Israel's Lack of Geriatric Care Is 'Ticking Time Bomb,' Says Health Minister

Yaakov Litzman issues warning after OECD data show Israel lagging behind developed countries for long-term care.

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A retirement home offering care for the elderly.
A retirement home offering care for the elderly.Credit: Klaus Rose / dpa / Corbis

Israel is still neglecting its long-term care patients, according to data released Monday by the Organization for Economic Cooperation and Development.

The OECD data indicate that Israel lags behind other developed nations when it comes to its care for the elderly.

Health Minister Yaakov Litzman said the OECD data must act as a wake-up call. “The state’s lack of preparedness for the aging population has become a ticking time bomb, and this is the time for long-term care reform,” he said.

“This is an emergency order to make systematic change about how Israel treats its aging population,” he added.

Researchers compared levels of social protection for long-term care in 14 OECD and European Union countries. Israel has a relatively high proportion of citizens over the age of 65 receiving long-term care (LTC) – 20 percent. However, it ranks relatively low on several parameters when it comes to social protection.

The researchers created three categories depending on the amount of care needed – from low needs (6.5 hours of care or less per week) to moderate (22.5 hours) and high-level needs. They found that Israel is among the few countries that does not provide any support for seniors with low needs, along with the United States, Croatia and the Czech Republic. Israel is also near the back of the pack when it comes to moderate and high-level needs.

Israel is one of the countries with the largest out-of-pocket costs for people with low incomes, because its social-protection system does not cover some services, “leaving part of the cost of LTC entirely to the individual,” the report said. The proportion of the cost for someone with median income and low assets receiving home care in Israel is 45 percent, according to the report, which puts Israel near the bottom with the Czech Republic and Croatia.

More disturbingly, at nearly 80 percent, Israel has the highest rate of out-of-pocket costs when it comes to home care for low-income individuals with moderate needs. In contrast, people with similar needs in Iceland, Sweden, Belgium and Britain do not pay anything for home care, while low-income individuals in the Netherlands, Canada and the state of California pay no more than 20 percent. The rate goes up to 22 percent to 42 percent in the Czech Republic and the state of Illinois.

Along with the United States and Great Britain, Israel is one of the few countries that expects people to spend all of their savings before they become eligible for social protection, the researchers said.

Israel does have means tests for institutional care, with “low-income people paying nothing toward the cost of care, and people with high assets paying the full cost,” according to the report.

Consequently, the results are mixed for institutional care. On the one hand, public coverage of institutional care in Israel is one of the most comprehensive in the OECD, at nearly 80 percent of expenses. On the other hand, the income test for institutional care in Israel is one of the most stringent in the OECD. The means test includes checking the assets of elderly patients, while the National Insurance Institute’s means test in the community (in other words, hours of aid given to seniors remaining at home) is relatively lenient.

Researchers project that the number of people aged 70 or over in Israel will double by 2035 – from 610,000 to 1.24 million. Assuming there are not dramatic developments in the functional ability of Israel’s senior population, this growth will lead to a surge in the rate of seniors in need of assistance.

A rapidly aging population combined with a lack of public LTC coverage and high rates of self-funding require the state to hurry up and advance long-term care reform that increases social protection for every citizen.

Health Ministry Director General Moshe Bar Siman Tov reiterated his ministry’s demand to raise the health tax to fund LTC reform.

“The Israeli public expects the best long-term care and health system from us, which will save it substantial private expenses, and it demands a modest rise of health insurance fees,” he said. “Israel is aging en masse, and we are not prepared for it on a national level.”

The research is part of the OECD Working Papers series, which does not represent the official views of the OECD or its member states.

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