Long-Term Care in Israel and the U.S.: Different Systems, Shared Challenges

In a recent Risking Old Age in America podcast, I had a fascinating discussion with Israel (Issi) Doron, chair of the Department of Gerontology at the University of Haifa in Israel, about the differences in the systems of elder care in our two countries. Unlike the United States, Israel provides up to 20 hours a week of free home health care for all but its most affluent residents.

Here are some excerpts from our conversation:

ROA: You and I have talked before about the differences between Israel and the U.S. in elder care — how it’s provided, how it’s paid for. Could you talk a bit about how that all works in Israel?

Doron: Elder care is a challenge all across the world, so the challenges are common in most developed countries…including the U.S. and Israel.

I will share [two] key issues about how Israel handles elder care and how it compares to the U.S. The first point is the fact that Israel, unlike the U.S., has universal healthcare coverage. So every resident of Israel from birth to death is covered. In the U.S., the federal program of Medicare does provide a sort of universal healthcare for older adults.

However, as we know, aging is a life course issue. So if in your 20s, 30s, 40s or 50s you didn’t receive adequate healthcare, when you reach your 60s, 70s, 80s, and 90s, it’s in some perspectives a little bit too late. So Israel provides a better starting point for older adults in the sense that when they reach age 65 or 67, they have experienced relatively adequate and good healthcare coverage on a universal basis.

The second element, which used to be unique to Israel, is that Israel was one of the first countries in the world that legislated and anchored in its Social Security legislation, what we called community-based long-term care insurance. Every resident of Israel who pays into the social insurance system is eligible for this coverage [of 20 hours of home health care a week]. There is a financial needs assessment, but it’s 1.5 times the average income, so the vast majority of older adults in Israel are entitled to receive that community-based support.

ROA: Has this program always been available?

Doron: It was enacted in the 1980s as one of the first such programs in the world at the time. Since then, many countries…have adopted similar programs and added them to the traditional social insurance and social security programs as part of a national coverage to provide answers to the rising needs of the aging populations.

And from a financial perspective, it’s cheaper and more financially viable to provide the care for older adults in the community. And that’s what they prefer, rather than to opt for traditional institutional based long-term care services, which are quite expensive and not what older people really want.

ROA: So, who provides the care?

Doron: So once again, this is a fascinating issue and a challenge. To begin with, like the U.S. and most developed countries, the vast majority of care for older adults is provided by family members. It doesn’t matter which system you have, that’s still what happens in the vast majority of the world. Family members…are the initial point of reference to provide care.

But once we move into the community-based long-term care services, it’s low-paid and the workforce is mostly women, often older themselves. After the fall of the former Soviet Union, we had a significant immigration of Jews…to Israel and a very significant portion of the care workforce were women…from the former Soviet Union.

More recently, there is a fascinating sub-sector of migrant workers from Asia, from Nepal, from the Philippines who come to Israel and basically provide 24/7 care for older adults at home. And you have a subgroup of Arab Israelis who work in this field. Unfortunately, it’s a low-paid job and not easy work to do.

You may listen to our entire conversation here.

For more from Harry Margolis, check out his Risking Old Age in America blog and podcast.  He also answers consumer estate planning questions at AskHarry.info.  To stay current on the Squared Away blog, join our free email list.