Optimism allows us to manage our daily routine without worries, such as what will happen if we suddenly reach a situation of loss of ability and cannot manage our affairs? What will happen in the event that God forbid we get hurt and die? At the same time, at a certain age you have to think about the future, and about events that optimism “saves” us from having to deal with. A situation where, God forbid, we will reach a loss of capacity – due to a medical condition, including a condition of death.
In this article I will review the legal tools that make it possible to control, or give control to a person you believe in and trust, usually a family member – to take care of your financial, personal and health matters. These tools make it possible to give that person instructions, and also provide control and review mechanisms, additional family members or the state through its attorney’s office. The tools I mean have names that don’t really explain what they give, who they are suitable for and in what situations.
What is the basis for the legal tools in case of loss of capacity and death, why should you rely on them?
Well, at the base of these tools there are two “ideas”[1] – money and the state. These ideas reside in our collective memory as a nation or residents – we all believe that the state and money will continue to exist even after our death. That is, our money will continue to exist and may be taken by those who we do not want to receive our money, and the state whose job it is to provide us with protection should prevent this.
The state does this in a certain sense, through the law – but the law cannot provide an answer for every person and every family. Therefore, the law provides a person with tools that allow him to determine and give instructions according to his preference and desire. If the person uses these tools – the state (which will continue to exist after him) will take care to protect his will.
How will she do it? In the Ministry of Justice, there is a general guardian division where attorneys (lawyers) work, civil servants, which is their job and strict ethics rules apply to them. From my personal acquaintance with some of them – they do their work with a great sense of mission.
Of course, their intervention is not always necessary – but the possibility of intervention always exists, and it is good that it is so. The need for one of the tools that I will write about arises from controlling one of the events according to the flow chart (starting from left to right):
Now that we understand the basis of the legal tools for loss of capacity and death – let’s begin.
First tool for loss of competence – lasting power of attorney –
This is a relatively new legal tool that allows a competent person to appoint someone they trust and believe in, to take care of their affairs in the event of loss of capacity. The first person is called Hammana, and the second person is called “Myopa HaKah”. The power of attorney must agree to act as a power of attorney, and he actually takes on a great responsibility to act honestly and faithfully in all his actions as a power of attorney.
Lasting power of attorney is given in 3 areas – financial matters, personal matters and health matters.
After the Lasting Power of Attorney is signed, it is submitted to the offices of the General Guardian and effectively sits there in a “dormant” state. That is to say, the person entrusted with the power cannot make any use of it. What “triggers” the lasting power of attorney is an event, which is written in the lasting power of attorney. This event is the situation in which it will be decided that the appointee can no longer handle his affairs. The default is that a medical opinion states that a person can no longer take care of their affairs, but this is a default that is not suitable for everyone.
for example-
Many times the medical staff hesitates to make a decision – sometimes because the diagnosis is not clear-cut, sometimes due to a different interpretation of the situation resulting from a lack of familiarity with the prescriber, and sometimes due to over-defensiveness and fear of a lawsuit. In my humble opinion, the appointee’s acquaintances and those he trusts are the appropriate people to determine whether the appointee is “qualified” to handle his affairs or not. Therefore I suggest that the “event” that will “trigger” the “dormant” continuing power of attorney will be the impression of the people who know it. of the authorized person, and of one other family member or close acquaintance. These will give an affidavit to a lawyer (a short and cheap process) that the appointee is no longer “competent” to handle his affairs and the affidavits will be submitted to the general guardian who “executes” the power of attorney. Enduring power of attorney?
Enduring power of attorney – to which entities can it be presented?
After “activating” the power of attorney, it can be presented to entities such as banks, commercial entities, medical staff, etc. – and act “in the shoes of the appointer”. On the face of it, it can be said that this gives too much power to the power of attorney or to the additional person who could in an extreme case” to “execute” the continuing power of attorney while the appointee is fully qualified, and perhaps without his knowledge. This risk is mitigated due to several things:
(1) Signing an affidavit is done after a person is warned to tell the truth, otherwise he is subject to the penalties provided by law. This refers to the punishment for giving false testimony – up to 7 years in prison.
(2) The power of attorney must sign a confidentiality waiver as part of which, during the examination of the power of attorney, the attorneys of the general guardian receive information about the power of attorney, with an emphasis on whether he has any criminal convictions. This is to make sure that there is no risk in the actual appointment.
(3) A continuing power of attorney does not give full power as will be detailed in the next paragraph.
What cannot be done using the tool for loss of capacity – lasting power of attorney?
It is not possible to sell the appointee’s apartment through a continuous power of attorney (it is necessary to contact the court). It is not possible to give gifts or donations, unless the appointor gives instructions within the continuing power of attorney that allow this, and that too up to a limited amount. In medical matters – it is not possible to make decisions in matters of not prolonging life, matters that can be settled using the penultimate tool in the article.
Of course, the authorized person is responsible and must act faithfully in his position – he must not do actions in conflict of interest (transfer money to himself, transfer to acquaintances, enter into transactions whose purpose is to benefit himself or his acquaintances, etc.). In addition, it is possible to monitor the power of attorney through “informed persons” – people, family members for example, who as soon as the power of attorney is activated will have an obligation to inform them. In addition, it can be determined that family members, for example, will be entitled to demand and receive an account of the activity. Another supervisory factor that can be determined (authority) is the state through a lawyer
A second tool for the loss of competence – preliminary instructions document –
As can be understood so far – a lasting power of attorney is a very “powerful” tool, which gives a great deal of control to the power of attorney.
Therefore, another tool was created that offers a less “strong” alternative to the continuous beautification of power. This tool is called an advance directives document. This document makes it possible to give the same instructions and powers that a lasting power of attorney gives, with one difference – the “activation” of the document is done through a court decision that states that the person is in a state of loss of capacity and needs a guardian.
In such a case, the court considers the instructions written in the instructions document – the identity of the guardian and the instructions given to him. This tool is especially suitable for unruly people, who on the one hand want control over what will happen once they are incapacitated, and on the other hand are not willing to give up control over their affairs out of a real fear that self-interested parties will try to take advantage of them. The document of the preliminary instructions is examined by the court, which is obliged to take into account the aforementioned, but is also authorized to deviate from the words if necessary, according to the circumstances.
A third tool for loss of capacity – a medical power of attorney according to the Patient’s Rights Law and the Dying Patient Law, or a document of instructions –
This is a power of attorney given in order for the power of attorney to make decisions on behalf of the appointee in medical matters when the appointee reaches a state of loss of capacity. Through an additional, special power of attorney, it is possible to establish that the same person will be able to make decisions also in matters related to not prolonging life.
Here too, instead of a power of attorney, there is an alternative in the form of a document of instructions, in which the person expresses his desire for which treatments will or will not be performed on him – and the medical team will act according to these instructions.
A legal tool in case of death – I will –
Contrary to all the tools presented before – a will is a tool that makes it possible to settle matters, mainly property, after death. Those who do not make a will are in fact allowed to have their affairs run according to the law of inheritance, which sets a default for a recognized division of property in which the property is divided half to the remaining spouse, and the half year is divided equally between the children. This arrangement suits some, and is very unsuitable for others.
But even if the “default” of the law sounds appropriate in terms of the relationship (for example, parents who are in a normal relationship with their three children). There are cases where it might be worth deviating from that “default”. For example – if one of the three children owes a lot of money, and enforcement or bankruptcy proceedings are underway against him.
What happens in case of death?
In the event of death, that child becomes the heir, and the inheritance money becomes an asset that creditors can discover, seize and take. If this is known in advance – the parent can draw up a will and within it establish various mechanisms in order to prevent such a situation. It is important to emphasize that this is the parent’s money, and he has the full right to do what he wants with it. Therefore, the same parent may determine that the child will not inherit anything, and that 1/3 of the excess will be divided among the others so that they will take care of the brother who will not inherit anything. This is of course a mechanism based on trust between the parents and the other two children – from a family point of view this can be a very strong mechanism, but from a legal point of view it is a weak mechanism because each of the children can decide to keep the part for themselves, and not give anything to the sibling who did not inherit anything. What will happen in a case similar to the one I described – only that this time the child with the debts is also the only child?
Mechanisms that can be activated within the framework of a will-
There are several mechanisms that can be activated within a will – one of them is called a private endowment, a mechanism similar to a trust. The idea is to create a body called the endowment, which can be defined as a type of private association that has regulations that state that the endowment should take care of the child. This endowment will be managed by people whom the testator trusts and those people by the state inspector.
Other cases in which it is important to draw up a will is if the children are incompetent and cannot manage their affairs.
If by default they inherit and do not have a suitable guardian, the state steps into their shoes and manages the money they inherit. about the costs and difficulties this may create.
In conclusion-
Despite the mental difficulty of thinking about complex situations – it is important to prepare in advance for a situation of loss of service or death, God forbid, in order to take care of ourselves and those who depend on us.
For consultation you can contact the contact details or mobile – 0546309657.
From November 2018, the new reform in nursing, shared with the Ministry of Health, the National Insurance and the Ministry of Welfare, was launched. This article comes to explain the new situation in accordance with the reform and to give tools for choosing between the various options. And:
Chapter I- Basic definitions:
When we come to examine what are the main changes in the new reform in nursing, we must define a number of main issues on which it is based.
1. Nursing allowance-
An allowance provided by the National Insurance Institute. Until October 2018, it was possible to receive the benefit in one of the following 2 ways:
A. Employers of Israeli workers – through a nursing company or directly to the bank account (this if the recipient of the benefit has the opportunity to prove that he receives the service of an Israeli nanny for 6 days a week and 12 hours a day).
B. Employers of foreign workers – through a nursing company (see my previous article), or with a direct benefit to the beneficiary’s bank account.
2. A.D.L. test
This is the functional test performed by the National Insurance through nurses coming to the home of the benefit recipient. The test consists of 6 main tests:
A. Getting up and lying down.
B. Mobility.
C. Bathing
D. Dressed.
3. Eligibility levels – 6 established levels:
A. Level 1 – between 5.2 and 3 points
B. Level 2 – between 5.3 and 5.4 points
C. Level 3 – between 5 and 6 points
D. Level 4 – between 5.6 and 5.7 points
E. Level 5 – between 5.7 and 9 points
F. Level 6 – from 5.9 points and above.
Chapter II – The main changes in the reform:
There are 2 main changes in the nursing reform
1. Change in nursing hours according to each level:
Until October 2018, there were 3 levels in receiving the nursing allowance.
Level A- It provided its recipients with 9.75 hours of nursing per week.
Level B- Granted its recipients 19 nursing hours per week when employing an Israeli caregiver and 16 nursing hours for employers of foreign workers.
Level C-Granted its recipients 22 nursing hours per week when employing an Israeli caregiver and 19 nursing hours for employers of foreign workers.
As of November, there are 6 levels for the benefit as written above. (In the rest of the article, the levels will be detailed according to the services that can be received in each of them).
2. Payment amounts when receiving the benefit or a portion of it directly, the amount of money paid to those entitled to the nursing benefit at each level has increased significantly.
Additional nursing services:
Laundry (0.25 hours per week for 5 kg),
club (2 weekly sessions per day),
Emergency button (0.25 hours per week)
Absorption products
Level B:
hours or a caregiver from a nursing company for 10 hours or a caregiver through a nursing company for 6 hours in combination with a financial allowance of NIS 820 per month.
Level C:
A caregiver through a nursing company for 15 hours or a caregiver from a nursing company for 11 hours in combination with a financial allowance of NIS 820 per month.
Exceptionally and according to the decision of a social worker referred by the National Insurance Institute, it will be possible to get a caregiver from a nursing company for 10 hours in combination with a financial benefit of 1025 NIS per month.
Additional nursing services:
club (2 weekly hours per day),
emergency button (0.25 hours per week),
Laundry (0.25 hours per week for 5 kg),
Absorption products
Level D:
Caregiver through a nursing company for 19 hours. or a nanny from a nursing company for 15 hours combined with a financial benefit of 820 NIS per month, exceptionally and based on the decision of a social worker referred by the National Insurance Institute, it will be possible to receive a nanny from a nursing company for 12.5 hours combined with a financial benefit of NIS 1300 per month. Additional nursing services:
• Laundry (0.25 hours per week for 5 kg),
• Club (2.75 NIS per day)
• Emergency button (0.25 hours per week)
• Absorption prod
Level E:
Caregiver through a nursing company for 23 hours. Or a caregiver from a nursing company for 19 hours combined with a financial allowance of NIS 820 per month. Exceptionally and according to the decision of a social worker referred by the National Insurance Institute, it will be possible to get a caregiver from a nursing company for 15.5 hours combined with a financial benefit of NIS 1570 per month. Additional nursing services:
• Laundry (0.25 hours per week for 5 kg),
• Club (2.75 per week per day),
• Emergency button (0.25 hours per week)
• Absorption products.
Level 6:
Caregiver through a nursing company for 28 hours. Or a caregiver from a nursing company for 24 hours combined with a financial benefit of NIS 820 per month. Exceptionally and according to the decision of a social worker referred by the National Insurance Institute, it will be possible to get a caregiver from a nursing company for 18.5 hours, combined with a financial benefit of 1910 NIS per month.
Additional nursing services:
Laundry (0.25 hours per week for 5 kg),
Club (2.75 per week per day),
Emergency button (0.25 hours per week)
Absorption products.
Chapter 3 – The services that can be received at each of the levels for benefit recipients who need 24-hour supervision.
Benefit recipients who employ foreign workers (and/or benefit recipients who employ Israeli workers for 6 days a week, for 12 hours a day), can choose whether to receive the money through a nursing company or through a direct benefit. In my previous article on this matter, I showed that there is a gap expressed in thousands of shekels per year between the employers who choose to receive the benefit directly, and those who receive the benefit through the nursing companies, therefore, we will not focus on that in this article. However, it is important to note the amounts of money paid by the National Insurance Institute to direct benefit recipients as follows:
Chapter 4 – Holocaust survivors 9 nursing hours
Holocaust survivors recognized by the Authority for the Rights of Holocaust Survivors and/or the Claims Conference are entitled to an additional 9 hours of nursing care per week beyond the nursing benefit provided by the National Insurance.
Eligibility for receiving these 9 hours is meeting a rating of 6 ADL points (level 3 as above) in the dependency test and in addition, in that the nursing allowance is not reduced due to income.
According to the new reform, those Holocaust survivors, who are entitled to this supplement, can receive this benefit financially directly to their bank account, which will add 1842 NIS to them every month.
The option to choose a direct benefit is only given to those who employ a 24-hour caregiver.
Chapter 5 – Considerations for receiving compensation in money or directly:
When it comes to receiving part or all of the benefit directly, we must take into account a number of factors that influence the decision:
1. Bureaucracy-
The nursing companies claim more than once that a benefit recipient is directly “alone” with the employees he employs. This assumption is devoid of any foundation since the corporations and private bureaus are responsible for the employment of the foreign workers. The nursing company has no responsibility towards the foreign worker. With the exception of the payment of the salary, she has no connection with him, even though she is considered his employer, the recipient of benefits and the holder of the license is the main employer. Therefore, he must manage the employment of the caregiver regardless of the nursing company.
In fact, the nursing company is a body that stands in the way between the recipient of the benefit and the employee, thus hindering the transaction. Therefore, the recipient of the benefit must know that, in any situation in which he employs a caregiver, he must treat it as a full employer and, therefore, must manage the employment as required by law. The nursing company will not give him the help he needs once the employee ends the employment. On the contrary, in most cases the recipient of the benefit learns that the nursing company did not give him the information he required as an employer and he is left alone in front of the workers’ organizations, led by “Ko Le Oved”.
2. Sharing family members-
As a result of the fact that the employment of a 24-hour caregiver requires the benefit recipient to manage the employment, it is very important for the family members to participate in this employment. This sharing can often be the difference between a successful deal and a failed deal. The family member managing the employment will be the one who deals with all bureaucratic matters in front of the employee and the various authorities. Any problem of the employee will be directed directly to the family member and the patient will be able to be the one who receives the service without disputes or conflicts regarding wages, conditions, vacations, etc.
3. The ability to use the payment received directly to finance nursing care-
According to the new reform, those Holocaust survivors who are entitled to this supplement can receive this benefit in monetary form directly to the bank account, which will add 1842 NIS to them every month.
The option to choose a direct benefit is only given to those who employ a 24-hour caregiver.
Unfortunately, many elderly people in the country do not “finish the month”. In such a situation, every amount of money, even the smallest, that goes directly to the bank account of the benefit recipient, is used for day-to-day financing and not for nursing care. Be and the family members are involved in the administration of the benefit, after all, they must act wisely and not use the money to buy products from the grocery store.
It must be taken into account that when the benefit recipient reaches a nursing situation, in most cases the situation is not reversible but only worsens and as a result, the nursing expenses increase. Various devices, medicines, hiring a 24-hour employee, receiving a private consultation from a specialist doctor, etc. cost a lot of money. Therefore, the more the family members involved save the money received directly and save it for the day they need it, the better off they will be.
A number of examples are given:
per month, the cost of employing a foreign worker is currently around NIS 9,000 per month. A private home visit by a specialist doctor (NIS 1,000-1,500 and double that in some areas). A wheelchair privately, 5000-3000 NIS. A benefit recipient who receives care from a nursing company and combines with the care a monetary benefit and saves the amount he receives directly actually prepares the ground for a better future for him.
Chapter 6 – Summary:
The new nursing reform gives the recipients of the nursing allowance many new options. There is no doubt that much thought was put into the reform in order to give more to the recipients of the nursing allowance. The change in treatment levels and the increase of hours at each level allow the recipient of the benefit to calculate and plan his steps forward – which was not part of the options until today. Correct planning and making the appropriate personal decision for each benefit recipient are a cornerstone in reaching the third age or a nursing situation. It is possible to ask whether the new reform is sufficient and the answer is likely to be no and there are many other things that need to be done, but there is no doubt that the new reform is an important first step in creating a comprehensive solution for seniors who are in nursing care.
The post was written by: Mordechai Seig, CEO of the SLA company – Aid, counseling and guidance for the elderly.
Yehuda, an 84-year-old elderly man who has a son and two daughters, drew up a lasting power of attorney about six months ago and according to his detailed instructions, he stated that he wished to continue living in his home, and that he wished to go once a week to eat ice cream at the beach in Nahariya, and he also requested that none of his children be placed in a nursing home .
Yehuda knew that when he was clear and aware of his actions, his instructions as he gave them would be carried out in practice one by one and therefore he asked to appoint his eldest daughter to take care of his affairs when the day came when he became incompetent to make decisions, the continuing power of attorney was entrusted to the general guardian at the Ministry of Justice.
In the last month Yehuda felt severe confusion and an inability to concentrate and had to rest in his bed for many days and his children began a ritual of advice regarding his matter, while different options were brought up by each of his children.
The son Atz ran to him and took one of the most expensive lawyers that could be obtained, in order to submit a request to be appointed as guardian for his father and so that he could make decisions for him, while the younger daughter turned to a neighbor who lives one floor above her and is a lawyer with an independent office, in order to appoint the younger daughter as guardian on her father and you can make decisions on his behalf.
When the lawyers submitted their requests to the court, the secretary of the court typed the father’s identity card into the general guardian’s database and there it was discovered that there is a lasting power of attorney that was entrusted with clear instructions from the father on how to behave with him and that according to his wishes the eldest daughter is the one who is appointed as his guardian.
The other children’s protests didn’t help, the ongoing power of attorney overrides their current requests and the father’s will, as determined six months ago, is fully complied with.
What is a durable power of attorney?
A durable power of attorney is a legal document that allows any adult (over the age of 18) to determine how and by whom his affairs will be handled in the future when he is unable to handle it himself, provided he understands the meaning, goals and results of granting the durable power of attorney.
The person (called the “appointee”) chooses of his own free will at the stage when he understands and is able to make decisions and carry out who will take care of his affairs and how his life will look if and when his condition changes for the worse (deterioration in his condition). Deterioration in his condition can result from an accident, diseases of old age (such as dementia), mental disabilities and intellectual disabilities that may impair a person’s judgment.
The way to do this is by appointing a proxy who will be authorized to act on behalf of that person in the future when he will no longer be able to make or carry out decisions concerning us himself.
The appointer can give a continuing power of attorney for all of his personal (including medical) and property matters or only some of them.
The power of attorney must act according to the instructions of the appointer, he must sign and confirm in writing before a lawyer (or before a professional in medical power of attorney) his agreement to the content of the continuing power of attorney, including the preliminary instructions included therein. In cases where the directive is impossible to carry out, illegal or when its execution will cause serious damage to it – the power of attorney must not act on it. In such a case, he can turn to the court and ask him to give instructions on how to act
A person can decide on the appointment of a single power of attorney as well as on the appointment of a replacement power of attorney in case the first power of attorney is unwilling or unable to act on his behalf. He can also appoint a number of proxies. It is possible and appropriate to determine whether the powers-that-be will act jointly or separately, what is the extent of the powers and responsibilities of each of them, as well as who will decide in the event of a dispute between them.
In order for the continuing power of attorney to take effect, there is no obligation for the person to lose his legal capacity, but it is certainly possible to establish that the continuing power of attorney will also be valid in this situation, and then the power of attorney’s entry into office can be done instead of appointing a guardian in the specific matters defined in the continuing power of attorney.
A person who wishes to set instructions in advance in the event that it is necessary to appoint a guardian for him, can draw up a document giving advance instructions, in which he can, for example, determine in advance who will be his guardian in the future (if necessary), as well as detail future decisions that will be made on his behalf or actions that will be taken on his behalf by the guardian appointed for him.
Below are some examples of instructions that can be given:
*The author of the power of attorney can determine within his personal medical affairs the type/identity of his preferred therapist.
*The author of the power of attorney can determine as part of his personal affairs that his place of residence in the future will be his home, and that the transition to an out-of-home arrangement will be made only under certain circumstances.
*The attorney of power can determine as part of handling his property affairs that the attorney will sell or rent his house under certain circumstances or instruct him to invest his money in a certain way.
Points to note:
From the date of entry into force of a continuing power of attorney, the person’s relatives and the “informed person” are entitled to receive information about the deposit of the power of attorney, the identity of the power of attorney and the “informed person” and the types of matters for which the power of attorney was given – unless the person in the continuing power of attorney limited the their eligibility.
From the date of the deposit of the continuing power of attorney until the date of its entry into force, the general guardian will send the appointing person a reminder, once every 3 years, to make sure that the person does not want to change the power of attorney for any reason.
An important point that must be noted and addressed carefully is that the power of attorney must be drawn up on special forms and signed before a lawyer who has undergone special training, and that he has no personal interest in the power of attorney. If this is not the case, then the power of attorney will not be legally issued.
In order for the continuing power of attorney to take effect, there is no obligation for the person to lose his legal capacity, but it is certainly possible to establish that the continuing power of attorney will also be valid in this situation, and then the power of attorney’s entry into office can be done instead of appointing a guardian in the specific matters defined in the continuing power of attorney.
Preliminary instructions:
A person who wishes to set instructions in advance in the event that it is necessary to appoint a guardian for him, can draw up a document of giving advance instructions, in which he can, for example, determine in advance who will be his guardian in the future (if necessary), as well as detail future decisions that will be made on his behalf or actions that will be taken on his behalf by the guardian appointed for him. For more information, see Provision of preliminary instructions for the appointment of a guardian.
In addition, any person who wants to prepare for the stage where he will have difficulty making decisions himself in the future, even if he has not filed a lasting power of attorney or will not be appointed a guardian, has another option, which is to appoint a person (officially) who will help him make decisions but will not make them for him. For more information, see Decision Support.
To Finish:
The author of the article is a lawyer and a qualified mediator with about 10 years of experience, in the past he was involved in the operation of large systems and the management of many teams of employees, he graduated with two degrees and in addition a degree in law, he owns a law office for family matters, inheritances and wills, he is qualified as the general guardian in the Ministry of Justice for drafting power of attorney Continuing and lecturing on family matters and the rights of the elderly.
Happy Seniors Services:
Happy Seniors offers a wide range of services to help elderly people living at home and their families. The services include assistance in finding suitable nursing caregivers, managing medical monitoring and personal care, and supporting daily challenges. The company also offers technological solutions that allow the elderly to stay connected with their families and enjoy community support, all with the goal of improving their quality of life and allowing them to age in a familiar and comfortable environment. Happy Seniors helps the elderly enjoy maximum support and advanced technology, thereby significantly improving their quality of life.
Different functional states in a person are determined in relation to his ability to perform basic actions called day-to-day actions. These actions are: dressing, eating, controlling braces, bathing, moving around and making transitions between positions (for example from lying down to sitting) independently at home.
These actions that seem “basic” to us begin to take on a different meaning when we reach old age. Also, with the elderly I take care of, they are not basic at all.
There are six functional states in the elderly based on the definitions and laws in the State of Israel. These definitions will determine which of the authorities is responsible for financing the out-of-home living arrangement of your parent or relative. In other words, according to the functional status, it is possible to determine where the person will live and what the conditions of his care will be.
Therefore, the importance of understanding these functional situations is very great.
1. Functional modes: independent-
Self-employed is someone who does not need help at all in day-to-day activities. Those who function on their own in an optimal way in each and every one of the activities. Therefore, he does not need the help of a person or a device (such as a walker, etc.) to maintain his lifestyle. Independent people, live without difficulty among the community in which they live, or if they chose to do so within the framework of sheltered housing.
If the older family member who is independent, feels lonely and is interested in a nursing home suitable for the independent. However, he does not have the financial ability to pay for the institutional housing, he must contact the office responsible for the elderly at the bureau of social services in his city.
He must ask her to help him begin the process of financing his stay in the institutional housing where he wishes to live.
To start the process, you will need to bring documents detailing the income of the older family member and his children. If the older family member owns an apartment, the cost of renting it will be taken into account. The welfare services usually transfer all the income of the older family member to them by standing order.
So he has about NIS 500 left in his account for monthly pocket money during his stay in the nursing home. The children will also be charged a participation amount based on the calculation of their income scale. It is important to know: there are nursing homes under the supervision of the Ministry of Welfare today that accept elderly people at the request of the Ministry of Welfare.
2. Functional conditions: exhaustion or body exhaustion-
When the level of functioning decreases and the ability to function independently in day-to-day activities is impaired, the elderly person moves to a new functional state called exhaustion, or body exhaustion. In this situation, the elderly no longer function completely independently, sometimes needing the assistance of a walker for mobility, help with bathing, etc.
How will we recognize that an elderly person has gone from a state of independence to exhaustion or physical exhaustion? When he needed help with 2-3 ADL activities (daily). For example – needs a walker and supervision in the bath. If your family member who is defined as debilitated or physically debilitated, is interested in a nursing home for the debilitated. In addition, he needs financing for his stay in a nursing home for the elderly, the process for receiving the financing is exactly similar to the process that takes place with an independent elderly person
3. Functional situations: nursing-
Only when the elderly is unable to function and needs full help in most ADL activities (activities of daily living) is he defined as nursing. That is, when he is confined to a wheelchair, does not control the braces, needs full help in bathing and dressing, he is defined by the authorities as nursing.
It is important to note that there is no connection between the physical state and the mental-cognitive state and an elderly person can be nursing and also completely lucid. In order to get help and make it easier for the elderly, long-term care health insurance should be taken out so that the expenses are reduced and the help is greater.
In addition, if the nursing family member needs help financing his stay in a nursing home, it is necessary to contact the website of the Ministry of Health. Forms must be downloaded from this website in order to obtain the Ministry of Health code. In addition, there is a list on the website of all the forms required to obtain the code for the Ministry of Health.
Collect all the required documents and submit them to the Ministry of Health as soon as possible. The process usually takes about two months until you can get the hospitalization code. If there is no choice and the family member must be rushed to a long-term nursing home, there are nursing homes that provide the option of pre-cod. That is, a partial payment given to the nursing facility for two months until the code is received from the Ministry of Health.
4. Functional situations: temporary nursing – a person in a rehabilitation situation –
Sometimes when an elderly person becomes nursing due to medical activity (for example surgery) but has rehabilitative abilities. For example, after the medical activity and with the help of proper guidance and training in a rehabilitation institution – he may return to a higher level of functioning. The definition of this functional state is temporary nursing.
In order to receive funding for a rehabilitation institution, it is necessary to contact the health insurance office in the area of residence or the office at the hospital where the elderly is hospitalized. The social security office will help in finding a rehabilitation institution according to the area of residence and the health fund of the elderly.
5. Complex nursing-
Patients who are nursing based on their function and in addition to that, special medical treatment is necessary for them. Below are some examples of medical conditions that may lead to hospitalization in a complex nursing setting:
1. Pressure sores of severity level 3-4.
2. Need for fluid infusion and/or intravenous drug therapy for an extended period of time.
3. Respiratory problems that require respiration, inhalations or inhalations more than once a day.
4. Dialysis or hemodialysis, a person suffering from a malignant disease and needs close medical monitoring and/or pain management.
If you wish to go to a complex nursing department in a nursing home, permission is required from the geriatrician responsible for this issue at the health fund. The referral to the geriatrician is made through the family doctor for the person living in the community or through the social service of the hospital if the person is hospitalized.
6. Exhaustion-
The definition of mental exhaustion does not concern the physical condition of the elderly at all, but the degree of his clarity. A person is diagnosed with dementia, when his level of dementia increases and his orientation in time, space and person decreases. The decrease in orientation levels is such that he needed constant supervision.
It is important to note that a debilitated person is not a mentally ill person but someone whose cognitive level is impaired due to diseases related to old age (Alzheimer’s for example). Although various tests to check the soundness of an elderly person (mini mental tests for example) are conducted by various parties, a qualified diagnosis accepted by the authorities is given by a psychiatrist who specialized in geriatrics only.
If the elderly person lives in the community, his family members should contact the family doctor in order to receive a referral to a psychogeriatrician. Also, if the elderly is hospitalized, a psychogeriatrician at the hospital performs a diagnosis in order to determine the functioning of the family member as a mental retardation.
After determining that the elderly person is mentally ill, the family must contact the health insurance office if the elderly person lives at home, or the hospital office. This is in order to help find a suitable institution for the mentally ill and to help start the process of receiving a hospitalization code from the Ministry of Health. The body that finances institutional arrangements for the mentally ill is the Ministry of Health, below is the link to the website of the Ministry of Health
In conclusion-
The different functional situations require different preparation of the elderly and his family members in order to continue the routine of life as much as possible. This, in order to enable the best and most appropriate care for each elderly person.
Article: Irit Rabinowitz, attorney M.A. degree in health and rehabilitation.
A Holocaust survivor for whom the following conditions are met:
Receives rewards from the treasury and financial assistance due to being in a nursing home,
recognized as needy,
diagnosed with dementia
may be entitled to participate in the financing of the nursing home.
In addition, if it is a Holocaust survivor, who:
lives in the community
does not receive any nursing hours from the National Insurance,
He has an Israeli therapist,
is entitled to assistance in financing the caregiver.
Participation in nursing expenses due to the dementia disease-
A Holocaust survivor, who is required to receive the assistance of a foreign worker, or to be hospitalized in a nursing facility due to dementia, is entitled to participate in the costs of the treatment or hospitalization at the rate of the relative part in which he was diagnosed with this disease.
This benefit is particularly relevant to those suffering from dementia (dementia) and it is highly recommended to submit an application for participation in nursing expenses.
Ways of participating in the expenses for dementia (dementia):
Assistance in participating in the financing of hospitalization in a nursing facility in the amount of 1400 NIS.
Assistance in financing the maintenance of an Israeli employee in the framework of realization of nursing hours from National Insurance in the amount of 740 NIS per month.
Assistance in participating in financing the maintenance of a foreign worker in the amount of 1000 NIS per month.
Assistance in participating in a stay in sheltered housing/ department for the debilitated in the amount of NIS 740 per month.
Participation in the maintenance of an Israeli worker-
Those who have been recognized as receiving compensation based on income according to the Nazi Persecution Disability Law and do not receive any nursing hours from National Insurance. In addition to this, he is assisted by an Israeli worker, he is entitled to participation in the amount of 740 NIS per month from the Authority for the Rights of Holocaust Survivors.
Where should I go to exercise the right?
In each of the requests, the Authority for the Rights of Holocaust Survivors belonging to the Ministry of Finance must be contacted for assistance. The payment will be made starting from the date of applying for the assistance.
In order to exercise this right, you can contact us and we can help you exercise this right.
When a person from the locality is asked “What do you know about dementia?”, those who have little or no experience in treating a dementia patient, usually answer something along the lines of “Oh… it’s just a disease of forgetfulness”. This is probably one of the most outrageous answers an experienced person can imagine.
Caring for an adult diagnosed with this debilitating disease at home is a task full of stress and anxiety. Until the word “forget” does not even come close to a correct description of the situation.
Caregivers must devote every minute of their time to caring for the adult.At all times they take care of his safety.They have no time for themselves.There is no need to even explain what this means about working and taking care of children at the same time.
Caring for a dementia patient at home changes the whole family dynamic. This brings a flood of conflicting emotions such as resentment, guilt, anger and unrelenting stress. In this article, we will try to explain why.
How dementia affects the person
Dementia is a debilitating disease that damages the brain and causes forgetfulness. Imagine your elderly father forgetting that he retired over twenty years ago. He forgets that his parents died thirty years ago. that he moved two years ago, his young wife got married…
And then there are the dangerous little forgetfulness. He forgets that his little granddaughter cannot yet chew or swallow solid foods when he gives her chocolate. He forgets to turn off the oven (and is sure to turn it off). He forgets to lock doors, how to eat, dress, use the phone and dozens of other things every day.
Imagine caring for a dementia patient at home. A person who raised you all his life and now has difficulty with the most basic actions and needs and needs close supervision and help in everything.
Home care for a dementia patient
The role of caregiver steadily takes over your entire life. This is the point where the stress and negativity starts. Dementia patients can ask questions “Can I move in with my friends?”. A question after which you will have to gently explain to them that their friends are already adults and cannot live alone without the help of others.
The patient can nod his head and understand this, but after five minutes he will forget about the conversation and repeat the same question again.
The cyclical cycle of actions is constantly in action when dealing with a dementia patient. Imagine repeating the same sentence 10 times a day, every day. When there is a pile of paperwork to handle in the office. When the children need to be picked up from school. And when you haven’t had time to eat since morning.
The caregivers begin to feel resentment and then guilt because they are aware that it is not the patient’s fault – they are experiencing resentment towards the person who has cared for them all their life.
This is the reason why most family members choose home care. Out of love, respect and commitment. But, it is only when they begin to carry out the task that they realize the enormous amount of work that is required.
The effects of treating a dementia patient at home
When a family member begins to spend more and more time caring for a dementia patient, it is only natural that this will affect other aspects of their lives. Especially children can feel neglected after the sudden change in the direction of attention towards the adult.
Once the child’s needs were above all else; Caring for a family member with dementia is in many ways like caring for another child. Therefore, when treating a dementia patient at home and bringing such a situation to the family, it is necessary to explain the situation to everyone in advance. Family members need time to prepare for the change.
And even then, the change itself will exceed their expectations and they will struggle to cope.
Behavior patterns of a dementia patient
There are dementia patients who suffer from aggression, which increases the stress level at home. They may become nasty and even violent, very different from their personality structure before they got the disease. In one case, the father suffering from dementia was cared for by his loving home;
As the disease progressed, his behavior began to change and he became more and more unpredictable. When the cat they raised at home died, his home was struck with grief. Instead of sympathizing with the loss, he started laughing and said “Blessed that we got rid of him!”
In other cases, people with dementia may withdraw from guests who come to their home and refuse to talk to them. They can become stubborn about meals. Maybe even refusing to eat until they get a certain portion they want, and then refuse to eat that too.
All these actions, which take place on a daily and consistent basis, can easily take a toll on the therapist and cause them (the therapists) to break down emotionally.
Friends and relatives of the caregivers may stop wanting to come to their home. Caregivers have less and less time to work, and little, if any, time for themselves. The therapists become “silent patients” who slowly begin to suffer from depression, stress, anxiety and other frustrations.
On top of all this, they suffer from a lack of sleep hours after waking up enough times to take care of a patient who has wet his bed and the sheets have to be cleaned and changed. This is just another addition to the pressure that is accumulating and growing.
Summary and advice for home care for a dementia patient
There are dozens of books, blogs and advice from people who, like us, document and share their experiences of caring for a person with dementia and advise others on how to do the same. The task is not easy and requires more patience than raising your children.
If you are also caring for a dementia patient, don’t take the whole burden on yourself. Share it with others and remember to take care of yourself too. If you need advice, please call me at 0547758564.
