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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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Planning and developing integrated communities in israel

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

Academic College, Israel

Lecture outline
Lecture Outline

Factors related to service planning

Aging populations

The socio-demographic picture of Israel

Policy and Legislation in Israel

Continuum of Care

Different service models

Issues and changes needed

Implications for Policy

Factors affecting service planning and design
Factors Affecting Service Planning and Design

Demographic Developments

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

Population aging
Population Aging

The new millennium of the 21st century confronts us with

numerous challenges regarding the aging societies of the

modern world.

Population aging1
Population Aging

  • In developed nations –

    phenomenon of global aging

  • More elders aged 75+, thus more

    dependency and need for care

  • Need for more support from state

    and family

Center for Research & Study of AgingIAGG collaborating Center

Composition of aged cohorts
Composition of Aged Cohorts

Young – old: 65-74

Old-old: 75-84

Oldest –old: 85+

Centenarians: 100

Changing demographics
Changing Demographics

  • Population aging is not necessarily apocalyptic for individuals, families, societies

  • Changedbalancebetween generations – challenge for social inclusion and integration

  • Aging can be a risk factor, or an opportunity

Vienna int l plan of action on ageing 1982
Vienna Int’l Plan of Action on Ageing (1982)

‘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.’

Vienna Conference logo

Madrid int l plan of action on ageing 2002

Article 10:

‘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)

Elder care networks in israel norms culture and religiosity
Elder Care Networks in Israel – Norms, Culture and Religiosity

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%

65 2030 1955 israel
% 65+ (2030 – 1955) – Israel

מקור: זקנים בישראל, עובדות ומספרים, 2009

Family status and living arrangements
Family status and living arrangements

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.

The israeli welfare state aged policy
The Israeli Welfare State - Aged Policy

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

Policy and the service system
Policy and the Service System

  • Basic objectives of service delivery to elders:

  • To enable maintaining maximum self-sufficiency and continue living in the community as long as possible - Ageing in Place;

  • (2) To enable active participationin society, considering their diversity and heterogeneity.

The ageing policy challenge
The ageing policy challenge

  • Dependency ratio

  • Labour supply

  • Meaning and purpose- being retired is not being adult

  • What is the social contract for older people? – How could we empower and help them stay active and involved?

Social capital
Social capital

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

  • Raising retirement age, as one form of preparing for societal aging; has been discussed and suggested in all OECD countries (e.g., Duval, 2004)

  • The state and private sector should develop programs to provide incentives for older workers to stay in workforce

Policy and the Service System in Israel

Four major sectors are involved in service provision:

Government agencies

Trade unions

Voluntary organizations

The private sector

Policy and the service system1
Policy and the Service System

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

Policy and the service system2
Policy and the Service System

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

Policy and the service system3
Policy and the Service System

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

What should be the appropriate balance
What Should be the Appropriate Balance ?

Formal Service Care

Informal Family Care

Changing family preferences for care
Changing family preferences for care

  • Societies unable or unwilling to continue support for older cohorts, alters family-society elder care balance (Lowenstein & Daatland, 2006; Walker, 2000)

  • Socio-political & policy challenges to social integration

  • A new generational contract is needed on individual, familial, & societal levels - should be further studied

Models for service development
Models for Service Development

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

Models for service development1
Models for Service Development

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

Complementarity versus substitution
Complementarity versus substitution

Data show:

  • Welfare state services do not erode family solidarity.

    Mostly the emphasis was on complementarity

  • Alongside service provision, the family specializes in forms of

    support suiting her best – emotional support

Policy implications
Policy Implications

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.