Nishmat's Women’s Health and HalachaIn memory of Chaya Mirel bat R' Avraham

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Harchakot, Disability, and Illness: An Occupational Therapy Perspective

By Na’amah Roselaar, Occupational Therapist

Harchakot, the laws restricting contact during niddah, can present a particular challenge when one spouse is ill, injured, or recovering from surgery. Halachic leniencies are available to enable couples to manage these situations without undue suffering, discomfort, or inconvenience. Each couple should ask a specific halachic question based on their particular needs.

Couples should also take advantage of any practical measures that can reduce the need for halachic leniencies – and often make things easier in general.

Manipulating cycles

If a woman is already using combination hormonal contraception, she may be able to plan her cycle so that she can use the mikveh before a planned surgery and then continue the active pills (or ring or patch) to remain tehorah for an extended time. Even for women not using hormonal contraception, hormonal manipulation can delay or prevent menses. Each case needs to be discussed on an individual basis with one’s physician in order to balance the risks and benefits. However, women should be aware that there is such an option.

Occupational and Physical Therapists (OT and PT)

If the woman is not using hormonal contraception, or if there was no opportunity for advance planning, an OT assessment should be requested. (This should be available in hospital, if the patient is hospitalized, or in the community, depending on the situation and the local health care system).  They should explain to the OT that for religious reasons, their spouse will not be able to assist them at times, and ask for suggestions as to how to get on and off chairs, in and out of bed, get dressed, etc. OTs are well-versed in these techniques, which are also necessary in the general population if the spouse will be at work all day or if someone lives on their own.  Both OTs and PTs understand the ergonomics of the body and can teach techniques for getting on or off of a chair, bed, or toilet that will make things easier.

Helpful equipment

(Links are provided for illustrative purposes only and are not an endorsement of or advertisement for a particular brand or supplier.)

Assuming that even with OT/PT input one cannot transfer independently, there are some basic equipment items that may be recommended by an OT. These may be available through the health care system, a gemach, or (in Israel) Yad Sarah.  For beds, one can get a “bed lever,” which goes under the mattress (no installation required) and provides a handle that one can use to push off from when standing up.  Easy chairs can also be raised (these usually need professional assessment to get the right ones), and a surrounding rail can be put around the toilet, also not requiring installation.  This is also available with an attached raised toilet seat, all to make getting on and off the toilet easier.  These might not work if the pipes protrude a lot around the back of the toilet, or a wall is very close to the toilet, but in general these are relatively cheap and very useful.

Regarding getting dressed, putting on tights/socks/trousers/underwear are usually the most difficult.  There are long-handled reachers that can be used to help with everything but tights and socks.  For socks there are “sock-aids,” which are a bit complicated and require instruction and patience.  There are also aids for tights.

Na’amah Roselaar has studied at Midreshet Lindenbaum, Drisha and Nishmat, and holds degrees in mathematics, Jewish Education and Occupational Therapy.  She practises as an OT in London, England.

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All health and health-related information contained within Nishmat's Women's Health & Halacha Web site is intended to be general in nature and should not be used as a substitute for consulting with your health care professional. The advice is intended to offer a basis for individuals to discuss their medical condition with their health care provider but not individual advice. Although every effort is made to ensure that the material within Nishmat's Women's Health & Halacha Web site is accurate and timely, it is provided for the convenience of the Web site user but should not be considered official. Advice for actual medical practice should be obtained from a licensed health care professional.

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