumb). The measurement of 9-11 gram is also assumed by Rabbi Moshe Mazuz (Or Torah, 5754, article 82; Or Torah, 5756, page 71, see He’arot Ish Matzliach to the Shulchan Aruch, 486:1). When necessary one may rely on this measurement even for a biblical kezayit. Practically, one may eat two thirds of a matzah in the first course, fulfilling their biblical obligation to eat a kezayit even according to more stringent opinions while fulfilling the accepted custom of eating two olives worth in the first course, based on the measurement of a third of a matzah. One who is having difficulty eating this amount may eat a third of a matzah or at the very least a quarter. For Korech and Afikoman, which are rabbinic obligations, one may be more lenient and eat a quarter of a matzah; and if they have great difficulty eating they are exempt from Korech and Afikoman.
30. The Shulchan Aruch (461:4) rules that one may fulfill their obligation with matzah soaked in water, as long as it has not congealed. One may be lenient for the elderly and sick regarding soaking the matzah in other liquids. Based on the Mishneh Brura (ibid., subarticle 17-20 and Biur Halacha), the order of priority is as follows: to break the matzah into small pieces and eat it dry; to swallow it together with water; to soak it in lukewarm water; to dip it in wine or other liquids; to soak it in wine or other liquids (this is the order written by Rabbi Avraham Sofer, Lev Avraham, chapter 11, article 5. This is the proper way to act for those who avoid gebrokts and prefer to eat crumbled matzah over soaked. According to Rabbi Ovadiah Yosef, Chazon Ovadiah Responsa, volume 2, article 34, soaking in water is permitted from the onset even for one who is healthy, and according to him there is no preference for crumbling matzah over soaking it in water). When necessary one may even soak it in hot water through a kli sheni, and if there is no other option, even with other liquids in a kli sheni (the Mishneh Brura ibid., subarticle 20, is stringent regarding a kli sheni, and lenient when necessary but specifically regarding water. Rabbi Ovadiah Yosef, ibid., is lenient when necessary even for other liquids through a kli sheni).
31. The Ashkenazic custom is to eat thin, hard matzot. See the Mishneh Brura, article 460:16; Shulchan Aruch HaRav, ibid., article 10. Rabbi Shlomo Zalman Auerbach writes that Ashkenazim should not be lenient and eat thicker matzot than normal (Halichot Shlomo, Holidays of the Year, Nissan-Av, chapter 9, footnote 80). This is also written by Rabbi Asher Weiss (Minchat Asher: Pesach Haggadah, article 15) that even though there is no concern for leavening with thicker matzah, it is possible that we are not experts in the matter and one should not deviate from the custom. However, for the sake of a sick person one may be lenient, and this is also written by the Peninei Halacha, Pesach, chapter 12:8, footnote 7.
32. The size of a kezayit of maror is about the size of an average lettuce leaf, see HaLayla HaZeh (earlier footnote 29, pages 263-266. For eating maror one may rely on the opinion of the Terumat HaDeshen, rulings, article 245when necessary, who holds that one fulfills their obligation with even less than a kezayit. See Mishneh Brura, article 473:43; Avnei Nezer Responsa, Orach Chaim, article 383; Rabbi Tzvi Pesach Frank, Mikraei Kodesh, Pesach, volume 2, Hararei Kodesh, footnote 4; Piskei Teshuvot, article 473:19 and footnotes 105-106. If he eats less than a kezayit, it is best that he does not make a blessing but hears it from another person. However, if the dementia patient is determined to make the blessing one should not withhold this from him.
33. The volume of a cup is a reviit (86 cm³, approximately half of a regular cup), and even though one should ideally drink the entire cup, when necessary it is enough to drink the majority of a cup. There are those who are strict to drink the majority of even a larger cup. Therefore, it is ideal if a person who does not intend to drink a lot should use a small cup with the size of a reviit at least. See Shulchan Aruch, 472:8; Mishneh Brura, ibid., subarticle 30,33.
34. The Shulchan Aruch (472:8) rules that one should drink four cups in their order, i.e. that the Haggadah be recited intermittently throughout them, and if one drank them one after the other they do not fulfill their obligation. This ruling also applies if he only drank a portion of the cups sequentially (see Mishneh Brura, ibid., subarticle 26). Therefore, for example, if a patient is very fatigued and cannot say Hallel, they cannot drink two cups sequentially after Birkat HaMazon and fulfill the obligation of third and fourth cups. Granted, the Pri Megadim (Mishbetzot Zahav, article 474:1) writes that one who is absolutely unable to read the Haggadah should drink the cups sequentially and fulfill their obligation for all four, because the obligation to drink four cups is a separate obligation than reciting the Haggadah (this is also the opinion of the Kaf HaChaim, article 474:6), however the Mishneh Brura (Biur Halacha, article 472, ד”ה שלא כסדר) writes that one fulfills their obligation only if they waited between them. Therefore, in a case such as this, he should drink the third cup of Birkat HaMazon, wait a bit and say or hear a few verses from Hallel (as explained earlier in footnote 25) and drink a fourth cup. If this is not possible, he is exempt from drinking the fourth cup.
35. It is a mitzvah to sit on the Seder night while reclining in the manner of free people (Shulchan Aruch, 472:2). The primary obligation of reclining is during the mitzvah of eating matzah and drinking the four cups, and if he reclines the entire meal – he is praiseworthy (Mishneh Torah, Hilchot Chametz U’Matzah, chapter 7:8; Rema, 472:7). The Shulchan Aruch (ibid., 7( rules that if one eats and drinks without reclining they must repeat their eating and drinking while leaning. Granted, the opinion of the Ra’avyah (volume 2, article 525) is that since nowadays free people do not recline while eating, there is no obligation to recline. Even thought the halacha is not ruled in accordance with the Ra’avyah, the Rema (ibid., article 4,7) relies on him both for exempting women from reclining and to determine that after the fact one fulfills their obligation if they did not recline. According to the Rema’s methodology, one should be lenient with a dementia patient who has difficulty reclining and allow them to sit normally. Even according to those who follow the Shulchan Aruch, one can rely on this opinion in cases of sickness (see what Rabbi Ovadiah Yosef writes, Chazon Ovadiah, Pesach, volume 2, Kadesh, article 7, page 9, that even though the halacha follows the Shulchan Aruch that one does not fulfill their obligation if they did not lean, a patient who has difficult repeating the drinking may rely on lenient authorities).
36. As we have written earlier, footnote 3, when fulfilling the mitzvah involves great difficulty or suffering, the patient is exempt from mitzvot.
37. See ‘Tzohar Ad 120’, Part 2, Chapter 12, https://bit.ly/49clHo2
38. See ‘The Holiday Season for a Person with Dementia’ (earlier footnote 4), Sukkot, article 4.
39. See ibid., article 5.
40. See ibid., article 6.
41. It is prohibited to launder clothing on Chol HaMoed, but for clothes that are constantly dirtied, such as washcloths and children’s clothes it is permissible (Shulchan Aruch, 534:1). Therefore, a person with dementia who cannot keep his clothes clean, is constantly changed, and does not have enough clothes for Chol HaMoed, one can launder their clothes. When washing with halachic approval, it is permissible to add other clothes into the machine that are required for the holiday. This is written in Yabia Omer Responsa, volume 7, Orach Chaim, article 48, and Shmirat Shabbat KeHilchatah, chapter 66, note 251 (even though he writes that Rabbi Moshe Feinstein prohibits this).
42. The authorities permit washing clothes in hotels. See Shemirat Shabbat KeHilchata, chapter 66, note 263. In medical institutions and assisted living facilities there is also the need to conserve hygiene. However, when there is no need for this it is proper to avoid laundering clothes during Chol HaMoed, however see Rabbis Y. C. Oknin and Rabbi Y. Moskowitz, ‘Hygiene and Cleanliness in Hospitals as Pikuach Nefesh’, Techumin, 43 (5783), pages 331-339, who defines conserving hygiene in hospitals as a matter of life or death.
43. [1] Shaving on Chol HaMoed is rabbinically prohibited (Moed Katan 14a; Shulchan Aruch 531:1). The Shulchan Aruch (31:2) rules that one should not put on tefillin on Chol HaMoed. The Rema there writes that the Ashkenazic custom is to put on tefillin, however nowadays Ashkenazim in Israel and the Chassidic cimmunities in the diaspora also do not put on tefillin.
44. As we have written earlier in footnote 5, when a person with dementia is not aware of the prohibition, they are not obligated in it and there is no obligation to prevent them from violating a rabbinic prohibition.
45. See I Ask for My Soul (earlier footnote 18), page 139, who write that he should count without a beracha. In footnote 12 there they bring sources from the Achronim which deal with the issue Sefirah when the person does not know what day it is and the issue of why the Diaspora does not count two days due to doubt as to their calendar, and they explain that one must be aware of Sefirah and therefore counting two days is not Sefirah. Here we are dealing with a separate case. The person is indeed confused, but it is possible that when reminded he remembers, even for a short period, and then his Sefirah is valid. Therefore, even though it is best that he hears this blessing from someone else, his blessing is valid; and if his competency is impaired, there is no need to prevent him from making the blessing.
46. Shulchan Aruch 493:2
47. See what we have written in ‘‘Obligations of a Dementia Patient on Fast Days and in Mourning Rites of the Three Weeks’ (earlier footnote 2), Customs of the Three Weeks, article 1-2 and endnote 14. The prohibition to shave during Sefirat HaOmer is lighter than the prohibition during the Three Weeks, and therefore one may be lenient also here.
48. See ibid., article 7 and endnote 19.