Major plan to expand geriatric care goes to Knesset

Reform would simplify bureaucracy and head off "tsunami of elderly" in coming decades.

By JUDY SIEGEL-ITZKOVICH
Holocaust survivor 311 (photo credit: Etti Cohen)
Holocaust survivor 311
(photo credit: Etti Cohen)
A plan conceived over the past year to raise health taxes by 0.5 percentage points or alternatively for the Treasury to increase allocations to reform geriatric nursing services and financing will be presented as a government bill by the Health Ministry to the Knesset during its winter session.
The bill, if passed and implemented gradually, would relieve the heavy costs to the middle and lower classes of caring for the sick and disabled elderly, and reduce red tape that requires families to go to half-a-dozen authorities to get help. Instead, the Health Ministry and the public health funds would take over responsibility for supervising and carrying out geriatric nursing care in hospitals and in the community.
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One of the major changes that would hearten the overburdened middle class whose rage has been expressed by tent demonstrators during the past three weeks is that adult children – and even sons- and daughters- in-law – of the elderly would not have to contribute from their income to admit and keep them in geriatric hospitals. Only the income of the elderly and supplementary or private insurance policies they may have would be considered for calculating their financial participation, Deputy Health Minister Ya’acov Litzman said at a press briefing in his Jerusalem office on Sunday.
The idea to transfer responsibility for geriatric care from the National Insurance Institute and other government authorities to the health funds was proposed by the Shoshana Netanyahu National Commission on Reforming the Health System (headed in the late 1980s by Justice Netanyahu, the aunt of the current prime minister) but never implemented.
Today, 70 percent of the population pay for geriatric nursing policies – most of them through their health funds and the rest through private insurance. But some private companies unilaterally cancel benefits that individuals paid for over many years, and they suddenly find themselves without coverage, said representatives of Ken Lazaken, a voluntary organization that held a demonstration Sunday night outside the Habimah Theater to demand passage of the bill and other benefits to pensioners.
Health Ministry director-general Dr.Ronni Gamzu said the geriatric nursing plan would be the third stage of major health reform after basic dental coverage for children (already implemented) and the transfer of responsibility for psychiatric treatment (now being discussed in the Knesset).
Asked by The Jerusalem Post how the reform could succeed without massive training of geriatricians, geriatric nurses and auxiliary staffers, Gamzu agreed that this was a prerequisite and noted that an important part of the settlement being worked on between the Israel Medical Association and the government was to provide financial incentives to doctors to work in specialties with too little manpower.
Dr. Tuvia Horev, a Health Ministry deputy director-general for economics, along with colleagues Nir Kedar and Idan Hershkovitz, developed the new plan. Horev bemoaned the fact that which bodies have responsibility for a geriatric patient depended on his state of health, whether he suffered from dementia, had a physical disability, needed rehabilitation equipment and other conditions.
The red tape has long created higher costs as well as frustration for the families.
Litzman said that the Treasury opposed higher health taxes and “it doesn’t like raising taxes,” and the National Insurance Institute also had complaints about the ministry’s plan, but that a way must be found out to resolve their differences. The Health Ministry’s suggested plan would add NIS 1.2 billion in funds to geriatric nursing services, he added. The poorest would have to pay only NIS 1 a month more in health taxes if they were raised by 0.5 percentage points to a maximum of NIS 36 monthly.
Horev said that Israelis must “realize that the country’s image of being a young country must change, and that it must recognize that the rate of people over 65 and 75 is rapidly rising to the levels of Japan, where life expectancy is the highest in the world.
“It is wrong to take money for the elderly from the wages of the young generation,” he said. The existing convoluted system was the butt of severe criticism by the state comptroller in his latest report.
“We are headed for a tsunami of elderly,” Horev said. “At present, 10% of the population is over 65; it will go to 12% in 2020 and 14% in 2030.”
If there isn’t enough money to take care of them, the whole system will collapse, he said.
If the public system doesn’t work, all the money will flow into a private system that will be prohibitively expensive, especially for the middle and lower economic groups, he said.
Horev said that geriatric nursing care in the home that is provided by state authorities is minimal – about an hour a day – and that this raises the risk of the elderly falling and breaking hips or taking medications improperly.
If people’s condition gets worse and then can’t be helped in the community, they will end up in general and geriatric hospitals, greatly increasing public costs.
The increased funding, he said, will provide the elderly with considerably more nursing care in the community and lower copayments to the patient. Today, many elderly are not entitled to any geriatric nursing care, even though they need and deserve it, he said.
The bill, if approved, would have to be implemented gradually within about three years to make sure that it works properly and without the elderly being taken advantage of by profiteers, he said. At the end of implementation, the National Insurance Institute and various ministries would hand over many of their powers regarding geriatric nursing to the health funds.
The association of nursing homes, in commenting on the new plan, called on Litzman to do everything he could so the process of reform does not fail. Those needing geriatric hospitalization must get authorizations from the health funds within a few days and in a way that will cover their hospitalization days retroactively.
Patients and their families must also have “freedom of choice” among the institutions without their choices being influenced by agreements made between the health fund and these institutions, the association said.
If the reform is not implemented properly, geriatric nursing care will be for “rich Israelis only,” the association said.