Ziva, an 84-year-old widow from Kfar Azar, spends her days at home or in the garden, listening to news on the radio.
Daily activities at the nearby senior citizen center ended weeks ago, although a staff member does call sometimes to see whether she requires any assistance. Friday night dinners with family have been replaced by phone calls from her grandchildren.
While the wider Israeli public is still coming to terms with strict restrictions on movement, the outbreak of the novel coronavirus forced Israel’s elderly population - the most vulnerable - to move indoors weeks ago.
For many, social distancing from their immediate family could be a matter of life and death. With no end in sight, the distance can also mean increased feelings of loneliness and isolation.
Two residents from Jerusalem’s Nofim Tower assisted-living facility are named among Israel’s five COVID-19 deaths to date, infected by a social worker who later tested positive for the virus. Their deaths issued a stark warning about the dangers posed to the elderly by the current outbreak.
Yossi Heymann, the executive director of JDC-Eshel, explains that the 2.5% of Israel’s senior citizens living in nursing homes or assisted living are most at-risk, often suffering from preexisting health conditions and becoming increasingly dependent on caregivers.
"As we have seen, if one staff member at an institution is infected and does not use protective equipment, it can be a disaster," Heymann, a former director-general of the Jerusalem Municipality, told The Jerusalem Post.
"Treatment is difficult in institutions, where family members are not permitted to visit and loneliness is a major problem. There is a conflict between isolation and loneliness. We need to isolate the elderly, but not let them be lonely. Loneliness also leads to deterioration."
For those opting to live at home, but relying on caregivers for help, including cooking and cleaning, reduced public transportation can severely disrupt their access to assistance.
"If younger individuals sit at home for a month, or hardly leave home, our level of fitness might go down, but all will be okay," said Heymann. "For an elderly person who hardly moves and sits in their chair, their physical deterioration will be severe."
It is "almost a death sentence," Heymann said, for individuals who have suffered a stroke or broken their hip, and are unable to receive vital physiotherapy.
Funded by the American Jewish Joint Distribution Committee, the Israeli government and donors in Israel and abroad, JDC-Eshel has been working to assist Israel’s older population for over 50 years.
Today, the organization is working to provide its knowledge and services remotely, including the launch of a dedicated website providing assistance to senior citizens, professional caregivers and family members to cope with the impact of the outbreak. A series of short, informative videos have also been produced in multiple languages, including Hebrew, English, Russian, Arabic and Amharic.
Roni Ozeri, chairman of the Association of Nursing Homes and Assisted Living in Israel, paid tribute to the "great dedication" of the 20,000 caregivers currently looking after residents with varying levels of physical and mental health.
While family members are unable to visit and group activities are canceled, staff try to maintain communication between residents and their loved ones, including facilitating video calls and even meetings through a glass barrier. Musicians are invited to play in the corridors, while residents stand in their doorway.
Despite their efforts, Ozeri emphasizes that the country’s 300 nursing homes and other facilities require far greater assistance from the government, which he says is "not aware of the needs" of the most vulnerable.
"We are greatly lacking protective equipment, including masks, gloves and disinfectants," said Ozeri, accusing the government of shutting its eyes to their needs. "The only thing that the government has provided is a small quantity of equipment that houses can use after an outbreak."
He also urged the government to reconsider its decision to dramatically reduce public transportation without first providing solutions for critical nursing staff.
"When we need help from the government, we run into a brick wall. The conclusion is that the government must create a plan, ahead of time, to assist those giving support to the most vulnerable population," Ozeri said.
As the number of unemployed individuals continues to soar, the association has been working closely with the Israeli Employment Service to recruit employees to fill some of the 6,000 open positions in nursing homes.
Despite the reluctance of many to work in the challenging nursing home environment, Ozeri said many jobseekers can be integrated into the workforce immediately, with zero to minimal training required for many positions.
IN ADDITION to physical well-being, loneliness and uncertainty regarding the length of lockdown measures are also likely to have a major impact on mental health, especially for those with psychological disorders.
Hilla Hadas, the executive director of Enosh – The Israeli Mental Health Association, explains that long-term mental health disorders are associated with greater exposure to physical illness, including metabolic disorders and heart disease.
"Aging occurs earlier among those with psychiatric problems," said Hadas. "If those over 70 are generally considered to be the at-risk group, those from 50 to 55 years old with psychiatric problems are already at risk."
While those already in contact with the association and other support networks know whom to turn to for assistance, Hadas says those who are not in contact with professionals are at greater risk of deterioration.
"There is the loneliness, the reality of the situation, their health is problematic, and they do not leave home to receive assistance," Hadas said.
"We know that families of individuals with psychiatric illnesses are increasingly likely to visit the public healthcare system due to stress or heart problems. In some cases, elderly parents may essentially be caregivers for an adult child with a psychiatric illness. This puts an additional mental burden on individuals who are already at risk."
Enosh’s team of professionals - including psychologists and social workers - are currently offering support to families via a dedicated phone line, established to assist them during the current crisis.
The call center, Hadas emphasizes, is not a 24/7 emergency hotline but a source of ongoing assistance staffed solely by trained experts.
DESPITE THE uncertainty of the current crisis, times of hardship often bring out the best in people, and the current outbreak has proved no different. Israel is awash with initiatives helping the most vulnerable.
In addition to the well-known but often overstretched organizations that often serve as the first port of call, grassroots initiatives have also emerged to assist the elderly.
Among them is Tozeret Ha’aretz, an organization established in 2012 to create student communities and develop Israel’s socio-geographic periphery. Some 1,000 students currently live in 13 towns nationwide, from Netivot near the Gaza border to Kiryat Shmona on the Lebanese border.
Determined to assist the most vulnerable, students and alumni are busy making phone calls to their elderly neighbors and bringing groceries to their doorstep. Together with the Association for the Elderly in Nof Hagalil, the students also deliver hot meals that would otherwise have been served in senior citizen centers.
Another initiative established by the organization - known as "Homemade" - encourages residents to turn their buildings into small communities, offering neighbors assistance when needed and providing accessible information.
"The new reality that is changing every day is causing confusion, anxiety and despair for many people," said Tozeret Ha’aretz CEO Lior Zorno Hefetz. "It is precisely at this time that we see that every individual has a responsibility to strengthen societal resilience, to become involved, and to care for one another."