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.
