Israel Is Abandoning Its Elderly When They Most Need It

There is an urgent need to anchor nursing services in the state’s list of covered medical services, reducing dependence on families.

 Itzik Shmuli
Itzik Shmuli
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Elderly Israeli couple.
Elderly Israeli couple.Credit: Hadar Cohen
 Itzik Shmuli
Itzik Shmuli

A random survey among Israeli workers would probably reveal that the majority are convinced that their monthly payments to the National Insurance Institute protect them from situations requiring special nursing assistance in their old age. If one of them were ever to require such assistance, however, he or she would discover the hard way that the coverage of such benefits is faulty and almost non-existent.

The absurdity of the situation is that the more one pays while working, the less chance one has of receiving any help during a crisis. (Anyone relying on private insurance should know that more than 40 percent of claims for nursing aid are rejected.)

In practice, public funding in such cases is so limited and tight-fisted that only those with one foot in the grave are likely to meet the stringent conditions set by the state, which in any event usually apply to people in dire financial straits only. All the rest have to manage on their own. The sad truth is that one out of four elderly people in Israel needs special assistance and this rate will only rise in the future.

Precisely at a time when the elderly require social benefits from the state more than ever — monitoring and nursing aid at home or, in more severe cases, special care in hospital — the state disappears and is not there for them.

The assumption that a lifelong payer of National Insurance dues receives fair coverage in old age is shattered by reality. In practice, the state does all it can (such as setting very high deductibles and closely examining the income of family members, including children and children-in-law) to impose the expenses of nursing care on the family, behaving as if the matter is of no concern to it.

Even for those who are found to be eligible for benefits, the amount of coverage is appallingly low and is far from adequate for the hours of care required.

Elderly people requiring nursing assistance are granted between 9.75 and 22 weekly hours of assistance, with 50% of those in need receiving only the minimal amount from the National Insurance Institute. What are people in need supposed to do for the rest of the week? Go to the bathroom in their beds? Eat purée that no one mashes for them? The state relies on families to fork out some 7,500 shekels ($1,925) a month for an assistant, in addition to other required services.

The condition of hospitalized elderly people requiring assistance is not much better. Here, too, the state’s participation is limited. With assistance costing an average of 15,000 shekels a month, 30% of the elderly do not receive the required assistance. Most of them are subject to deductible fees of up to thousands of shekels a month. Some are found to be eligible but have to pay a 100% deductible.

The overall annual cost of nursing in Israel amounts to 9.7 billion shekels ($2.5 billion,) 42 percent of which is covered by private financing. That, in a country in which 20% of the elderly live beneath the poverty line.

The state's cynical policies are based on the assumption that families won’t abandon their elderly members. The enormous gap between what the state provides and what is required is bridged by family members who have to cover the huge expenses, sometimes by taking out loans and going into debt for private insurance plans, nursing services and private nursing aides. Many people quit their jobs in order to support an elderly parent, seriously impacting their livelihood.

This huge burden is ignored by state authorities. In addition to the financial burden, families are faced with serious dilemmas, such as whether to place an elderly person in a closed ward, against his or her will, in order to relieve the family’s financial burden.

Reliance on private funding of nursing requirements is problematic, especially in light of the huge expenses involved. There is an urgent need to anchor nursing services in the state’s list of covered medical services, reducing this dependence. Universal coverage with adequate hours of assistance will truly guarantee that no elderly person is left behind.

The writer is a Knesset member from the Zionist Union.

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