Introduction:

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.