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.
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 client, unsure if she wanted to take on the role of guardianship for her mother who has a moderate level of dementia, came to me for help. The woman said her mother could still recognize people but did forget what day it was from time to time.
Her mother also began to suffer from delusions. She was convinced that her mother was still about to think clearly, and could make decisions for her mother. Although her doctor and I explained that the disease was rapidly progressing, the daughter refused to begin the guardianship process.
It wasn’t until her mother fell and needed surgery from her broken leg that she discovered her mother was worse off than she thought.
Doctors would not do the surgery without her mother’s permission, and since they felt she was unable to give it, they did a mental test. She scored low on the test. It was then a social worker took temporary guardianship of the mother.
This process took several days to resolve, and the mother had to remain in the hospital in pain before surgery could be performed. She was given painkillers often to help with the pain. This would never have happened if the daughter had listened and assumed guardianship over her mother.
Guardianship: Should you become one? and the legal process behind it.
Many people, as they age, have dementia. The more serious the dementia is, the more help the person will need in their day.
Elderly dementia patients are at both physical and financial risk due to their susceptibility to abuse (such as physical, emotional, financial, etc.) and their own decisions. These patients needed even more protection from predators.
For example, an older adult who refuses to allow a caregiver in their home or refuses to move to a nursing home could be deemed risking themselves and their environment.
If the same person suffers a stroke and can no longer talk and needs assistance 24 hours a day, they are no longer able to provide their input into the kind of care they will get. This is why guardianship was designed.
What Is A Guardianship?
A guardian is selected to make someone’s personal decisions for them. This is a person who is unable to decide for themselves where they will live and what kind of health care they need.
The guardian can make these decisions for them. And, an elderly person can have more than one guardian– one person can make financial decisions; another person can make healthcare decisions. Also, they can both be a guardian for both kinds of decisions.
Should You Become A Guardian For Your Loved One?
When you take on the role of guardianship, you have to let the court know every so often about how the person is doing.
Make sure you fully understand the role you are about to take on before you become their legal guardian. If becoming a legal guardian over someone sounds tedious, there are other alternatives to consider.
If an emergency arises, you could always file for a temporary guardianship, where the court assigns who the guardian will be.
Corona virus vaccine – the types of vaccines developed
In Israel began the operation “Returning to Life”, which the population is vaccinated with Pfizer and Moderna vaccines against the Corona virus. The Corona virus vaccine have been approved for use by the US Food and Drug Administration. The purpose of corona virus vaccine is to introduce the body to only the spike protein found on the surface of the virus, without exposing the vaccinated person to the whole virus. This means that the body will produce antibodies against this specific protein.
The effectiveness of the corona vaccine
The vaccines of Pfizer and Moderna have been tested in several countries and in several stages of development, as is customary in any process of vaccine development. In the first stage, the corona virus was vaccinated, tested on animals and found to be effective. Next, the vaccines on humans were also tested and were also found to be effective in the development of antibodies to the corona virus.
The protection of the corona vaccine
The Corona vairus vaccinae of Pfizer and Moderna have been tested in several countries and in several stages of development, as is customary in any process of vaccine development. In the first stage, the corona virus was vaccinated, tested on animals and found to be effective. Next, the vaccines on humans were also tested and were also found to be effective in the development of antibodies to the corona virus.
Side effects that require consultation with a doctor
If within 4 hours of receiving the first dose patients suffer from one or more of the following symptoms, the attending to the doctor should be consulted regarding receiving the second dose: – Skin system irritation (rash, scabies, itching, redness on the face). – Difficulties in the respiratory system (shortness of breath, troublesome cough, wheezing). – Cardiovascular symptoms (rapid pulse or decreased blood pressure). – Gastrointestinal disorders (nausea, vomiting, diarrhea).
Should a mask be worn after receiving the vaccine?
It is still recommended even for those who have been vaccinated to take all known precautions: masks, social alienation and maintaining hygiene, in order to maintain personal and public safety. This is also the recommendation for those who have recovered from Corona disease. Once the State of Israel has a large mass of vaccinated, we can probably give up these precautions.
Our body needs the energy to survive. Where does that energy come from? Food, of course! Food is broken down into tiny molecules of sugar called glucose; from glucose, we get energy. Diabetes disease is, actually, a group of diseases that arise due to abnormal levels of glucose in the bloodstream.
Glucose levels in the blood are controlled by the hormone insulin, which is produced in small amounts by the pancreas. People with diabetes either do not produce the sugar-regulating hormone, or the cells in their body have, unfortunately, become immune to it. This results in the fundamental problem behind the condition: too much sugar in a person’s blood.
Diabetes is a life-long disease with approximately 415 million people being afflicted with it all over the world – that’s 1 in 11 people! There are two main types of diabetes, simply referred to as Type 1 and Type 2. We’ve explained what they are and the difference between them below.
Types of Diabetes
Type 1: Insulin-Dependent Diabetes disease
In Type 1 Diabetes, the pancreatic cells in the body are unable to produce insulin (because they’re destroyed by the immune system). Afflicted people are dependent on external insulin injections to stay healthy.
Type 1 is commonly diagnosed during childhood and adolescence and usually develops in people who have diabetes disease in their family. For example, having diabetic parents increases the chance of diagnosis.
In lesson common cases, Type 1 diabetes also occurs due to coming into contact with something in the environment. The immune system becomes activated and attacks insulin-producing cells in the pancreas, thus resulting in diabetes.
Approximately 10% of all diabetes disease cases account for Type 1 diabetes in children. It’s spread evenly among boys and girls and is mainly characterized by a deficiency in blood sugar.
Type 2 Diabetes: Not Dependent on Insulin
Unlike people with Type 1, people diagnosed with Type 2 diabetes disease are able to (some extent) produce insulin. The problem, however, lies in the fact that the amount of insulin produced is either not enough, or else the person’s body has become resistant to insulin.
When there is not enough insulin in the bloodstream or the body doesn’t absorb it as it should, the levels of glucose in the blood increase (since there’s no one to stop them) which results in the disease.
Type 2 diabetes is the most common form, with approximately 18 million Americans being affected. It usually occurs in people over the age of 40 and with existing health conditions like obesity.
In many cases, doctors are able to predict the onset of Type 2 diabetes and detect it during early stages (pre-diabetes) when blood sugar levels in the body are slightly higher than normal. This type can be prevented by doing regular exercise, maintaining a healthy diet, and controlling your weight.
Unfortunately, even though Type 2 diabetes occurs most commonly in adults, nowadays it is also being diagnosed in children. It is extremely important to promote healthy eating and fitness in schools, to prevent obesity in younger people so that they become less prone to being afflicted with diabetes.
Type 2 Diabetes: Gestational diabetes disease
Aside from the conditions above, there is a third type of diabetes which sometimes happens in pregnant women. Gestational diabetes is triggered due to the changing hormones in the body during pregnancy. The chances of developing it increase in women who are over 25 years old, have a family history of diabetes or were overweight before their pregnancy.
Blood sugars usually return to normal approximately 6 weeks after childbirth; It does, however, result in an increased chance of the mother developing Type 2 diabetes afterward. Approximately 4% of women are affected by Gestational Diabetes Worldwide.
Admitting a loved one into a long-term nursing home is probably one of the hardest decisions a person has to take. In many cases the debate about nursing homes is fierce.
Families do it for a multitude of reasons. The biggest of which is that the aging senior can no longer live by themselves. They need constant supervision from a skilled medical and para-medical stuff due to health issues. We’re all aware of the general opinion regarding nursing facilities, and an elder’s aversion towards them. However, what do the seniors really think about nursing homes?
We at Happy Seniors have provided a perspective of some seniors to the debate about nursing homes. Read on to find out two true stories of Carol Hathaway and Emily Gardener. As they talk about their lives after being admitted to a full time nursing home.
The Story of Carol
Carol, 85 years old, was admitted to Rosenfield Senior Home ten years ago. After a devastating fall left her body paralyzed from the waist down, her family made the decision of full time care. Leaving behind her home was in no way easy. But she made her peace with the decision after seeing the everyday struggles her family underwent to take care of her.
After arriving though, Carol was quite pleasantly surprised. First of all, there was no indication of the “smell” that apparently existed in nursing homes; Rosenfield was as clean as their house. She had been scared of going into an entirely new environment and having to live there for who knew how long.
It turned out that the seniors didn’t just sit around all day staring out windows as she had feared; the inhabitants of Rosenfield were all kept busy with their very own tasks. Gardening, sewing, painting, and even cooking: they each had something to keep busy and throughout the day. Even though she still missed home, her family was never very far. Carol began to find her place in the community. She felt especially happy at no longer having to trouble her loved ones.
The Story of Emily
In some ways, 75 year old Emily’s story was not much different. Inflicted with dementia two years ago, she had been cared for her by her eldest daughter for one year before coming to Rosenfield. Emily wasn’t very good at remembering short-term memories; but, her memories of her days as a carefree youth were still clear in her mind. She liked talking about them and was happy to share her story with us.
Emily worked as the chef in a restaurant for 40 solid years before age forced her into retirement; she was already living with her beautiful daughter when the diagnosis came. When Clare had to quit her job to take care of her mother, Emily first began to look through the brochures of Rosenfield. She would never be willing to burden herself on her daughter who still had a long life ahead of her worth living.
Emily was still upset though on moving day; leaving was never easy. Clare came to visit every week, and still did so even a year later. Emily needs a nurse’s full time support now for her meds and supervision. The funny thing was… in the past year, the change that had at first made her unhappy, had turned into her greatest source of joy. Most of the nurses felt like a daughter to her. And there were others she could talk to if she wanted; no one forced her to do anything she didn’t want to do. The other residents were all like family now and she loved staying with them.
