The Long-Term Care Insurance Program in Israel: solidarity with the elderly in a changing society

Abstract

The Long-Term Care Insurance Program (LTCIP) in Israel is a social security program administered by the National Insurance Institute (NII) since 1988. LTCIP focuses on home-based personal care services. Differently from most other programs under the responsibility of the NII, LTCIP benefits are in-kind benefits and are delivered via multiple for-profit and not-for-profit organizations. In recent years LTCIP has been the target of various legal amendments and numerous administrative changes. While many of these changes may have had significant effects on individuals, they have not altered the fundamental principles of the program. Thus, many of the characteristics of beneficiaries have remained quite stable over the years; other characteristics of the population of beneficiaries have changed over the years reflecting the aging of Israeli society. A central issue related to LTCIP is whether benefits are adequate to meet the needs of the growing elderly population of Israel. While the generosity of LTCIP benefits is questionable, economic and political struggles have limited the scope of changes introduced thus far.

Between older adults' needs and the law: The Israeli Long Term Care Insurance Law from the Perspectives of Service Users and Providers

“…There is no clear supervision of the paid home care workers and in fact, although the NII provides financial assistance towards the employment of paid carers, it takes no responsibility for the quality of services provided. Home care services in Israel have been outsources and are currently in the domain of the home care industry, which supplies paid carers and also supervises their services (Asiskovitch, ; Borowski, ).…”

“…Another shortcoming of the LTCIL lies in the fact that it has outsourced the home care services provided to older adults. These services are currently supplied by an external industry (Asiskovitch, ; Borowski, ). It also is important to acknowledge that the law supports only those older adults who wish to remain in their homes.…”

After providing end of life care to relatives, what care options do family caregivers prefer for themselves?

“…The rationale for using these two scenarios was that they are the most common scenarios in which preferences for EoL long term care are decided in Israel and many other locations. For example, the Israel National Insurance Institute provides some support for home care or for live-in care by migrant worker based on ADL function and on need for dementia care and supervision [ 37 – 39 ]. For both questions, participants were given the following choices: (i) care in a nursing home/long term care institution, (ii) care by a caregiver at home, (iii) care by family at home, (iv) suicide, (v) euthanasia (euthanasia is currently illegal in Israel, however it is a generally known practice, and the topics of assisted suicide tourism [ 40 ] and euthanasia are part of public discussions [ 41 ]), and (vi) “I do not want to think about it.” For the bivariate analyses and path analysis, responses were further collapsed down to either 'Care' (responses (i), (ii) and (iii)) or ‘Termination of Life’ (responses (iv) and (v)).…”

Becoming a Home Care Worker: Job-Seekers’ Push and Pull Factors

“…As in other countries in Europe and Asia (Kodate & Timonen, 2017), Israeli older adults enjoy a relatively strong family support system (Katz, Lowenstein, Halperin, & Tur-Sinai, 2015) and at the same time, they are offered a relatively generous support from the welfare system provided by the state (Ayalon & Green, 2013). This support may come in the form of home-based personal care services (Asiskovitch, 2013). About 16% of those aged 65 and more are limited in carrying out daily activities and receive financial assistance through the Long-Term Care Insurance Law that aims to support family caregivers and maintain older adults in their community for as long as possible.…”