Home free?

A privatization plan raises the question of whether Jerusalem intends to improve services for the elderly, or is just profiting at their expense.

elderly senior 88.224 (photo credit: )
elderly senior 88.224
(photo credit: )
Jerusalem is a young city. About 65,568 residents of this city are older than 65, totalling nearly 10 percent of the population. And so, according to statistics, such as those provided by the Central Bureau of Statistics and the Jerusalem Institute of Israel Studies, the ancient city of Jerusalem has a very young population. The average life expectancy in Israel today is 77.3 years for men and 81.2 for women, so a majority of the elderly are women. Their senior years in Jerusalem can be the best of their lives, the worst of their lives, or anything in between. In fact, not all of Jerusalem's elderly fare well in their golden years. Perhaps the most telling statistic regarding the situation of the elderly in the capital is this: 23,000 of the elderly citizens of Jerusalem are serviced by or at least known to the municipal welfare department. This means that at least 23,000 elderly people in this city are poor, sick, lonely or all of these combined. Some 12,000 elderly in Jerusalem subsist solely on their National Insurance Institute allocation, approximately NIS 1,500 a month. Some 21% of Jerusalem's elderly are "poor" and unable to meet their own needs, caught between the cuts in the National Insurance allocations and the increasing costs of medical care. Says Aviva Goldberg, head of the municipality's department for the elderly, "This is the ridiculous sum that these people, the weakest in our society, receive from the state in order to pay for their rent, their food and their medication. "No wonder we have these terrible reports about old people looking for food in the garbage or having to chose between food or medications, or heating and having to decide if they buy food and medications, or trying to choose between heating and glasses or caring for their teeth." According to a 2003 report compiled by the JDC Brookdale Institute of Gerontology and Human Development, some 26% of Israelis, many of the elderly, are forced to choose between vital expenditures such as heating, electric bills, and medication. As a consequence, the majority (64%) forgo the purchase of food. The city does provide information services regarding seniors' rights and services, private as well as municipal, including a Web site, brochure and toll-free number with social workers available to answer questions in Hebrew, Russian, English and Arabic. Day services include senior clubs, where the independent elderly can spend a few hours engaged in social activities and conversation, and day-care centers for the physically and mentally frail. And elderly people in the city do have some choices regarding where they will spend their last years. Most would prefer to stay at home, if they could, and those who cannot manage totally on their own but are still independent might be able to manage with the help of a community-based supportive program. Some may choose to live in a sheltered private or semi-private living situation, such as the Nofim Towers in Kiryat Hayovel. But these facilities are costly. Most will have to move into one of the public homes for the elder. The municipality of Jerusalem maintains a system of these public homes, outsourced to Idan, a non-profit organization established nearly 30 years ago by the Joint Distribution Committee. Among its other projects, Idan is responsible for the administration and operation of three homes, one respite facility ("nofshon") where elderly can reside temporarily, a day-center and the supportive community project throughout the city. Spontaneous visits by In Jerusalem to the homes maintained by Idan reveal that they are quiet and well-organized, nicely apportioned, clean, and spacious. The rooms are shared by two elderly, with an ensuite bathroom. Overall, staff ratios are one caretaker for three residents. Elderly who come to the homes for the day may enjoy a variety of games and activities as well as two full meals. For some, these are the only meals they will eat for the entire day. They may also lie down quietly on a bed if they feel tired. Goldberg says that the real concern is the people who live alone. "If no one prepares them in the morning and gets them ready on time for the transportation, or if they live on high floors without elevators, they won't come to the day centers. They will just die slowly in solitude." Yet, despite the quality of the care provided by Idan, just over one year ago the municipality notified the non-profit association that the management of this complex of services would be privatized within the year. Tenders will be issued and any formal group, whether public and non-profit or private and for-profit, will be able to compete for the contract. The move toward privatization, and the anticipated terms of the tenders themselves, are extremely controversial. The national Tenders Law stipulates that outsourcing of any facility owned by a local authority must be submitted for public tender, in order to assure transparency and equal opportunity. The public old-age homes managed by Idan were built on property provided free-of-charge by the Israel Lands Authority in the 1970s. The facilities themselves were constructed through donations raised by Idan with the aid of the Jerusalem Foundation and other organizations. When completed, the buildings were transferred to the municipality, and, since then, have been managed by Idan. In response to IJ's queries, the municipality's responses to the issue relate almost solely to the legal aspects of the decision. According to the municipality's legal advisers, the tenders are in accordance with the National Tenders legislation and in keeping with the prevalent trend of privatizing social services in Israel, which contends that private companies will provide these services in a more cost-efficient manner. Critics say otherwise. Many are critical of the cancellation of the contract with Idan, an organization which has provided high-quality services for three decades and developed significant expertise in the provision of services to the elderly in Jerusalem. Says a high-ranking employee of the Social Affairs Ministry (which is not involved in the decision), "Privatization could be dangerous. It is not merely a question of whether Idan will actually win the contract or not. "But imagine," the employee continues, "that a private company wins the contract. What kind of a message is this to the public? It tells the public that a non-profit organization that has created a high level of social services can simply be replaced, under cover of the law, by businessmen attracted by the potential to earn money. Do we want to give the message that a non-profit organization and a financial company make the same contribution to society?" Nahum Ido, Spokesman for the Social Affairs Ministry and a social worker by training, declined to comment on the specifics of the case although he is, he says, familiar with the issue. He was, however, willing to comment in general. Ido notes that when the Social Affairs Ministry publishes tenders for contracts, it provides the non-profit organizations with a relative advantage to win the contract and an added opportunity to prove that the service they will provide if they win the contract will be better than the service profit by a for-profit company. "For example," he explains, "the Ministry includes a clause in which they ask all candidates to detail what services they will add over and above the minimum levels set by the Ministry." Equating a for-profit company with a non-profit is "outrageous" says Ayala Lavie, Director of Idan. "There's no doubt that from the very moment our homes will fall into private hands the only law that will prevail will be profit - profit at any price, including the price of giving less attention, less care, even less food and less hygienic care, in order to assure more profit." She adds, "These homes will become warehouses where old people, too weak to defend themselves, will be sent to an undignified death." Sources at the municipality confirm that the municipality has been "more than satisfied" with the quality of services and administration provided by Idan and that the decision to privatize the management of the old-age homes is motivated by a desire to save money. The terms of the tenders, which have yet to be made public, will put Idan - and any other non-profit organization - at a distinct disadvantage, but bode well for the municipal treasury. Lavie reveals that representatives of Idan met with the general manager of the municipality more than a year ago. "He listened to us and assured us that the issue will be handled very delicately and that the needs of the elderly will be kept in mind," she says. But it is now apparent that the municipality will require the winner of the tender to place a sum of not less than NIS two million into the municipal coffers "as a deposit." And the municipality, Lavie accuses, has gone even further in its attempt to generate income: The winner of the tender will have to hand over one percent of the budget transferred by the Health and Social Affairs Ministries to the municipality. The Health and Social Affairs ministries allocate NIS 6,500 a month for an infirm elderly person and NIS 9,500 for an elderly person who requires nursing care. The National Insurance Institute pays for the hours an elderly person spends in a day center, including the cost of social activities, two meals, some exercise and transportation; this sum can be exchanged for up to 15.5 hours a week for a personal aide for those people who do not wish to go to the center. Demands Lavie, "I'm asking you, who gave the municipality of Jerusalem the right to put its hands on that money!?" Idan cares for nearly 400 elderly, not including the respite center. Thus, the one percent levy could "easily turn into a huge profit for the municipality." As Lavie makes clear, if the winner of the tender is required to deposit a sizable sum with the municipality and hand over a percentage of their income, then there is only one source left for them to make a profit - the services provided to the elderly themselves. "Does anyone really believe that a private company will give these old people what we give them?" she challenges. "Lavie is right," says a source in the department who spoke on condition of anonymity. He explains, "The final decision has not been reached, but the idea of levying one percent has definitely been raised." Vice-Mayor Rabbi Shlomi Attias is in charge of the municipal welfare department, but says that he is not "interfering in the issue." "I have total confidence in the professionals in the department, and I don't want to know more," he says. "I know that everyone is satisfied with Idan's performance but I do not have a personal opinion on the issue." Regarding the one percent levy, Attias only says, "If it turns out that it is not legal, then the municipality' s legal advisers will have to do their job in order to obey the law." He then adds, "Everyone should know that it's the same for everyone, and that's the price 'they' have to pay" - an oblique hint that those who demanded transparency over properties and facilities outsourced to the haredim should not be surprised when they, too, are bound by the same demands. Ruth Ralbag, city councilwoman from "Jerusalem Will Succeed" and a high-ranking official in the Health Ministry, say she is considering raising the one percent levy at the next city council meeting. "I do not know if it's legal and I am going to find out," she says. The municipality's decision should be viewed in the context of the general trend toward increasing privatization of social services in Israel. Professor Yochanan Shtesman, former head of the National Insurance Institute, says he is not concerned by the decision to privatize the old-age homes. "The best way to avoid corruption is not to let people think that they have something for granted for life. Once in a while, you have to open things to the public and look for someone who might do an even better job." Regarding the percentage that the municipality would like to levy, Shtesman says that the decision is "normal, since the facilities belong to the municipality, meaning to the public. The fact it hasn't happened until now doesn't say anything about the right to do it now." But Yoav Lif, spokesman for the Association of Civil Rights in Israel (ACRI), has another view. Several months ago, ACRI unsuccessful petitioned the High Court of Justice regarding the right to a minimum standard of living. "This decision is one more step in the general tendency of privatization, led by the last governments of Israel. [But] now we are talking about privatizing social services, even the most important, those which the state is obligated to provide, such as education, health, welfare and employment. Shtesman continues, "This is a dangerous path, which deprives the most needy of the citizens of their most basic rights, and transforms them from the bearers of rights into mere clients." Tami Molad-Hayo, a member of the Labor Party and long-time social activist, acknowledges that "not every case of privatization is bad. But there must be some core, basic services that the State is supposed to provide to its citizens. These must be guaranteed." And the privatization of services to the elderly, Molad-Hayo concludes, is particularly easy. "The elderly do not have the political strength or power to oppose these decisions. That is exactly why we should never cut their rights." The terms of the public tender should be made public within two weeks. The municipal toll-free number for information on services for the elderly: 1-700-700-120.