Israel's long-term care insurance scheme

Concerns about the implications of population ageing and the size of the elderly population with disabilities led Israel to began to implement its Long-Term Care Insurance (LTCI) Law fully in 1988.

Even though Israel is relatively young demographically, the population has aged rapidly. Migration, mostly from the former Soviet Union has comprised of high proportions of older people.

The LTCI law sought to provide long-term care benefits as a matter of right under clearly defined eligibility criteria,  to benefit chronically severely disabled elderly persons living in the community through the provision of personal care and homemaking services.  It also sought to support  the caregiving family within the framework of home- and community-based services. In that way, the aim is to reduce the demand for institutional placement.

Features of the LTCI law:

• it covers women aged 60 years and men aged 65 and over with who have disabilities and are permanent residents of the State of Israel. It also includes new immigrants who arrived in Israel after reaching the age of 65. In March 2009 there were 135,336 LTCI beneficiaries (70% women, and 30% men)
  
• eligibility is subject to an income test – income test limits are generous (three times the average wage) that only 1% of the applicants were excluded from benefit entitlement by the income test in 1996
• it provides a basket of specified in kind services - including personal care, help with household management, transportation to and care at day centres, laundry services, incontinence products and personal alarm units
• service delivery is contracted out to authorised voluntary nonprofit and proprietary for-profit organisations
• the number of beneficiaries has outstripped the early projections of the future number of functionally disabled elderly persons who would require care services

Limitations and suggestions for improvement:

• the scheme is underfunded; it serves only the most highly dependent populations, while those with less severe disabilities must rely on different and far less generous sources for funding of services
• there needs to be a considerable improvement in training of home care workers - and a need to increase the level of professionalisation (e.g., social work, gerontology, and nursing) among the executives and middle managers of home care agencies
  
• home-care organisations rely almost exclusively on an unskilled, non-nursing, female labour force. The government has taken some measures to improve employment conditons and job security for these workers – including an act that has forced the nongovernmental agencies to improve the working conditions of the home care workers (paying fringe benefits such as health insurance, paid vacations, sick leave,etc.)