1. 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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2. 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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3. 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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4. Population Aging
The new millennium of the 21st century confronts us with
numerous challenges regarding the aging societies of the
modern world.
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5. 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 Aging
IAGG 5
collaborating Center
6. Composition of Aged Cohorts
Young – old: 65-74
Old-old: 75-84
Oldest –old: 85+
Centenarians: 100
7. 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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8. Vienna Int’l Plan of Action on Ageing (1982)
Vienna Conference logo
‘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.’
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9. 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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10. 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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11. 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%
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13. 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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14. 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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15. 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.
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16. 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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17. 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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18. Policy and the Service System in
Israel
Four major sectors are involved in service provision:
Government agencies
Trade unions
Voluntary organizations
The private sector
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19. 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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20. 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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21. 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 were
created, with representation of local service providers and
elders
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23. What Should be the Appropriate
? Balance
Formal Service Care
Informal Family Care
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24. 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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25. 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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26. 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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27. 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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28. 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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