National Insurance: 309,435 nursing elderly in Israel, about 55,000 of them in a difficult nursing situation

In November 2018, the reform in nursing came into effect, after years in which there was criticism of difficult tests for nursing in their homes, treatment of nursing senior citizens, and fragmentation between different bodies and the exhaustion of rights was flawed.

The State Comptroller’s report in 2017 accelerated the implementation of the reform when he noted that the average life expectancy in the State of Israel is among the highest in the OECD countries, so that according to the forecast in 2050, for the first time in history, there will be more people aged 60 and over than children.

While before the reform, there were 3 levels of benefit, the reform introduced 6 levels and the possibility of assistance for minor nursing situations in order to prevent deterioration and the number of weekly units was expanded.

In the 4 years since the reform was introduced, it has been found that there is an increase indicating that the eligible have received rights in approximately 131.4 thousand nursing homes. As mentioned, the treatment of one body, the high life expectancy in the State of Israel, the change in the regulations that removed the fear of applying for an allowance and reliance on medical documents that brought about the long-awaited change before the reform.

While between the years 2016-2017 about 90 thousand new applications were made to the National Insurance, between the years 2021-2022 there are about 125.6 thousand applications. It should be noted that, in recent years, teeth have been made in the dependency assessments that refer to medical conditions and their consequences on the functional status and also refer to the risk of falls out of a decision and policy of providing tools and help before the health condition deteriorates.

According to the data of the National Insurance, the levels of the benefit (1-6 with level 6 indicating the most severe medical condition) are found: until the age of 69 the average level of the benefit is 2.5, from the age of 70-74 – 2.8, from the age of 75-79 – level 3, and the level increases when At the age of 95-99 the average is level 5.3.

According to the distribution of those entitled, there are about 41.4 thousand nursing citizens at level 1, about 61.5 thousand at level 2, about 48 thousand entitled at level 3, about 48 thousand at level 4, about 34 thousand at level 5 and about 54.7 thousand at level 6. Since Following the introduction of the reform, the share of those entitled to level 1, the most basic, decreased considerably.

According to the research administration of the National Insurance, it is clearly seen that during the Corona period and the recognition that the elderly were in a central risk group alongside the actions of the state in imposing closures and movement restrictions, the National Insurance responded immediately to the fear of the beneficiaries and their families of foreigners entering their homes and allowed those who did not use treatment hours to receive a cash allowance, which was automatically deposited into the eligible accounts. So in the months of April and May 2020, the number of recipients of the cash allowance increased significantly. Today, about 14.5% receive a cash allowance, 57% receive a combined allowance (money + hours of care) and about 28.5% receive a benefit in kind (a service in the form of nursing care).

At the low nursing care levels, the senior citizens prefer to receive a cash benefit and they testify that they use the allowance for basic and medical needs such as: the purchase of absorbent products, the purchase of medicines, private doctors, hearing aids, dentistry, household care, paying bills and personal needs such as: food, clothing, transportation etc. The answers of the senior citizens and their families show that the money is used by them for basic needs of the individual’s life and it is used to improve their situation and purchase things that would not be within their reach if it were not for the allowance.

In levels 2-6, there are few recipients of an allowance in cash only and the nursing elderly request more nursing care such as: nursing care at home, visits to day care centers, ancillary products, distress transmitters and more.

In the satisfaction indices conducted by the National Insurance, it was found that nursing elderly and their families tend to indicate that they receive all the nursing care they need, as the benefit level increases and includes actual treatments as well and not just cash benefits. The highest rate of respondents in the satisfaction index, 77.9%, was among those receiving an allowance in kind at level 6.

It should be noted, the reform brought with it the possibility to change the treatment mix at any moment and in accordance with the medical condition of the senior citizen. Among the low levels, the respondents claim that they need additional financial help to help them purchase health services and/or medicines.

The National Insurance believes that there is a balance between the fact that senior citizen allowances have not increased significantly in recent years and the nursing allowances that allow receiving a cash allowance that is used for basic and daily needs.

Regarding the degree of satisfaction with the nursing care, in levels 3 and 4 the rate of respondents giving a positive answer exceeds 80% and in the other levels ranges between 70%-80%. The rate of respondents approached 90% among those receiving benefits in kind at levels 3-4 and at level 1 between 60% and 70% answered positively.

From the results it appears that the level of the benefit has a relationship with satisfaction and that the more the benefit includes a larger component of services, the higher the satisfaction.

According to the Director General of the National Insurance, Yarona Shalom: “Fortunately, the reform resulted in the reduction of the bureaucracy, an adequate response to the various needs of the senior citizens and they were given the option of choosing according to their medical and economic situation. Today, there are almost no long-term care insurances in the private sector that will ensure a dignified life for the elderly, and this is parallel to the fact that old-age pensions have not increased significantly over the years, and thus the nursing reform has brought about a fundamental change in our ability as a society to provide assistance to the needs of senior citizens in Israel.”

Illustration. Credit: freepik

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