Chapter 1 - Overview of Services for the Aged in Israel
Israel's general population is still significantly younger than that of other western
countries, as a result of a relatively high birth rate. The proportion of elderly in Israel is
roughly 10% of the total population of 5,200,000. Compared with the United States
and Europe, Israel has a unique position on the aging map. Israel has a disproportionate
number of the old-old: more than 42% of Israel's elderly are aged 75 and over. The
number of those 75 and over increased by 90% between 1970 and 1990. The recent
wave of immigration from the former Soviet Union has increased the number of elderly
by 15% from the beginning of 1990 to mid-1994.
During the 1970s there was major growth in social services in general in Israel and the
services for the elderly increased in tandem. In the 1980s, while this general growth had
come to a halt, the broad range of services for the elderly continued to increase,
reflecting recognition of the considerable degree of unmet need. This awareness led to
the expansion of a broad range of services, including increased entitlements to home
care and day care under a new Community Long-term Care Insurance Law, enacted in
1988.
Rates of institutionalization are low in Israel: 3.0% reside in skilled nursing facilities and
1.4% reside in non-medical facilities. The expansion of community services, together
with the commitment of families to maintain the elderly in the community as long as
possible, are viewed as major factors in preventing or delaying institutionalization among
the elderly.
Responsibility for services for the aged is shared by numerous governmental, public and
voluntary agencies. These agencies operate within a clearly defined but complex system
in which responsibility for financing is determined by type of service and level of
disability as classified along a continuum of dependency - semi-independent (dependent
primarily in homemaking ability), frail (moderately dependent in personal care (ADL)), and
severely dependent or cognitively impaired (the severely disabled in personal care, the
homebound and incontinent, and the mentally frail). The main government agencies
involved in the care for the elderly are the Ministry of Health, the Ministry of Labor and
Social Affairs and the National Insurance Institute (Israel's Social Security
Administration). The principal public and voluntary organizations responsible for the
development of services for the aged are the four major health insurers (HMOs),
including the Kupat Holim Sick Fund of the General Federation of Labor (the Histadrut);
the Association for the Planning and Development of Services for the Aged in Israel
(JDC-ESHEL); and the division of the Histadrut for services for the elderly (MISHAN). In
addition, there are many other smaller voluntary organizations involved in the provision of
services throughout the country, including local associations for coordinating services for
the elderly at the community level.
The Ministry of Labor and Social Affairs has primary responsibility for services for the
well elderly, which include a network of social clubs. These services are supplemented
by a number of voluntary organizations, including MISHAN, and a range of immigrant
associations. The Ministry of Labor and Social Affairs is also responsible for institutional
care and the provision of personal care services for the semi-independent and frail
elderly, the provision of homemaking services to all the disabled, and the operation of
day care. The Ministry operates through a network of social welfare offices that are
administered by local authorities and which provide care on a discretionary basis within
defined budget constraints.
The Ministry of Health is responsible for institutions for the severely disabled and
mentally frail elderly, the operation of psychogeriatric clinics, and the development of
preventive services in family health clinics. The care is provided through a network of
regional public health offices.
The National Insurance Institute (NII) has responsibility for implementing social security
programs for the elderly which include a flat rate basic pension and supplementary
benefits for those without additional sources of income. The national pension system is
supplemented by work-related pensions. The NII has also become heavily involved in the
provision of long-term care services as the administrator of the Community Long-term
Care Insurance Law, which provides financing for community services for the more
severely disabled as well as funds for construction and development of the infrastructure
of institutional and community care.
Medical care is the formal responsibility of the Ministry of Health, but most medical care
is provided by voluntary sick funds. Israel's citizens may enroll in one of four sick funds
(HMOs). Less than 5% of the population is presently uninsured, however the recent
passage (June, 1994) of a National Health Insurance Law mandates universal coverage.
The sick funds provide primary, hospital and rehabilitative care to the population and
some degree of long-term care. For example, the sick funds provide some
supplementary personal care services, particularly during the first several months of
disability, and for the more severely disabled on a discretionary basis. Moreover, they
are the exclusive providers of professional home care, including home care visits by
nurses, doctors and other paraprofessionals.
Reforms in the Israeli health care system following the implementation of the National
Health Insurance Law slated to be implemented in January 1995 will affect the overall
system of services for the elderly. The new law will prevent discriminatory enrollment
practices, by requiring that all health insurers accept members regardless of age and
preexisting conditions. While the basic level of benefits currently provided will not
decrease, the extent of the impact of the reform on the system of services for the elderly
will only become clear over time.
|