Editor’s Note: Irit and Avidor Rabinovich are the founders of Happy Seniors, a resource website for Israeli seniors and their families. The couple will be guests on the Seekers of Meaning Podcast September 13. This guest blog post, written by Irit, is reposted from the Happy Seniors blog.
Let me begin with MY personal story that would best illustrate the state of nursing homes in Israel, first hand…
Upon graduation from the University of Haifa in 2006, I begin my career working in nursing homes. Small ones at first, but eventually, I started working in a nursing home relatively large in the North of Israel.
I enjoyed working in a community; loved the individual and group work with the residents; and felt truly happy and fulfilled helping the elderly and their families.
What frustrated me working in nursing homes in Israel?
Most nursing homes in Israel are private. They fall under the rules and regulations of the Ministry of Labor, Social Affairs and Social Services; But they are also oriented toward maximizing profit.
Abuse, Mistreatment events, inability to work according to the ethics of the profession (we all had to work under the order of specific management – not always inclined towards social care and the benefit of the residents), there was no avoiding the drawbacks in this line of work.
However, I did not give up.
Where there was a need to report, I insisted on reporting. Even if it came up with criticism or even dismissal.
I stuck to my values as much as I could.
Shortage of personnel in the wards and sometimes the work of the staff themselves led to the occurrence of mishaps. There was also the intense reluctance of the caregiver teams to receive training and learn professionalism. Only because they had to stay for an extra hour at their own expense.
All of this gradually made me lose my desire to continue working in nursing homes.
This is my own experience. Of course, not all the institutions in the country are of the same condition.
Great nursing homes indeed exist in Israel. We mostly hear about the bad ones – because they reach the news…
In today’s article, I’m going to examine the current situation of nursing homes in Israel. With an emphasis on nursing homes for the elderly. I will also provide general information about what is happening in nursing homes in Israel. Both from literature and from personal experience.
I will try to remain as objective as possible.
The shortage of nursing staff in nursing homes in Israel –
A caregiver taking care of an old woman.
It is no secret that the shortage of manpower in nursing homes and in hospitals is high. As a result, the treatment provided to the elderly is sometimes deficient. In light of this, below is a quote from an article published in Globes magazine:
“In an administrative Petition by the Israel Association of Nursing Homes; It was argued that the reduction in the number of foreign workers in Israel, through the Population and Migration Authority, has caused a great shortage of caregivers for tens of thousands of elderly in need.
According to the petitioner, the construction industry did not suffer from the shortage of foreign workers; Because it was important for the state to solve the housing shortage in Israel.
But tens of thousands of caregivers and mentally frail elderly were abandoned by it.”
Attorneys, Baumbach, and Ronen continue to write; That the population in the world, and in Israel in particular, is rapidly growing. However, Nursing homes are not growing at anywhere near the same rate.
Moreover, the attention of decision-makers in Israel has not been drawn to this problem; And the emphasis has not been placed on finding a systemic solution for the treatment of the aging population.
The phenomenon of abuse in nursing homes-
A woman abusing an old man.
It has been found that among staff members, low-income and foreign caregivers are at highest risk of abusing the residence they take care of; Due to the demanding nature of their work and the stress they are experiencing (Shanan-Altman and Cohen, 2009).
Those caregivers are required to exercise basic human skills. Their work involves physical and mental care for the elderly; Assistance in fulfilling their mental and social needs and maintaining their quality of life.
Studies performed in the United States and Israel found out that being a therapist in nursing homes has been characterized by:
- poor employment conditions
- lack of opportunities for advancement
- low job security.
What makes therapists frustrated and how to overcome it?
Lack of Personnel In Nursing Homes and the Implications on Senior Treatment
The above factors are causes for people engaged in this profession to experience a lot of frustration and bitterness. They come to work reluctantly and have nothing to make them feel more enthusiastic and eager about their work.
Institutions, who understand this phenomenon organize for these therapists “fun days”, and give them bonuses for good work.
Also, it doesn’t hurt to pay them a healthy salary which is above the minimum wage.
Finally, organizations that provide paid training courses to these caregivers motivate them to participate and actually learn.
Research evidence of the phenomenon of abuse in nursing homes in Israel –
Further evidence that shows the phenomenon of abuse in nursing homes was presented by Dr. Tova Band Winterstein of the gerontology Sciences Department at Haifa University:
“In research, I conducted for the past 16 years, I have witnessed the great risk to the elderly population from abusive behavior and neglect. Those seniors are completely reliant upon the caregivers and stuff. They live in a micro-cosmos of the nursing home with its rules and regulations”
Dr. Tova Band Winterstein
She states that the elderly are a population that depends on staff members and is subjected to the routine life in an institution.
This dependency, combined with the stereotypical attitude that sees the old man as a burden; As someone transparent and irrelevant; In certain situations allows the existence of abuse and neglect. “
Dr. Winterstein adds that many times the demanding organizational atmosphere and climate in a nursing home causes a great erosion of the staff; And inflicts on them a tremendous deal of stress.
Existence of abuse and neglect
Which authorities are saddling this problem and how?
Another issue related to the phenomenon of abuse in nursing homes comes not only from homes and caregivers but also by the police and the supervisory authorities.
Police encourage family members to file complaints on the alleged abuse. However, in many cases, it is difficult to convict the people responsible due to a lack of evidence. In addition, the physical and mental condition of the elderly doesn’t allow them to testify.
And, in many cases, the seniors are also afraid of retribution, due to their complete dependence on their caregivers. This is also the reason why residents are afraid to report on abuse to social services in the nursing home.
Even upon reporting to the welfare authorities, cases are not always handled properly; Due to the heavy burden on CPOs and social workers who work in the social welfare sector.
According to data from the Ministry of Social Affairs, each social worker who works for the welfare authority is responsible for hundreds of cases. And one of the most common mechanisms of dealing with abuse is through a welfare officer serving the elderly.
Unfortunately, due to this burden, the treatment which the welfare authorities provide is inefficient. And there are inadequate follow-ups of cases of abuse reported to the welfare officer.
Simply put – those cases are, in many time, “forgotten”…
It should be noted that there is a procedure to be followed by nursing homes to prevent abuse and report cases.
A dedicated internal committee on abuse is obliged to conduct a meeting once every three months. Its mandate is to prevent and report cases of abuse.
The committee is composed of the multi-disciplinary staff from the institution. Participants of the committee are social workers, doctors, and nurses, as well as other skilled workers; It depends on the reported case.
What is the process of hiring caregivers for nursing home?
Caregivers in a Nursing home
There is a problematic phenomenon in the process of hiring caregivers for nursing homes.
Following an extream shortage in manpower, there is no organized screening process. In many times, people who wish to work as caregivers at nursing homes in Israel, do so because they have no other choice.
Consequently, almost anyone who wants to be accepted to work as a caregiver is accepted; Without a thorough examination on his or her personality, experience and in extream cases criminal record.
Moreover, many caregivers who were negligent in a particular institution and were fired, go to work for another institution. They are hired there because of caregivers shortage.
It should also be noted that when the nursing institution is large – with several departments – and the caregiver is suspected haphazard in any sort of way, they will not be fired immediately.
Initially, they will be transferred to another department in the same nursing home. This is in order to keep them in the nursing home. Once again due to the same problem.
Simply put – not enough caregivers and therapists with real experience want to work in a nursing home.
Supervision by the ministries of health or ministry of Social Affairs on nursing homes in Israel –
What are the responsibilities of both ministries?
The ministries of health and welfare fulfill the role of governance by legislating laws, and officiating procedures, to the institutions which are under their control.
They are also responsible for supervising that those laws and regulations are followed. That the nursing homes provide the required service to their elderly clients.
There are private nursing homes, which are not regulated by these offices and are paid (and regulated) privately. However, most nursing homes are under the supervision of the office; And most seniors that use their services receive funding from the government ministries.
The Ministry of Health supervises institutions for handicapped and mentally frail people. The Ministry of Welfare supervises institutions for independent and frail seniors. If you are interested in learning about the various functional states and the financing process; Read about the Functional conditions in the third age.
Obligation to report –
When there is any suspicion of negligence or abuse in a nursing home in Israel; It is mandatory to report the case to the Ministry of Health or Welfare by the nursing home stuff.
The ministry representatives need to contact the social worker in charge, and the abuse committee at the nursing home, and monitor how the case is being handled.
Unfortunately, this process is not always done by the letter. But, the Ministry of Health does check if the case is handled; And the members of the abuse committee monitor the cases that are reported to the ministry.
Criticism of the Ministry of Health –
Review of the Association of nursing homes A.b.a on the conduct of the Ministry of Health:
“The Ministry of Health is paying for most long-term care beds”-
Says Roney Ozeri, Chairman A.b.a (Association of nursing homes and assisted living in Israel). A.b. a represents more than 200 nursing homes and non-profit private sheltered housing with 25,000 residents.
“But, in fact, the ministry of health pays only 30% of the actual expenses of the nursing homes. They wish to save money at the expense of nursing homes for the frail.”
Due to this situation, bad nursing homes manage to survive and exist.
Also – You have to understand that this is not due to a lack of manpower quotas. The numbers are correct, but there is no manpower to fill the vacant positions. I expect the Ministry of Health to do two immediate things:
For starters; Approve another 2,000 of the 5,000 foreign workers required for the caregiving sector. and then set up a committee headed by a lead economist who will determine the rate of hospitalization. This way, the criminals will know that they have something to lose. ”
Data from the Taub Center for Social Policy Studies in Israel – on nursing care – indicate that the extended geriatric hospitalization system has about 21,000 beds in 333 geriatric institutions.
About 70% of the beds are staffed by patients who are legally funded by the Ministry of Health. The rest of the beds are privately sponsored by the patients and their families.
About two-thirds of the homes are privately owned; The rest are in public ownership. But all operate under the professional guidelines of the Ministry of Health and serve as the operating arm of the ministry.
Israeli government obligations
This means that the state of Israel is obligated to provide the elderly with the BEST possible treatment and care at the dawn of their lives.
The state determines the mandatory therapeutic guidelines through the Department of Geriatrics in the Ministry of Health; And supervises their implementation.
Therefore it is the one that bears most responsibility and thus the continuing failure of treatment.
To summarize the state of nursing homes in Israel–
According to the Population and Immigration Authority; In many developed countries, there is a very high shortage of local manpower in the caregiving sector.
This is mainly due to the rapid pace of aging of the population and changes in family structure. A situation which has led to a significant reduction in “formal;” and experienced labor force, and rise of “informal” and inadequate labor.
According to an analysis of demographic, economic and social trends, this shortage will worsen in the coming decades.
This problem is not going to “go away”.
What must be done in the meanwhile?
- The state needs to intervene to solve the shortage of professional caregivers by increasing the quotas of foreign workers.
- change in the manner of payment of wages to social workers in order to avoid a conflict of interest.
- Increase the minimum wage for caregivers and regulate the industry in regards to the rules of hiring and maintaining caregivers.
- Increase the quota of civil servants in the sector of aging. There should be more CPOs because they have a crucial role in identifying and treating cases of abuse.
- The police should handle more serious abuse cases reported to them; And not close almost every case due to a lack of evidence.
- Usage of technology should be encouraged more – state-of-the-art EMR systems, monitoring equipment, robotic companions, etc.
Social workers, working in retirement homes, are the enforcers of ethical and governmental rules and regulations.
Hence they should receive their salaries from the Ministry of Health and not from social home. In this way, they will be less inclined to speak out due to fear of being fired.
This crucial change, however, is still but a dream…
Rabbi Richard F. Address, D.Min, is the Founder and Director of www.jewishsacredaging.com. Rabbi Address served for over three decades on staff of the Union for Reform Judaism; first as a Regional Director and then, beginning in 1997, as Founder and Director of the URJ’s Department of Jewish Family Concerns and served as a specialist and consultant for the North American Reform Movement in the areas of family related programming. Rabbi Address was ordained from Hebrew Union College-Jewish Institute of Religion in 1972 and began his rabbinic career in Los Angeles congregations. He also served as a part time rabbi for Beth Hillel in Carmel, NJ while regional director and, after his URJ tenure, served as senior rabbi of Congregation M’kor Shalom in Cherry Hill, NJ from 2011-2014.