Advice for Pesach and the Seder Night with a Dementia Patient

Rabbi Yuval Cherlow

The fulfillment of mitzvot is a very challenging process for people with dementia, especially on Pesach and the Seder Night.

A central aspect of halacha is manifests in the spectrum between the ideal halachic practice, performed full of commitment and will, and the bare minimum obligation, of which it is prohibited to deviate from, the most basic actualization of the fundamental halachot. This is true in all settings, especially on Pesach, where Jews as a whole have taken on great stringencies, such as chasing after every crumb of chametz. The divide between these two planes allows on the one hand to strive upwards as much as possible, where we oftentimes find the saying “he who is stringent upon himself will be blessed”, and on the other hand allowing us to act differently when under extenuating circumstances, while still following the basic requirements of halacha. 

Is the presence of a person with dementia considered extenuating circumstances? The matter is very dependent on the situation at hand. At times the answer is yes, due to many reasons: everything written later in this paper obviously depends on the stage of dementia and the level of deterioration; the attentiveness the person requires, the behavioral ticks that can spontaneously arise and cause harm to themselves or others, and the influence of changing the patient’s daily routine, which has been known to confuse the patient’s mind, etc. Therefore, each family needs to act differently within the spectrum between the bare minimum to fulfill one’s obligation and striving beyond.

The goal of these halachic guidelines is to clarify these principles. They are not designed to encourage people to be overly lenient, chas ve’chalilah, however they can offer the family treating the person with dementia the most basic halachic requirements, in order to understand the halachic procedures that allow them to act in good faith both towards the halachot of Pesach and towards their family member who has dementia.

Biur Chametz and Nullification of Chametz

One is fundamentally obligated to eliminate chametz the size of a kezayit or greater from their home. In the majority of homes – there is no chametz of this size outside of the kitchen or pantry. Therefore, while the host of cleaning is, as stated, a wonderful custom and a proper activity – it is in the domain of things that one may renege on if there is a need to treat a patient properly or if the matter would change their environment radically. And thus, one should determine whether the act of changing the atmosphere of the house will disturb the patient or not. 

In the kitchen: of course, in the kitchen there is an additional obligation, the prohibition of eating chametz, of which even a tiny amount of chametz is prohibited. The requirement therefore is to kasher the kitchen properly, swapping out the dishes or performing hag’alah, etc. If there is an extremely vital need, one may consult with a talmid chacham for the specific details which can be modified in this process.

The Obligation of One with Dementia to Fulfill the Seder Night Mitzvot

Many families discuss how much to “force” or at the very least to try and feed the matzah and maror to the patient, say Maggid, drink the four cups of wine, etc, or whether it is best to let go. Ruling in this issue is based on many different factors, many of which are therapeutic, such as whether the matter will benefit the patient or harm them. 

Halacha’s place in this discussion is to instruct that the main determinant needs to be contribution to the general welfare of man and not the halachic obligation. A person who is unable to take responsibility for their actions – is not obligated in mitzvot. This is true when dealing with the developmental process of children: “Our rabbis taught: a minor who knows how to shake is obligated in lulav, to wrap oneself is obligated in tzitzit, to maintain tefillin, his father should take tefillin for him…” (Sukkah 42a). This is true even in later stages of life, and when the person becomes unable to perform these actions – they are no longer obligated. Therefore, there is no obligation to force observing any of these mitzvot. Of course, it is possible that this activity could be very therapeutic for the patient, and therefore it is proper to hope to maintain this practice, however anything that does not benefit the person – is not obligatory. This is true regarding recounting the story of the Haggadah as well as other obligations.

All this only takes into account the dementia patient. However, it is very important to emphasize: when dealing with the entire family – the fundamental mitzvot of the Seder Night are directed at the children, “you shall tell your son on this day saying”, and it is improper to dedicate the entire seder night only towards the dementia patient.

Abridged Seder Night

As a middle ground one may conduct an abridged seder night – if it is appropriate for the setting. Four cups, matzah, marror, korech, a basic “maggid”, birkat hamazon, and hallel. Oftentimes, the person will go to sleep afterwards and then it is possible to go over everything, and recount yetziat mitzrayim all night. As previously stated, remember that the main mitzvah is towards the children.

Experts in the field note that the music – the tunes and songs, etc. – can be an especially successful experience to penetrate through to the patient’s consciousness. Therefore, one should certainly focus on the musical parts of the Haggadah, hallel, and the piyyutim.

 You may be interested in:

  • Television on Shabbat for a Dementia Patient
  • Should one force dental care on a parent with dementia?
  • Early dementia – how to talk about it.

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