Planning and Developing Integrated Communities in Israel. Lecture, IFA Global Conference, Prague, May 2012 Prof. Ariela Lowenstein, Gerontology Dept., Center for Research and Study of Aging, University of Haifa Head, Dept. of Health Services Management, Yezreel
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Lecture, IFA Global Conference, Prague, May 2012
Prof. Ariela Lowenstein, Gerontology Dept., Center
for Research and Study of Aging, University of Haifa
Head, Dept. of Health Services Management, Yezreel
Academic College, Israel
Factors related to service planning
The socio-demographic picture of Israel
Policy and Legislation in Israel
Continuum of Care
Different service models
Issues and changes needed
Implications for Policy
Composition of Various Aged Groups
Global Perceptions – Ageing in Place, Active Ageing
Societal Norms and Culture, Religiosity
Social and Political Fabric – Policy & Legislation
Examples of integrated services
The new millennium of the 21st century confronts us with
numerous challenges regarding the aging societies of the
phenomenon of global aging
dependency and need for care
Center for Research & Study of AgingIAGG collaborating Center
Young – old: 65-74
Oldest –old: 85+
‘A longer life provides humans with an opportunity to examine their lives in retrospect, to correct some of their mistakes, to get closer to the truth and to achieve a different understanding of the sense and value of their actions.’
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‘the potential of older persons is a powerful basis for future development. This enables society to rely increasingly on the skills, experience and wisdom of older persons, not only to take the lead in their own betterment but also to participate activelyin that of society as a whole’.Madrid Int’l Plan of Action on Ageing(2002)
Israel is multi-cultural, pluralistic, and democratic,including a
variety of national, religious, and ethnic groups
Israel an urbanized welfare state, relying on a mixture of govt. and market forces that shape its welfare policies and services
Population diversityaffect needs, expectations, and patterns of support
Thus, Israel serves as a natural laboratoryfor understanding effects
of culture and ethnicity.
In 2011 Israel’s population was 7.6 million, 80% Jews and 20% non-Jews. The aged (65+) comprise 10%
Differences exist between Jewish and non-Jewish aged. In the Jewish sector, elders’ percentage is close to 12%. Among non-Jews, elders comprise only 5.2%, due to higher fertility rates
Close to 19% of Jewish elders are disabled in ADL. Among non-Jews – close to 31%
מקור: זקנים בישראל, עובדות ומספרים, 2009
Most aged have an informal support network, with spouses the main source, followed by children
There is a strong emphasis on family role in elder care, reflected, for example, in the low institutionalization rate: 4.4%; The Alimony Law, 1958.
A country’s social system and professional practice are affected by historical, religious, and cultural forces - place great emphasis on social and familial responsibility.
Political structure and population heterogeneity also shape service planning and delivery - the principle of cultural and ethnic pluralism
Important to use social capitalinherent in the growing “young-old” population - activating political power. In Israel the Senior Citizens party which caused the creation of a Senior Citizens Ministry
Policy and the Service System in Israel
Four major sectors are involved in service provision:
The private sector
In each local authority the local welfare office has to provide services to needy, including elders.
Major community services: pensioner clubs; day care centers for frail and mentally frail elders; supportive neighborhoods; meals on wheels; activating volunteers
Primary and acute health care are provided by 5 Sick Funds (HMO’s) through primary health clinics in every neighborhood, and activate home-nursing programs.
Currently an attempt to develop an integrated service model – with strong collaboration between the clinics, day care centers, hospitals, social services and informal carers
In 1969 the Ass. for Planning and Development of Services for the Aged(ESHEL) was created to: coordinateactivities of the various ministries; to promote service planning on a national level; to develop partnerships between public and voluntary sectors.
In each community Local Associations for the Aged were
created, with representation of local service providers and elders
Formal Service Care
Informal Family Care
There are several modelsfor service provision to families with elder members
The substitution approach- A Scandinavian model, favoring direct govt. involvement, supplying rather generous services, mostly public
The conservative modelof continental Europe, leaning heavily on insurance-based arrangements.
US liberal regime, limited residual state responsibility.
Countries with a more traditional-familial view and a family-based social policy, like Israel, a complementary approach- responsibility is shared and services are developed to assist caring families
Mostly the emphasis was on complementarity
support suiting her best – emotional support
In the future, elder care will be by public-private mix, the exact ratio varying by country.
Specifics of the mix will depend on : (a) the family culture that guides readiness to use public services; (b) availability, accessibility, quality, and cost of services.
Thus, services must help families define their willingness; Families should be compensated for the care they provide.