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Waters of Purity: Accessible for All?

An Overview of Mikvaot in Israel

Sarah Feldman-Margolis

Key Words: Accessibility, Women's health, Privacy, Procedural changes,

Assistive devices, Religious practice, Rituals, Jewish Practice

Abstract

This article depicts the world of mikvaot (ritual baths) from an accessibility point

of view. According to a recent census taken from a mikvah directory, there are

eight Israeli mikvaot that advertise that they are accessible to those with special

needs. Mikvaot have been renovated to accommodate the physical needs of

women, however sensory and mental health impairments have not typically been

accommodated to date. Procedural changes need to be made, as well as other

modifications, to accommodate those with sensory, cognitive, and mental health

impairments. Recommendations are made to provide comprehensive service to

the population of individuals with special needs. The importance of occupational

therapy principles and intervention is highlighted as the spiritual, sensory,

physical, and environmental activities of daily living are revealed through

mikvah practice.

Introduction

Spirituality plays a vital role in the holistic make up of each person (Pedretti &

Early, 2001). As a person engages in religious ritual, his or her spiritual

essence comes to life. For a religious Jewish person, mikvah attendance plays a

vital role in daily spiritual practice. Enabling a person to properly engage in

religious ritual and practice addresses is a central area of occupational

performance. Moreover, religious practice is an important activity of daily

living that contributes to a person's identity (AOTA, 2002). As occupational

therapy modules seek to address all needs of an individual holistically,

spirituality and religious practice must be addressed as well. The role of the

occupational therapist is essential within the field of accessibility consulting

and design. Occupational therapy modules can direct the building and

reconstructing of facilities appropriately to ensure that activities of daily living

can be executed by any and all individuals. Accessibility consulting can

Sarah Feldman-Margolis, BOT, Accessibility Consultant.

sarah@accessforall.co.il

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provide practical recommendations for each facility to be built under the rubric

of "design for all" principles. Moreover, these two fields combined can address

matters such as assistive device usage, procedural changes, and pre-arrival

preparation before mikvah attendance.

Recent Law in Israel

According to recent legislation passed under Israel's Equal Rights for

Individuals with Disabilities Law, "There must be an accessible mikvah in a

city that has more than 100,000 residents…within this mikvah there must be at

least one attendee who will assist an individual with disabilities with all

movements throughout the mikvah [process] in order to ensure safety and

comfort…and house a hoist for the transfer of disabled persons…either a

standing hoist or a ceiling lift" (Equal Rights for Individuals with Disabilities

Regulations, 2011).

The Israeli law allocates two specific categories of accessibility consulting:

structural and service. The former addresses all the physical aspects of building

and reconstruction (parking, doorways, ramps, bathrooms, elevators and stairs),

while the latter addresses issues pertaining to obtaining and benefitting from

services, (signage, lighting, assistive devices, equipment, etc.) in addition to

procedures to increase accessibility for individuals with specific needs (Equal

Rights for Individuals with Disabilities Law, 2005). Subject to these

regulations, all new and existing facilities that service the public must

gradually be made accessible from all structural and service aspects. This

applies to government buildings, restaurants, educational institutions, medical

buildings and all commercial facilities. Accordingly, these recent regulations

apply to religious services as well. For example, in the mikvah, a new type of

chair that accompanies a woman into the water and allows her to immerse

safely is now the required chair within mikvaot. As the mikvah trainees

undergo comprehensive training they are required to learn the safe and proper

use of each lift and chair (Equal Rights for Individuals with Disabilities

Regulations, 2013).

Mikvah Use as a Common Jewish Practice

The word 'mikvah' literally means a gathering of waters. The actual mikvah

waters are natural waters that originate from a spring or cistern and are used

for the act of purification (Shamberg & Barr, 2006). The mikvaot waters

purifies one who become impure following menstrual flow, converts a non-

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Jewish person into a Jew, and purifies a Jewish spirit in preparation for a holy

Sabbath or holiday. It also prepares a bride for entering the holy covenant of

marriage prior to her wedding. In addition to the personal use of a mikvah, the

mikvah waters are commonly used to sanctify new dishes upon purchase and

dishes purchased specifically for the holiday of Passover prior to use. No

matter the reason or use, mikvah immersion is equated to spiritual

enhancement.

The mikvaot worldwide play a pivotal role in Jewish communal life as they

facilitate the immersion process of all those in need of purification. According

to rabbinic authorities, a community is only established once a mikvah is built

(Jachter, 2002). Individuals who contend with physical, sensory, mental health

or other impairments have the same right to make use of these facilities as any

other person in society. However, these facilities often lack the appropriate

modifications for full functional use. Research has been done worldwide

regarding the need for environmental modifications for mikvaot. The evidence

points towards many facilities being equipped with electronic lifts, ramps,

enhanced lighting, in addition to providing training to the mikvah attendees

(Israeli Ministry of Justice, 2011). What still remains untouched within the

field involves adaptations for individuals with visual and hearing impairment

in addition to those who contend with mental health disorders (MayimHayim,

n.d.). Regarding the latter, any woman who contends with post-traumatic stress

disorder following a water incident, must undergo therapy, coaching, and

assistance during the immersion process. Additionally those with hearing aids

are required to remove hearing aids prior to mikvah use, and rely upon

additional assistance or sensory replication during immersion. Anyone with a

visual impairment would be uncertain about the obstacles in her path preceding

and during the immersion (Access for All, n.d.).

Accessible Mikvaot in Israel

To date, there are eight mikvaot throughout the country that are listed as

"accessible to individuals with disabilities" (Access for All, n.d.). Several city

municipalities, such as Tel Aviv, Ramat Gan, Tzfat, and Jerusalem, have

provided financial assistance to local mikvaot. In the neighborhood of Musrara,

Jerusalem, there is a mikvah that has been renovated completely to

appropriately accommodate individuals with disabilities. This mikvah can

accommodate a broad range of impairments ranging from muscle weakness,

paralysis, lack of sensation, deafness, and post-traumatic stress syndrome.

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Close to 5 years ago the Jerusalem municipality financed this facility to

implement environmental modifications specifically for the disabled

population.

Disability advocacy groups, such as MILBAT and ZECHUT advocate on

behalf of these populations to ensure cooperation from the municipalities.

Currently the mikvah in Musrara offers the following accessibility features:

accessible parking, an entrance ramp, a doorbell with braille, an automatic door

opener, a clear passageway at the entrance, electronic lifts, ceiling lift,

modified toileting and showering facilities, commode chair, and assistive

devices to help with mikvah preparation. In addition, the mikvah attendees

arrange pre-set appointments with women who have special needs. These

attendees demonstrate empathy, support, respect and dignity as they walk each

woman through the process of mikvah use, and listen to individual's needs and

concerns. This facility offers several services to the individuals with

disabilities. With respect to woman with PTSD, attendees sit with the woman

and speak with her prior to the immersion. Upon immersion, they hold her

hand and grant her extra time for the immersion. The attendees walk her

through the immersion process at a slower pace so that she completes the

mikvah immersion, as required, and does not experience any relapse. This

allotted time is relevant as well to women who contend with physical and

sensory impairments who require more time to go through the mikvah

immersion.

The role played by the occupational therapist/accessibility consultant

involves training mikvah attendees to assist women with disabilities starting

from accessing the facility, undressing, preparing for mikvah immersion,

immersion, and post-immersion dressing. Each step is an activity of daily

living that could require assistance or assistive device usage, and must be

addressed precisely (Pedretti & Early, 2011).

Other mikvaot in the country are advertised as partially accessible. These

facilities may house lifts and commode chairs, but the preparation rooms are

often not wide enough to accommodate a wheelchair. Moreover, often there is

insufficient lighting throughout the facility, hampering the preparation process.

Another obstacle is the hallway leading to the actual mikvah pool, which is

frequently too narrow, too cluttered and not sufficiently lit. A predominant

difficulty is that mikvah attendees generally lack the time and patience to truly

address the needs of those with special needs. A mikvah must be

comprehensively renovated to best accommodate those with special needs

(Nishmat, n.d.).

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Walking Through the Mikvah Experience:

Step-By-Step Accessibility Features

Mikvah attendance involves sensory, mental, physical, and environmental

activities of daily living. As such, the role of occupational therapy can be

pivotal in promoting maximal participation in all mikvah activities. Each step

must be understood and mastered by an individual so that the process is

experienced safely and with personal satisfaction. Each of the following steps

can allow for occupational therapy intervention.

Mikvah Attendance: When do I Go?

A 7-day counting period is associated with the mikvah immersion, during

which time a woman checks that she no longer has any menstrual flow. At the

end of these 7 days, she is able to immerse in the mikvah. However, an

individual with a cognitive impairment may have difficulty remembering the

day on which she is required to immerse. Recently, an inexpensive online

program called the 'Mikvah Calendar' has become available. This is an

invaluable resource for individuals with cognitive impairments who have

difficulty remembering the actual dates of their expected immersions. With the

help of the online mikvah calendar, a woman's expected date is calculated, and

an email is sent to her reminding her of the accurate date and location of her

upcoming immersion. This can assist any woman with memory, orientation and

planning difficulties in preparing for the imminent immersion

(www.mikvahcalender.com).

Parking

More often or not, the accessible parking for any building is located in close

proximity to the building's accessible entrance. Since the mikvah is only used

after sunset, the parking for these facilities must be very close to the main

entrance. Moreover, anyone who arrives at a mikvah via a special needs

vehicle or transportation must have sufficient room to accommodate van lifts

or car lifts. The parking lot should have adequate lighting to enable safe

descent from a vehicle. If the individual is accompanied by an assistant, there

should be enough room for him/her to help the woman as she exits the vehicle.

Entrance

The mikvah entrance must be labeled clearly and lit in such a way that the user

can see the entrance, yet her required privacy is maintained. A bell with a

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braille option should be installed. Upon arrival at the mikvah there should be a

bell that signals the attendee to automatically open the door from within. An

entrance ramp is also needed to enable safe entry into the area. Should there be

any stairs within the entrance, they should be made according to the designated

standards and be equipped with appropriate handles. The entrance way should

be free of obstacles or objects both before and after the entry.

Payment

Payment at mikvaot is now completed through automated machines that stand at

the entrance of the facility. Following payment, the door automatically opens and

the individual enters through. If this payment machine cannot be modified, an

attendee must greet an individual with special needs at the entrance and take

payment without the use of the machine. Modifications made to the payment

machine include: lowering the height of the machine, adding braille and voiceover

to each button, applying large arrows to each button and placing a large sign over

the machine that states the payment required prior to entering the mikvah.

Moreover, an online payment method prior to arrival could be implemented.

Attendees

Each attendee should demonstrate dignity and respect; allowing an individual

complete freedom to act independently while making use of special

accommodations. If a pre-arranged meeting has been made, attendees should

make note of the special needs of the woman to prepare the facility for her

imminent arrival. Should the woman arrive at a facility spontaneously, she

should be guided through the facility, and her special needs should be

determined upon her arrival. As disabilities vary, the level of assistance varies

as well. Some woman require assistive devices as they complete the

preparation for mikvah, others require added light near the mikvah waters,

while others need an attendee to hold their hand during the immersion process.

In the Musrara facility, each woman with a disability is told that: "if you need

us we are here, if you don't, we will grant you your space". Due to the

intimacy and personal nature of the mikvah experience, this philosophy should

be practiced by all mikvah attendees who assist woman with special needs.

Preparation Rooms

Prior to immersion, a woman must clean all areas of her body and check that

she is ready for the mikvah immersion. Each room should be equipped with

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modified showering and toilet facilities, including transfer boards, commode

shower chairs and easy to use faucets. There should be enhanced lighting in

each room, and assistive devices such as long handled combs, long handled

tooth brushes, standing mirrors, a hands-free dryer and soap dispenser, and a

wall mounted mirror. There should also be an appropriate intercom system

within each preparation room. One button should be used to call mikvah

attendees when a woman is in need of general assistance. The second should

be used to signal an emergency, such as falls, medical problems, emergencies,

and other serious predicaments. A third should be a call button to alert the

mikvah attendee that a woman is ready and prepared for mikvah immersion.

The mikvah attendee must explain the difference between these buttons and the

appropriate use of each button. At the Musrara facility, a ceiling lift

accompanies a woman from the preparation room directly to the water, and

lowers her into the water for immersion. This creates a fluid path enabling her

an obstacle free access to the mikvah and return to her room following

immersion. The latter feature requires that mikvah attendees learn how to

operate the ceiling lift, and if need be, obtain additional assistance so that the

person can be transferred safely. Extra training is required for this process, but

interviews with a number of women who used this ceiling lift indicated that

they all felt that the ceiling lift created a less invasive mikvah experience since

rather than being transferred to the mikvah by attendees, they were lifted by an

electronic lift.

Immersion Into the Waters

An electronic lift should be placed next to the water in a safe and secure place.

All obstacles in the mikvah waters should be removed and set aside. Sufficient

lighting should be placed in this area ensuring that anyone can see it clearly.

Attendees should be attentive when providing assistance during this process.

The blessing recited upon immersion should be written in large bold print and

placed in an accessible site. Assistance should be provided to recite the

blessing, as needed or required. By implementing these modifications and

procedural changes into the mikvah facility, a number of different impairments

can be accommodated.

Conclusion

Mikvah attendance requires ample support and modification for those who

contend with disabilities. In order to properly ensure maximal participation of

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community members, modifications should be made so that these individuals

can access these facilities with ease and comfort. Currently mikvaot are

partially accessible, however, more accessible modifications should be

implemented so that a broader range of disabilities can be accommodated. With

more research and accessibility consultation, facilities can be renovated, and

procedural changes can be implemented to create barrier-free environments.

Through such changes, Jewish religious practice can be implemented with

greater ease and comfort for all community members, regardless of ability or

disability. With more knowledge and implementation of occupational therapy

principles, mikvaot can accommodate a broader range of disabilities.

References

Access for all: Israeli non-profit organization conducting research and

assessment on the accessibility of Israeli services. Retrieved from

http://www.aisrael.org/?CategoryID=1245&ArticleID=10034

American Occupational Therapy Association. (2002). Occupational therapy

practice framework: Domain and process. American Journal of

Occupational Therapy, 56, 609-639.

Israeli Ministry of Justice (1998). Equal Rights for Individuals with Disabilities

Law. Retrieved from

http://www.justice.gov.il/MOJHeb/NetzivutNEW/Mishpati/Hakika/

NosahHokShivyon.htm.

Israeli Ministry of Justice (2005). Equal Rights for Individuals with Disabilities

Law. Accessibility chapter.

Israeli Ministry of Justice (2011). Equal rights for individuals with disabilities

regulations - Accessibility in existing building which is a public place.

Retrieved from

http://www.justice.gov.il/NR/rdonlyres/FC920E01-5F70-4A80-B0B7-

0D0A829D8AB1/34878/AsufatTakanotNegishutBinyanKayamAPR12a.pdf-

Israeli Ministry of Justice (2013). Equal rights for individuals with disabilities

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Jachter, H. (2002). The building and maintenance of mikvaot - Part 1. Retrieved from

http://koltorah.org/ravj/12-1b%20The%20Building%20and%20

Maintenance%20of%20Mikvaot%20-%20Part%201.htm

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MikvahCalender: Online service for preparatory and immersion of regular

mikvah users. Retrieved from from www.mikvahcalender.com.

Mikvah in USA: MayimHayim. Facility for accessible mikvah use with

therapeutic activities included Retrieved from

http://www.mayyimhayyim.org/Resources/Facilitating-Mikveh-

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