Israel May Have the World's Highest Rate of Foreign Health Aides – and It's a Luxury, Not a Need

Unfettered migration of foreign health care workers has lead to a type of inflation that pushes Israelis out of the industry while acutely harming the foreign workers' rights

An elderly man with his Filipina nursing worker in Jerusalem, March 6, 2019.
Emil Salman

Some 8,000 foreign nursing care workers arrive in Israel every year, a large portion of them from the Philippines. Ostensibly, they come for a set period of five years, so that they don’t put down roots and demand rights as immigrants. And yet the average Filipino spends more than eight years in Israel: Some 40 percent stay for more than six years, and 21 percent stay for over 10 years. Israeli regulations permit them to apply to stay longer for various reasons, and every year, some 3,000 to 4,500 such workers receive permission to extend their stay.

A Filipina hired as a home health aide for an elderly or disabled person is permitted to stay with her employer as long as the latter is alive, and if the elderly patient dies and leaves behind a widow, she is permitted to continue working for the widow for the rest of the widow’s life, too. If the home aide’s patient passes away and another Israeli wishes to hire the aide, she’ll receive permission to move to a new employer; and if she wants to work for an elderly or disabled person with serious health problems, she’ll receive permission to do so even if she’s already spent 13 years in Israel. A young disabled person may need decades of care, and the Filipina is permitted to stay in Israel as long as the care continues.

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In practice, the law does not limit the amount of time that a foreign home health aide can stay in Israel - and it also doesn’t limit the number of health aides who can come to work here. As opposed to all other sectors of the economy, for which the government imposes caps on foreign workers, there’s no such cap in the home health aide industry. Any elderly or disabled person who receives a permit to hire a foreign aide may do so, and permits are handed out generously.

Some 41 percent of Israel’s elderly received a permit to hire a foreign worker, according to research carried out by Yossi Avraham and Yossi Tamir in 2012. In comparison, only 9 percent of elderly Canadians received a permit to hire a foreign home health aide during that period. Since 1996, the year Israel opened its doors to home health workers from the Philippines, their number has shot up from 8,000 to 57,000. In terms of percentage, this figure has increased much more than the number of elderly who need nursing care. Research conducted by Prof. Zvi Eckstein for the Israel Democracy Institute in 2010 estimates that by 2025, there would be more than 100,000 foreign health aides legally employed in Israel. This works out to one foreign home health aide for every five Israeli elderly people, a rate not seen anywhere else in the world.

No other Western nation permits unfettered migration of home health workers, and most nations don’t permit them at all. Israel’s policies have led to a type of inflation - some 50 percent of home health aides in Israel are foreign, compared to 26 percent in other developed nations. This pushes Israelis out of the industry while acutely harming the foreign workers' rights.

Israel, the home health aide capital

Israelis love their ability to bring in foreigners to care for their aging parents. It’s incredibly cheap and convenient, but the convenience shouldn’t blind them to the fact that they’re taking part in a horrible exploitation: The Filipinos living in Israel receive payment for one full-time job, even though in practice they work three full-time jobs: they live with their patients, meaning they’re at work 24 hours a day, six days a week. An estimated half of all workers have left children behind in their homelands, and should they dare to get pregnant, they and their children are unceremoniously kicked out of Israel. No developed nation acts this way.

Israel could have a more intelligent immigration policy that doesn't involve importing young women during their peak childbearing years. According to Israel Population and Immigration Authority data, some 50 percent of health aides came to Israel before age 40. If permits were given only to women over 40 years old, the “illegal pregnancy” issue would be prevented, and the women would also be less likely to leave behind young children.

A simpler solution would be capping the number of foreign health care aides. As opposed to the prevailing opinion that there’s no alternative to Filipina aides, most developed nations - where the percentage of elderly population is much higher than in Israel - do fine without them. According to Tamir, only 15 percent of elderly people in Western nations need around-the-clock assistance, versus some 50 percent of elderly people in Israel who receive such care. Doron Raz, chairman of the association of caregiver employment agencies, agrees that the number of elderly Israelis with round-the-clock care is significantly higher than the actual need. The high number of foreign workers pushes Israelis out of the industry, as they don’t want to - or can’t - work a job that includes sleeping at their patient’s home.

In developed nations that don’t have cheap foreign workers, some 85 percent of elderly people manage with local health aides who come to their house for several hours a day. The aides help with tasks such as bathing, dressing, cleaning the house, errands and shopping. A neighborhood supervisor looks out for the elderly, and there are centers where they spend most of their daytime hours.

An event against the deportation of children born in Israel to Filipina workers, at Abraham Hostel in Tel Aviv, February 23, 2019.
Ofer Vaknin

If Israel were to shift to this model, the health aide industry could offer employment to tens of thousands of local workers from disadvantaged population groups, who would receive better work options and salaries. In order to pay such a salary, we would need to forgo the model of cheap live-in caregivers and shift to the model embraced by other developed nations. The few people who actually need round-the-clock care could receive it at nursing institutions.

The massive growth in the number of Filipina health aides, compared to the number of elderly and disabled Israelis who need nursing care, indicates that the boundless import of health aides does not stem from an actual need, but rather luxury. Eckstein notes that the rate of home care aides increases among families with more financial means and higher education levels.

There are apparently significant financial interests behind this growth. It is thought that every Filipino worker who comes here pays an illegal fee of some $10,000 to $12,000. Most of that money stays behind in the Philippines, but it’s likely that at least some of it trickles into Israel, motivating lobbyists to keep quotas out of the industry.

In 2019, Israel signed an agreement with the Philippines to enable the government to sponsor the process of sending health aides to work here, which is likely to cut into the middlemen’s illegal profits.

“Employing foreign workers means we have to address legal and ethical questions,” wrote Avraham and Tamir. “Romantic relationships and children born in Israel can endanger the worker’s status and lead to his or her expulsion. This pushes workers into social and familial isolation, as they are asked to dedicate themselves to caring for their patient at the expense of their personal needs.”

We’d do well to remember that sometimes.