Sabrin Titleman is a Holocaust survivor. He immigrated to Israel from Belgium in 1952 and married Zipora in 1957. They had three children and five grandchildren. In June 1999, Titleman suffered a stroke, and was hospitalized at the Fliman Rehabilitation Center in Haifa, which is soon scheduled to close. But he was soon back to his old self.
Eight months ago, however, he suffered a second stroke and since then, he has been unable to speak or write and has trouble swallowing. After three weeks at the Rambam Medical Center, he was sent once again to Fliman. Titleman is now considered an invalid since his condition is not improving. Should the decision to close Fliman go ahead and he is transfered out of the center, his family will have to put him in a nursing home.
However, it was announced on Thursday that the Health Ministry's geriatrics' department has ordered a halt to the transfer of any more funds to hospitalize elderly patients at geriatric nursing homes until early next year. This decision followed a decision by the Finance Ministry to stop NIS 60 million in funds for this purpose.
This essentially means that until the end of the year, no new elderly patients can be hospitalized in the state-run homes.
Zipora Titleman has practically gone out of her mind from worry. "We continue with the rehabilitation [program] because we are hoping for a miracle, hoping that his condition improves. We cannot anyway bring him back home, he needs constant medical treatment. I do not know what to do now that they want to close Fliman. The fact that they will not approve the hospitalization of any new terminal patients makes the situation one hundred times worse. Where am I meant to hospitalize him? It is an intolerable situation. A man who has served the society, served 25 years in the civil guard, a man who perfectly understands what is going on around him how can they treat him like this?" she asks, her voice filled with pain.
Health Minister Danny Naveh told Haaretz on Wednesday that the waiting time for a bed in a nursing home could become as long as a year. "Since we now have NIS 60 million less to deal with an aging population, we have less money to treat them. Thus, elderly patients will have to wait nine months to a year for a bed in a nursing home. Since there will be no new patients hospitalized until the end of the year, this means the waiting time will be an entire year. This is inhumane. How can we shirk our duty to take care of our parents and grandparents' generation?"
Indeed, many in the country's health system are predicting the "collapse of the geriatric care system."
Figures from the Health Ministry show that almost 10,000 elderly citizens sought government help for their nursing home care. Only 7,572 received the state's approval. Not everyone who seeks state assistance and qualifies for the help actually get into the homes. The ministry's figures also show that in 2002, 2,328 elderly people were waiting to be admitted, with 1,532 still going through the bureaucracy to get the necessary permits while 796 were waiting for a bed.
Closing down Fliman with its 200 beds and the ministry's order not to hospitalize any more elderly patients will only make the situation even worse.
Garciella Cohen, a veteran social worker at Assaf Harofeh Hospital's geriatrics' department, says that the waiting period for getting the state approval is intolerable. "We see people who are unable to eat, drink, get dressed, bathe themselves; how can we even think of not treating them? Today they have bedsores, tomorrow worms, the next day their entire body is rotting. A year's wait? Sometimes three weeks is an eternity for these people," she says.
Another social worker at the hospital claims that the situation today is far worse that it has been in previous years and hospitals are no longer willing to admit elderly patients until an arrangement has been found for them. "Hospitals today immediately release anyone whose health maintainence organization does not pay. They check every penny as they too are facing tough times," she says.
Dr. Shai Beril, head of the Geriatrics Association of Israel, also believes that waiting up to a year for government assistance is simply unacceptable. "Not only is a stroke a traumatic even medically speaking, but the bureaucracy and the waiting time for receiving treatment kill the patient economically speaking. If the state does not help, the entire onus falls on the patient or their family. How many people can afford NIS 11-16,000 a month in nursing homes fees?" he asks.
Dr. Efraim Eisen, the head of the Fliman workers' union, says that the delay in transferring the funds will cost human lives. "Currently a geriatric patient in Haifa waits 3-4 months for a bed until he gets the funding. Now it will take 10 months, maybe a year; there is no doubt that some of the elderly patients will die. Others will go more to the government-run hospitals which will cost the state many more than the millions it is trying to save," he claims.
The health minister claims that he is doing everything he can to reverse the decision and that he had ordered the ministry officials to find an alternative source for this funding.
Zipora Titleman, however, is not comforted by this. She has a two-fold problem: if they close Fliman, she will lose all hope of rehabilitating her husband and will be forced to find a nursing home for him. Without the state funding, though, she will have to put him in a private home and pay out of her own pocket. "This is unforgivable," she says, "simply unforgivable."
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