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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 Academic College, Israel

ariela@research.haifa.ac.il

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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

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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

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Population AgingThe new millennium of the 21st century confronts us with

numerous challenges regarding the aging societies of the

modern world.

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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

 

Young – old: 65-74

Old-old: 75-84

Oldest –old: 85+

Centenarians: 100

 

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Changing Demographics

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

Changed balance between generations – challenge for social inclusion and integration

Aging can be a risk factor, or an opportunity

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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

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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 actively in that of society as a whole’.

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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 diversity affect needs, expectations, and patterns of support

Thus, Israel serves as a natural laboratory for understanding effects

of culture and ethnicity.

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Demography

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

2009מקור: זקנים בישראל, עובדות ומספרים,

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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.

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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

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Policy and the Service System

Basic objectives of service delivery to elders:

(1) To enable maintaining maximum self-sufficiency and

continue living in the community as long as possible -

Ageing in Place;

(2) To enable active participation in society, considering

their diversity and heterogeneity.

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?

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Social capital

Important to use social capital inherent 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

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Four major sectors are involved in service provision:

Government agencies

Trade unions

Voluntary organizations

The private sector

Policy and the Service System in Israel

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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

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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

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Policy and the Service System

In 1969 the Ass. for Planning and Development of Services for the Aged (ESHEL) was created to: coordinate activities 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 werecreated, with representation of local service providers and elders

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What Should be the Appropriate Balance?

Informal Family Care

Formal Service 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

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Models for Service Development

There are several models for service provision to

families with elder members

The substitution approach - A Scandinavian model,

favoring direct govt. involvement, supplying rather

generous services, mostly public

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Models for Service Development

The conservative model of 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

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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

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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.

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Thank You