April 11th, 2020
By Sharona Tsadok-Rosenbluth
CPA, MHA, PhD candidate and Adjunct Faculty Member, Department of Health Systems Management, the Guilford Glazer Faculty of Business and Management Ben-Gurion University of the Negev.
- Impact of COVID-19 on people who use and provide long-term care so far
On April 9th, 9,968 individuals in Israel had been diagnosed with COVID-19. The death toll was 86 (Moh, 2020) of whom 24 were residents of sheltered housing or LTC institutions. In Israel 11.7% of the population are 65+ years old while the OECD average is 17.2% (OECD, 2020). The outbreak in sheltered housing and LTC institutions started with “Migdal Nofim”, a sheltered housing facility in Jerusalem. On March 15th it was published that a social worker, who is a member of the staff, had been infected with the virus which resulted in the infection of a resident, two members of the staff and two foreign-residents LTC care givers. According to a news report (ynet, 15.03.2020), the manager of the institution said that the residents and staff were all in self-quarantine but that they had not been tested. On that date, there were 213 COVID-19 cases in Israel and the policy for testing was limited to those who had symptoms and were in close contact with a diagnosed person or had returned from high-risk countries. The MoH did not permit any other testing. As of the 11th April,[AC1] four residents from “Migdal Nofim” have died from the virus.
Another cluster is the “Mishan” sheltered housing complex in the city of Be’er Sheva. The outbreak was first published in the press on March 27th when a resident from the nursing care unit died in the local university hospital. By April 7th, 27 out of the 35 residents of the nursing care unit were positive for the COVID-19. In addition, 13 of the staff of the unit were positive and two residents of the independent living unit. Only on April 1st, after demonstrations by family members mainly at the entrance to the residence and press involvement, did the MoH approve SARS-CoV-2 testing for all residents of the facility (dependent and independent). Until then, the only treatment was complete isolation of all tenants in the independent unit. The quarantine guidelines issued on March 27th included a directive from the NIII forbidding the entrance of all nonliving-in care-givers under NIII supervision to the residence, thus denying care for the independent residence. Today, Saturday April 11th, in response to the request of the medical director of the “Mishan” sheltered housing chain, the MoH approved the termination of the quarantine since 15 days have passed and only 2 residence and one care giver tested positive after the quarantine began. The death toll of the LTC unit of this institution is currently 13.
On the 11th April it was reported that[AC2] [s3] a nurse working in a different sheltered housing complex had tested positive for Covid-19. The chairman of the residence told the press that they feared the same outcome as that of the outbreak in “Mishan” Be’er Sheva. She called for testing of all residents in sheltered housing or LTC institutions who have been exposed to the virus.
2. Brief background to the Long-Term Care system in Israel:
It is important to note that in Israel, the old age homes and long-term care (LTC) institutions and home based care have different regulators and the responsibility is shared between different entities. The entire LTC system and treatment of older people in Israel is decentralized, which is difficult in normal times and has become an acute issue under the COVID-19 reality. While private sheltered housing is overseen by the MoLWSS and nursing homes are required to be licensed by the same ministry, the MoH is in charge of LTC institutions, the Medical Health Organizations (MHOs) (Kupat Cholim) are in charge of the treatment of the LTC patients who need complex medical treatment (mainly chronic diseases) and the National Insurance Institute of Israel (NIII) is responsible for LTC (personal assistance) at home while the MHOs are responsible for the medical treatment to these patients.
3. Long-Term Care policy and practice measures to mitigate the impact of COVID-19
3.1. Care homes
On March 10th, the Ministry of Labor, Welfare and Social Services (MoLWSS) issued a directive that due to the Coronavirus crisis, all visitors are forbidden to enter residential care homes and sheltered housing. The directive included instructions that any visit by family members or other guests must take place outside of the facility and only those who are not under orders to self-quarantine or share a household with someone who is under self-quarantine may visit. The chairman of the old age home association was quoted wondering why the rules of the MoLWSS are much stricter than those of the Ministry of Health (MoH), which at the time allowed the entrance of first-degree relatives, only prohibiting those who had travelled abroad. His fear was that this policy would result in a worsening of the residents’ loneliness (Calcalist, 10.3.2020).
3.2. Community-based care
On March 15th, the MoLWSS published directives aimed at the LTC workers that take care of home-based patients. These instructions were published in Hebrew, English, Chinese, Russian, Thai, Turkish and Ukrainian and include the implementation of the guidelines set by the MoH regarding social distancing. Only on April 3rd did the MoH publish their instructions.
4. Lessons learnt so far
There is an urgent call to change the criteria for performing tests so that the 14 day quarantine, which is extremely difficult for this population, will not be the only measure in practice to try and stop the spread of the virus.
In addition, it should be clear which ministry is responsible for the policy and distribution of guidelines for preventing and treating the outbreak of the virus in nursing homes or sheltered housing and guidelines for nursing home staff and home care providers.
Links to news articles used for some the information provided in this article (in Hebrew):
MoH (2020), Daily Report, https://www.gov.il/BlobFolder/reports/daily-report-09042020/he/daily-report_daily-report-09042020.pdf
MoH (2020), Guidance for LTC care givers treating home patients following the corona eruption) – 173978620 [Hebrew]
MoLWSS (2020), Preparation of welfare services – Coping with the Corona Virus – COVID-19 – Directive No. 3 (2020-003) [Hebrew]
OECD (2020), Elderly population (indicator). doi: 10.1787/8d805ea1-en (Accessed on 11 April 2020)
 The death toll of residents of sheltered housing and LTC institutions was calculated by the author with data originating from news report.
 The one resident is the wife of a resident that died due to the virus. The other resident and the care giver have left the sheltered house.
Tsadok-Rosenbluth R (2020) Report: Contagion and deaths related to COVID-19 in Israel in sheltered housing and long-term care institutions – lessons to be learned. 11th April. Article in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE.