Imtroduction-
I will start with my personal story,
I started my work in nursing homes, in 2008. First in small nursing homes, and then I moved to work in a relatively large nursing home in the northern region. I really enjoyed working in community, individual and group work with the tenants and also, I enjoyed helping the families of the elderly, both in emotional support and in exercising their rights in front of the various offices.
What did I enjoy least about my work in nursing homes?
From the gray exceptional events, from the fact that I could not always work according to the ethics rules of the profession, because I was subordinate to management that preferred to hide (not all managements).
But, of course, I didn’t give up and where it was necessary to report, I insisted on reporting even if it resulted in criticism towards me or even dismissal.
Lack of manpower in the wards and the fact that sometimes as a result, the work of the treating staff led to those unusual events. The reluctance of the care teams to receive training and professionalize, just because they had to stay another hour at their own expense.
All this, made me gradually lose my desire to continue working in nursing homes.
In this article, I’m going to scan the state of nursing homes in Israel, with an emphasis on long-term nursing homes. Of course, not all nursing homes in Israel are in the same situation, some are of better quality and there are less, and I am going to give general information about what is happening in the nursing homes in Israel both from the literature and from my personal experience.
The shortage of nursing personnel in nursing homes –
A woman takes care of an elderly woman
It is no secret that the shortage of personnel in nursing homes and hospitals is high. As a result, the care given to the elderly staying in nursing homes is sometimes deficient. As proof of this, a quote from an article in Globes-
In the administrative petition, it was claimed by the Association of Nursing Homes in Israel that the reduction in the number of foreign workers in Israel, through the Population and Immigration Authority, resulted in a great shortage of nursing care workers for tens of thousands of elderly people who need it. According to the petitioner union, the construction industry did not suffer from the lack of foreign workers, because it was important for the state to solve the housing crisis in Israel, but tens of thousands of the state’s nursing and mentally exhausted elders were abandoned by it.
Lawyers Bombach and Ronen add and write, on behalf of the nursing homes, that
The population in the world, and in Israel in particular, is living longer and longer. But at the same time, the attention of the decision makers in Israel was not drawn to this, and the emphasis was not placed on finding a systemic-national solution for the treatment of the aging population.
The phenomenon of abuse in nursing homes-
The phenomenon of abuse of residents Among the staff members, it was found that the auxiliary forces are the group of caregivers who are at high risk of abuse of residents, as a result of the abrasive nature of their work (Shannan-Altman and Cohen, 2009).
These caregivers are professional support workers, who are required to exercise basic skills in care and their work involves physical care of the elderly, assistance in fulfilling their mental and social needs and maintaining their quality of life.
In studies carried out in the United States and Israel, it was found that the nursing profession in Israel and the United States is characterized by low status, little income, poor employment conditions, lack of promotion opportunities and low job security.
What causes therapists to become frustrated and how can this be overcome?
All that was said above, causes people involved in this profession a lot of frustration and confusion. They come to work reluctantly and have nothing to make them want to continue working.
Institutions, which have learned to understand this, organize fun days for those therapists, rewarding them with bonuses for good work. It will also not hurt to pay a salary that is above the minimum wage. Also, organizations that will give more paid training to those caregivers, will cause more responsiveness on the part of the caregivers to participate in that training.
Another testimony that causes the phenomenon of abuse in nursing homes was given by Dr. Tova Band Winterstein, from the Gerontology Department at the University of Haifa.
In the research I have conducted over the past 16 years, I have witnessed the high risk of the elderly population for abusive and neglectful behavior.” According to her, this is a population that depends on the staff members and is subject to the procedures and routine of life at the institution. This dependence, combined with stereotypical age attitudes that see the elderly as a burden, transparent, and irrelevant, allow in certain situations the existence of abuse and neglect.” She says and adds that Many times the atmosphere and the demanding organizational climate cause a great burnout of the staff, a great deal of stress and therapeutic burden that can cause lack of compassion.
Who are the factors enforcing this problem and how?
Another problem related to the phenomenon of abuse in the nursing homes comes not only from the nursing homes and caregivers, but also from the police and supervisory authorities. The police encourage family members to file complaints on this issue, in many cases it is difficult to convict due to a lack of evidence. In addition to that, the physical condition of the nursing elderly does not allow them to testify, or they are afraid to testify due to their proximity and dependence on caregivers.
Therefore, many times even the professional workers who come to talk with them, do not always receive information on this subject from the elderly. In addition to reporting to the police, it is also possible to report to the regional welfare officer, especially when it comes to grayer cases, where it is not possible to collect clear evidence from the elderly or his environment regarding any suspicion of abuse. Even after reporting to the relief officials, the cases are not always handled optimally, this is due to the heavy burden on the relief officials and the social workers handling this issue.
According to the data of the Ministry of Welfare in Israel, each social worker dealing in this field handles hundreds of cases. One of the important mechanisms to deal with this phenomenon is through a relief official in the elder service. Due to the load, the treatment is lacking and there is insufficient monitoring of the cases of abuse reported to the welfare officer.
It should be noted that there is a procedure that the follow-up will be on the part of the abuse committee, which is obliged to take place once every three months by the members of the committee for the prevention of abuse, which consists of the multi-professional team of the institution. Of course, it is mandatory that a lawyer, a doctor and a nurse, the other professional employees participate, depending on the reported case.
What is the process of hiring caregivers for the nursing home?
In addition to this, there is a very problematic phenomenon in the recruitment of caregivers to nursing homes. Due to the lack of auxiliary staff, there is no regulated and professional selection process for accepting people who wish to work as caregivers in the nursing homes. As a result, anyone interested in being accepted to work as a therapist enters the job, without a thorough examination of their personality and experience. In addition, many therapists who were negligent in their duties in a certain institution, were fired and moved to work in another institution.
They were hired due to the lack of caregivers. It should be noted that if it is a large institution – with several departments – if the caregiver is suspected of certain negligence, he will not be fired immediately, the first few times, he will be transferred to another department in the same nursing home. This is in order to preserve it, because again the problem that repeats itself in this case too: there are not enough experienced therapists who want to work in a nursing home.
Supervision of the Ministry of Health or Welfare –
The roles of the Ministry of Health and Welfare-
The Ministries of Health and Welfare, their role is to issue procedures to the institutions under their supervision and supervise them in the various controls. There are private nursing homes that are not supervised by these ministries and the clients pay for them privately and there are nursing homes that are under the supervision of these ministries and most of the clients who come to them receive funding through them.
The Ministry of Health supervises institutions for nursing and debilitated people and the Ministry of Welfare supervises institutions for the independent and debilitated. If you are interested in getting to know the different functional conditions and the funding process for them, you are invited to enter the article on functional conditions in the third age.
Reporting Obligation-
When there is any suspicion of any negligence or abuse, it is mandatory to report to the Ministry of Health or Welfare depending on the nursing home where the elderly person is staying.
The Ministry of Health or Welfare, their role is to contact the responsible attorney and the abuse committee at the nursing home and find out about the case.
Also, to follow up on the case and how it is handled. To tell the truth, this follow-up is not always done, but the Ministry of Health does check in controls whether the members of the abuse committee, which is also their role, do follow up on the reported cases of abuse.
The review of the Ministry of Health-
In addition to this, there is an audit by the ABA Nursing Homes Association on the conduct of the Ministry of Health in the nursing homes:
The Ministry of Health is the one that pays for most nursing beds Says Roni Ozari, chairman of the ABA (Association of Nursing Homes and Sheltered Housing in Israel), which represents over 200 public (non-profit) and private nursing homes and shelters where about 25,000 residents live. “But in fact he pays 30% of the actual expenses of the nursing homes. He wants to save money at the expense of nursing homes.
A situation has arisen where those who are not good survive and exist. It should be understood that this is not substandard.
The standards are correct, but there is no manpower to fulfill them. I expect the Ministry of Health to lift the glove and do two things immediately: He will approve another 2,000 foreign workers out of the 5,000 required for the nursing industry as a start and then he will establish a forum led by an economist, which will determine the rate for the day of hospitalization, so that we will not reach what we have reached so far. That way the criminals also knew they had something to lose.
Background data from the Taub Center for the Study of Social Policy in Israel on the subject of nursing care indicate that the system for long-term geriatric hospitalization has approximately 21,000 beds in 333 geriatric institutions.
About 70% of the beds are occupied by hospitalized patients financed by the Ministry of Health according to law. The rest of the beds are financed by the hospitalized patients and their families privately.
About two-thirds of the nursing homes are privately owned and the rest are publicly owned, but they all operate according to the professional guidelines of the Ministry of Health and serve as the operational arm of the Ministry of Health, that is, It is the state that is obligated to give the elderly the good, adequate and proper nursing care in the last chapter of their lives. It is she who determines the mandatory therapeutic guidelines through the Geriatrics Division of the Ministry of Health, which dictates the guidelines and supervises their implementation, and she is the one who bears the brunt of the ongoing failure.
In conclusion-
According to the data of the Population and Immigration Authority, in many developed countries there is a very serious shortage of local personnel in the nursing sector.
This is mainly due to the rapid pace of the aging of the population and a change in the family structure, which resulted in a considerable reduction in the informal workforce.
According to an analysis of demographic, economic and social trends, this shortage will get worse in the coming decades. As a result, policy makers must intervene in market forces and look for creative solutions in order to stabilize the level of demand and supply of personnel in the nursing field. Also, it is very important that the police treat the reported cases more seriously and not close almost every case reported to them by the nursing home due to lack of evidence.
Standards must also be increased among public service workers in the field of aging: more relief clerks, because their role is important and decisive in locating and treating cases of abuse in nursing homes. Paid therapist training, more bonuses, fun days, discounts and fair treatment of the institution’s management towards the therapists. Strict selection of employees.
And in addition, changing the way social workers are paid in order to avoid a conflict of interest: The social workers working in nursing homes will receive their salary from the Ministry of Health and not from the managers of the nursing homes. That way, they would be less afraid to speak up for fear of being fired. But, for now it’s just a dream