COVID-19 and the Long-Term Care system in Israel

Structural characteristics of the LTC system, impact of the pandemic, measures adopted and new reforms

This country profile contains a section of the LTCcovid International Living Report on COVID-19 Long-Term Care that brings together information on the experience of the long-term care sector (focussing on people who use and provide care) during the COVID-19 pandemic in Israel, as well as description of the system and of new reforms. The LTCcovid Living report is updated and expanded over time, as experts on long-term care add new contributions. This profile also provides links to research projects on COVID-19 and long-term care, to key reports, and lists key experts on the impacts of COVID-19 on the long-term care sector in Israel.

Experts on COVID-19 and long-term care in Israel that have contributed to this report:

Liat AyalonShuli Brammli-Greenberg, Shoshana Lauter, Sharona Tsadok-Rosenbluth

Living report: COVID-19 and the Long-Term Care system in Israel

PART 1 – Long-Term Care System characteristics and preparedness
  • 1.01. Population size and ageing context
    In 2015, the total population of Israel was 8.46 million, of whom 939,000-11%- were aged 65 and over. One in four households in the country included a person aged 65 or more (source: Brookdale Report).  
  • 1.02. Brief description of the Long-Term Care system

    Israel has a fragmented LTC system with the National Insurance (NI), the Ministry of Health and the Ministry of Welfare and Social Affairs, holding different yet overlapping responsibilities for publicly funded LTC (source: Taub Centre).

    Notably, Israel was one of the first countries to introduce publically financed LTC insurance. Still, it is not universal and is of partial coverage for the mild and severely disabled older people. Most of the LTC treatment in Israel is community-based. At the beginning of 2020, some 220,830 older people received publically funded LTC services at home (The National Insurance, 2020).

  • 1.03. Long-term care financing arrangements and coverage

    In 2016 the total LTC expenditure in Israel was estimated to represent 0.6% of Gross Domestic Product (source: OECD). The National Insurance (NI) is the primary public funder of home-based long-term care services and does so through the Long-Term Care Insurance Program (LTCIP).  LTCIP is income-tested to exclude the highest income earners. As of 2014, the NII subsidizes the care of approximately 160,000 seniors at the cost of NIS 5.31 billion (appx. 1.2 bill GBP). Assisted living (e.g. LTCFs) is primarily funded by the Ministries of Health and of Labour and Social Affairs, and accounts for 14% of publicly-funded LTC services. Complex inpatient care is funded by the health system and accounts for 6% of public LTC funds. In all, public funds account for 55% of LTC services, with the remaining 45%  privately funded (sources: Taub Centre)

    Home care and community-based services are the main LTC service for older people in Israel. At the beginning of 2020, 220,830 individuals (of retirement age) were eligible to receive publicly financed LTC services at home (sources: International LTC Policy NetworkNational Insurance Institute of Israel).

    There are also geriatric hospitals and sheltered housing facilities, many of which are owned and managed by the coordinated governmental healthcare system via the four non-profit health plans (HP’s). These provide long-term geriatric treatment (including wards for older people with cognitive disabilities) as well as departments for active geriatric care (including complex nursing, hospice, and rehabilitative care) (source: Tsadok-Rosenbluth et al, 2021); they became the primary source for concern and emergency response during the COVID-19 pandemic.

    LTC insurance in Israel is universal ,and LTC services are substantially funded by private and out-of-pocket expenditure (45%). In April 2018, as part of the LTC reform, the National Insurance launched a program to entitle home-based unpaid caregivers to long-term care benefits. Made a national policy in August 2019, family members can be paid as caregivers under certain conditions; statistics on the implementation of the policy are unavailable (source: Adva Centre).

  • 1.04. Long-term care system governance

    Accountability is an issue in LTC services in Israel, due to the private and insular nature of Israel’s predominant culture of at-home LTC services. The creation and implementation of a national care coordinator and a working group to streamline LTC enrolment and increase transparency were explicit components of the 2018 governmental reform. Results of the effectiveness of this rollout have been unclear, and undoubtedly interrupted by the COVID-19 pandemic.

  • 1.07. Care coordination and personalization

    There is a blurred line separating medical and functional assistance. Generally, the tendency is to leave patients in their homes (community-based care), with the primary task of LTC defined as practical, mental and social assistance in functioning, with limited medical intervention.  The Israeli healthcare system is a national health insurance plan that provides universal coverage to all Israeli citizens or residents. All residents register with one of four competing non-profit health plans (HP’s).  The HP’s are reponsible for geriatric and complex care and has dominated the discourse regarding services for the vulnerable during the pandemic (source: Traub Centre). Community long-term care is a branche of social insurance while institutional LTC is under the supervision of the Ministry of Health (MoH) and the Ministry of Welfare and Social Affairs (MoWSA) . The large percentage of privately funded LTC services and the widespread culture of unpaid, family caregiving suggest a lack of ease that social care users have with understanding, navigating, and accessing the full extent of LTC services.

  • 1.08. Information and monitoring systems 

    The Israeli National Insurance (IN) publishes annual reports and regular studies on community-based LTC resource allocation and service outcomes. Information on vulnerable and older adult populations in need of care services is also gathered through various social policy think tanks and NGOs: JDC (Joint Distribution Committee)-Eshel (source: The Joint), which conducts an extensive study of care users and produces annual reports on aging. The evaluations of resource allocation and services are shared with the Israeli Government (source: Myers-JDC-Brookdale Institute.  JDC-Eshel in partnership with Mashav produce an annual statistical yearbook of Israel’s aging and care user populations (source: Myers-JDC-Brookdale Institute).

  • 1.09. Care home infrastructure

    As of 2017, amongst OECD countries, Israel had one of the lowest numbers of LTC beds available in its hospitals at 23.6 beds per 1000 people aged 65+ (the OECD average is 47.2 beds) (source: OECD). Notably, The proportion of people aged 65+ who receive LTC in institutions in Israel is the lowest among OECD countries (under 2%), while the number of recipients of care in the community is among the highest in these countries (source: Muir, 2017).

  • 1.11. Workforce conditions: pay, employment conditions, qualification levels, shortages

    Israel holds a significantly higher ratio of LTC providers to older population compared to other countries, with 11.1 LTC

    Israel holds a significantly higher ratio of LTC providers to the older population compared to other countries, with 11.1 LTC workers available per 100 people aged 65+ (e.g. the UK’s ratio is 3.3 for every 100) (source: OECD).

    Israel is listed as a country that subsidizes education to attract people into LTC training, including the provision of scholarships for nurses specializing in geriatric care (source: OECD).

    Personal, at-home caregivers make up approximately 90% of the LTC workforce in Israel, with the majority of around-the-clock workers consisting of migrants from Southeast Asia (70,00 migrant care workers are currently hosted by Israel, nearly 40% of whom are from the Philippines) who are contracted out to LTC users through agencies (source: OECDAdva). At-home care workers in Israel are granted certain rights (e.g. a separate and private room in the employer’s (user’s) home, weekly vacation days, and 2-hour rest periods). The hourly wage set for long-term care workers by the National Insurance is the minimum hourly wage; caregivers often hold multiple jobs and live on the poverty line. Those with valid work visas are provided with limited health insurance (source: Attal et al, 2020).

    Though standards for medical service delivery are particularly high and demanding, Israel’s required training qualifications for long-term caregivers in the community are amongst the lowest among OECD countries (source: Bank of Israel). Digital aids assist personal care workers in performing tasks such as taking a care recipient’s temperature or blood pressure (source: OECD).

  • 1.12. User voice, choice and satisfaction

    Choice of LTC service is highly dependent on financial means and ability to acquire private LTC services. Eligibility with NII to receive state-funded services is dependent on certain proofs of retirement, disability, need, lack of income.

  • 1.13. Equity

    Extensive reliance on private funding has given rise to inequality in LTC services received by Israel’s older people from different socioeconomic backgrounds (source: Taub Centre).

  • 1.14 Pandemic preparedness of the Long-term care sector

    Preparedness for COVID-19 in Israel was limited, which led to considerable death toll particularly in residential care settings. A broad public outcry about the lack of testing and preparedness, as well as some contradictory directives (e.g. on visitation) ensued. On April 20th 2020, following pressure from family caregivers, and long term care managers and staff, new guidelines were established as part of the “Fathers’ and mothers’ shield” program, which specifically addressed older people in long term care settings.

    Sources:

PART 2 – Impacts of the COVID-19 pandemic on people who use and provide Long Term Care
  • 2.01. Impact of the COVID-19 pandemic on the country (total population)

    As of November 23, 2021, there have been 1,341,262 cases of COVID-19 in Israel and 8,178 deaths (Source: Clalit, 2021). According to Israel’s COVID Data Dashboard, those aged 70 and older have accounted for approximately 79% of COVID-19 related deaths in Israel so far. The pandemic was maintained at a reasonably low number of infections in Israel between February 21, 2020 (first case detected) and September 2020, with an effective first lockdown easing by May. In September 2020, the first major wave coinciding with the Jewish High Holidays resulted in a second lockdown. This first wave peaked at 6,276 cases on September 27. In tandem with a record-breaking vaccination campaign rollout, a second wave began in mid-December. The daily number of cases peaked at 8,624 on January 17, 2021, with the majority of cases due to a new, more virulent strain (Source: CGD). On November 22nd, there were only 711 new cases, assumably attributed mainly to the booster shots given to 4,054,691 Israelies.

  • 2.02. Deaths attributed to Covid-19 among people who use and provide Long-Term Care

    The first outbreak in a long-term care facility in Israel began in mid-March 2020, sixteen days after the first patient was diagnosed in Israel. Only a month after the initial outbreak, and following massive public criticism and a call for help from the managers of long-term care facilities, the Israeli government appointed a national-level team to manage the COVID-19 outbreaks in long-term care facilities. As of October 12, 2020, there have been 704 COVID-19 related deaths in long-term care facilities, which accounts for 39% of the total deaths in the population. There were 45,000 people in long-term care facilities in Israel. Therefore, the number of COVID-19 related deaths in these facilities represents 1.56% of this population . Furthermore, according to a survey, 50% of all COVID-19 related deaths occurred in residential care settings, while the overall share of people infected in care homes only amounts to 8.5%. Although the Israel Ministry of Health provides ongoing statistics concerning COVID-19 deaths, place of residence does not appear on their dashboard, even though age is used as a descriptor.

    Sources:

    Tsadok-Rosenbluth, S., Hovav, B., Horowitz, G. and Brammli-Greenberg, S., 2021. Centralized Management of the Covid-19 Pandemic in Long-Term Care Facilities in Israel. Journal of Long-Term Care, (2021), pp.92–99. DOI: http://doi.org/10.31389/jltc.75

  • 2.04. Impacts of the pandemic on access to health and social care services (for people who use Long-term Care)

    Evidence is limited, though there are some indications that adult and adult day centers for at-home care users have closed. According to the National Insurance (NI) website, day centers contacted their service users individually to help them find alternative programs.

    report from May 2020, described that special efforts were made to ensure access to a range of health services for people living in residential care settings. This includes management of chronic illnesses, treatment and care for acute medical problems, and the provision of preservative rehabilitation treatments.

    Due to the pandemic and a recurring situation in which caregivers were confined to quarantine or the care receiver was in quarantine, it had become more and more frequent that LTC recievers found themselves without a caregiver. In response, the National Insurance (NI)  published on their website a directive saying that recipients of LTC services can choose to receive the allowance in cash (instead of in-kind) if they can’t have a contracted caregiver come in.

  • 2.05. Impacts of the pandemic and measures adopted on the health and wellbeing of people who use and provide Long-Term Care

    Israel’s Ministry of Health collaborated with JDC-ESHEL, a social policy and research incubator NGO, to provide long-term carers and service users with information and resources on pandemic-related physical and mental wellbeing. Of note was their guide for caregivers of dementia patients, and efforts to combat loneliness amongst older people. The welfare and strengthening of resilience amongst older people during times of lockdown and social isolation have been of primary concern in the national COVID-19 plan for the aging (Magen Avot V’Emahot).

    One important finding was a report on the psychosocial effects of the pandemic on migrant carers which highlights a particularly unique feature of Israel’s LTC system. These carers are often vulnerable members of the workforce, working minimum wages on precarious work visas without a pathway to citizenship or permanent residency (unlike other high-income countries). During COVID-19, East Asian caregivers also faced harassment and discrimination. Issues of gender equality amongst unpaid carers were reported.

    Research conducted in long term care settings has highlighted the negative emotional impact of lockdown on caregivers and older residents. In addition, older residents also experienced deterioration in the health and physical functioning as a result of discontinuation of “unnecessary” medical and social care during the first was of the pandemic in Israel (Avidor & Ayalon, 2021, Ayalon & Avidor, 2021).

    Sources:

    Avidor, S., and Ayalon, L. (2021). “I Didn’t Meet My Mother; I Saw My Mother”: The Challenges Facing Long-Term Care Residents and Their Families in the Age of COVID-19. Journal of Applied Gerontology. https://doi.org/10.1177/07334648211037099

    Ayalon, L. and Avidor, S. (2021) ‘We have become prisoners of our own age’: from a continuing care retirement community to a total institution in the midst of the COVID-19 outbreak, Age and Ageing, Volume 50, Issue 3, May 2021, Pages 664–667, https://doi.org/10.1093/ageing/afab013

PART 3 – Measures adopted to minimise the impact of the COVID-19 pandemic on people who use and provide Long-Term Care
  • 3.01. Brief summary of the overall pandemic response (not specific to Long-Term Care)

    The pandemic was maintained at reasonably low levels of infection in Israel between February 21 (first case detected) and September 2020, with an effective first lockdown easing by May. In September, the first major wave coinciding with the Jewish High Holidays resulted in a second lockdown. This wave peaked at 6,276 cases on September 27. In tandem with a record-breaking vaccination campaign rollout, a second wave began in mid-December. The daily number of cases peaked at 8,624 on January 17, 2021, with the majority of cases due to a new, more virulent strain (Source: CGD)

    As of November 24th 2021, a total of 8,178 people died due to COVID-19. However, due to massive vaccination, there are currently (November 2021) only 6,505 individuals defined as active COVID-19 patients, and 124 defined as severely ill. As of November 23rd 2021, only 603 new cases were identified.

    The Israeli Ministry of Health was charged with leading the Government’s pandemic response, with publishing both weekly and daily press releases starting January 24, 2020. Lockdown measures were implemented the second week of March, which proved effective in terms of minimizing the rate of infection. According to the Government Stringency Index produced by the Oxford COVID-19 Government Response Tracker, the Israeli Government’s policies (e.g., stay at home orders, business closures) were most stringent in April at a score of 95 (when rates were low). In the first and second wave, the index measures were at 85 (with a significant drop to a score of 40 and a reopening of society in November 2020) (Source: Our World in Data).

     

  • 3.02. Governance of the Long-Term Care sector's pandemic response

    LTC facilities in Israel are supervised by the Ministry of Health and/or the Ministry of Welfare and Social Affairs. At the same time, the National Insurance carries responsibility for LTC services in the community.

    Early in the pandemic the vulnerability of people with LTC needs was recognized which led to the establishment of the ‘Fathers and Mothers Shield task force’. This taskforce was made up of representatives of all relevant government ministries, the Israeli army, Israeli intelligence organizations, and public sector organizations. Measures implemented by the task force include an increase in testing among residents and staff in residential LTC settings, setting up Corona Wards in geriatric hospitals and LTC facilities, and regulation around visiting. The authors of a paper assessing the management of COVID-19 in the long-term care sector concluded that the centralized management implemented in response to the pandemic ‘had led to a welcome change in LTC policy in Israel’.  At the decline of the 4th wave of the pandemic in Israel, it is hard to say that the centralized management of the pandemic in LTCFs will impact broader and long-term changes regarding the organization of the LTC system in Israel (Tsadok-Rosenbluth, 2021).

    Sources:

    Tsadok-Rosenbluth, S., Hovav, B., Horowitz, G. and Brammli-Greenberg, S., 2021. Centralized Management of the Covid-19 Pandemic in Long-Term Care Facilities in Israel. Journal of Long-Term Care, (2021), pp.92–99. DOI: http://doi.org/10.31389/jltc.75

  • 3.02.01. National or equivalent Covid-19 Long-Term Care care taskforce 

    Following an outbreak in LTCFs in mid-March and a national outcry for the need of increased attention to LTC-specific needs, Israel’s Government rolled out a national task force and plan entitled ‘The Fathers and Mothers Shielsd’ (Magen Avot V’Emahot) in April 2020 (Source: Ministry of Health). The task force served as a coordination effort catered explicitly to the care and concerns of LTCFs, ‘to ensure national resilience and protect the elderly populations and the population of people with disabilities staying in out-of-home settings, while providing optimal care in a comprehensive national vision’ (Source: Health.Gov). Among some of the top priorities of this project were: increasing the scope of COVID-19 testing in LTCFs, including in those with no identified COVID-19 patients; upgrading protection measures for both staff and residents of LTCFS, including (dis)infection training; prohibiting LTCF staff members from working in more than one facility; and allowing families to visit only in special instances (and subject to rules of social distancing) (Source: Tsadok-Rosenbluth et al, 2021).

    References:

    Tsadok-Rosenbluth, S., Hovav, B., Horowitz, G. and Brammli-Greenberg, S., 2021. Centralized Management of the Covid-19 Pandemic in Long-Term Care Facilities in Israel. Journal of Long-Term Care, (2021), pp.92–99. DOI: http://doi.org/10.31389/jltc.75

     

  • 3.02.03. Measures to support, facilitate and compensate for disruptions to access to care

    Oversight of COVID-19 has been given to the Ministry of Health, which set up the National Coronavirus Information and Knowledge Centre alongside the armed forces (IDF) Intelligence Directorate. Oversight the extension of welfare benefits is in the hands of the National Insurance.

    In the COVID-19 Economic Plan first released in April 2020, under immediate civil and health provisions, measures towards the reduction of risk for high-risk populations included: 130,000 hot meals to older people and people in-need, bi-weekly groceries baskets, and food vouchers for at-risk families, people with disabilities living in the community, and people with mental health problems in the community.

    Many day centers for older people were closed due to coronavirus. According to the National Insurance website, day centers contacted their service users individually to help them find alternative programs (Source: GOV.IL). However, day centers reopened in July, 2020.

    It is important to note that over time, specific guidelines were developed for different types of settings. For instance, continuing care retirement communities (called sheltered housing in Hebrew). These settings that cater to independent and relatively affluent older people) now have their own specific guidelines. Hence, there is now a better understanding of the unique characteristics of different LTCFs.

  • 3.03. Monitoring Covid-19 impacts in the Long-Term Care sector: data and information systems

    COVID-19 is being tracked by the Israel Ministry of Health’s Data Dashboard. The Ministry has introduced a smartphone app, HaMagen (“The Shield”), for their track and trace programme. The Ministry’s Center for Disease Control also publishes a broader surveillance of respiratory viruses each week. Israel has an extensive and highly digitized online medical system. This made the creation of appointment smartphone apps to set up automatic scheduling and appointment reminders for vaccination relatively easy (Video:14:10). Nonetheless, the Dashboard does not post data concerning LTCFs. Daily reports of the monitoring and operations of the national task force were published on the task force’s website daily until February 2021 [in Hebrew].

  • 3.04. Financial measures to support users and providers of Long-Term Care

    At the beginning of April 2020 the LTCFs management and owners have cried for financial help. After many discussions (and one canceled High-court appeal), they received some support, mainly for the purchase of PPE. A few months later, some institutions received direct financial support mainly for openning inpatient Covid-19 wards within the facilities (primarily Geriatric institutions and hospitals) and for increasing caregivers shifts (source: Health.GOV).

    Some have criticized the Ministry of Health for transferring funds to institutions without proper oversight of the intended use of those grants (source: Calcalist).

    Care receivers in the community were entitled to replace the in-kind benefit with a cash benefit due to the lack of available caregivers and the concern some families had of having a non-family caregiver entering the older person’s household.

  • 3.05. Long-Term Care oversight and regulation functions during the pandemic

    Regulation guidelines in LTCFs during COVID-19 that overrode regular protocols were issued by the national taskforce, The Shield of the Fathers and Mothers. Three of the major policy measures that had particularly important impacts were: the increased testing in LTCFs; the re-evaluation of family visitation policies; and the opening of specialized COVID-19 wards within LTCFs (to reduce the burden on general hospitals and stop the spread of infection from LTCFs to local communities). A study has been published outlining the adaptation and level of success.

  • 3.06. Support for care sector staff and measures to ensure workforce availability 

    Reports of increased volunteerism to assist NGOs and care sector staff are available, although there is limited information on formal processes (source: Haaretz).

    In Israel, the Ministry of Health made special teams available for periods of 7 to 14 days to support residential care settings that were acutely short-staffed, and a 24 hour call center was established to support LTC facility managers with medical and management advice (source: EuroHealth, 2020)

    The Government also enacted emergency measures to ensure the availability of migrant home care workers in Israel. As of July 20th, 2021, the work permit of 3,000 migrant home care workers was extended to ensure continued care for older people during the pandemic (source: The Marker).

    This regulatory ease did not solve the shortage of foreign workers in the field of LTC because this guideline does not apply to a foreign worker in case the care receiver named on the working permit dies. In this case, the work visa of the foreign worker is revoked, denying the legal frame to go work for another patient. At the same time, the state did not approve the entry of new foreign workers into the country, so the shortage of foreign workers (which existed before the epidemic) only worsened. The lack of thousands of foreign workers impacted the demanded wages of the caregivers, and families report wage demands that may reach as much as NIS 15,000 a month, which has made the care impossible for many families (source: The Marker).

  • 3.07. Infection Prevention and Control measures in the Long-Term Care sector: guidance, training and implementation support

    Guidelines, procedures, and information for professional teams (e.g. public health system, justice system, medical staff, airports, food delivery systems) regarding COVID prevention and control are accessible on the Ministry of Health’s website. Guidance was timely; reports were first published in Spring 2020 and regularly updated. JDC-Eshel’s worked with the national  task force ‘TheFathers and Mothers Shield’ task forcewho are  primarily responsible for training and implementation of support of carers/people relying on care in the community. As already noted, specific regulations were developed for continuing care retirement communities, which have different characteristics from the traditional nursing homes or assisted living institutions.

  • 3.07.01. Measures in relation to transfers to and from hospital, from community to care homes and between settings

    Different measures were introduced to minimize the transfer of LTCF residents between hospitals and facilities, including the opening of specialized COVID-19 wards within LTCFs and Geriatric Hospitals for those with mild or moderate cases. Required testing and potential quarantining following hospital visits and before returning to facilities was also introduced (source: Tsadok-Rosenbluth et al, 2021).

    Magen David Adom is the state ambulance and emergency medical service, providing primary assistance for testing, vaccination and ambulatory transfers between hospitals, care homes, and communities (source: MDAIS).

    It is important to note that coordinating the transfers and publishing directives to ensure successful and smooth transfers were one of the issues the task force managed.

    Sources:

    Tsadok-Rosenbluth, S., Hovav, B., Horowitz, G. and Brammli-Greenberg, S., 2021. Centralized Management of the Covid-19 Pandemic in Long-Term Care Facilities in Israel. Journal of Long-Term Care, (2021), pp.92–99. DOI: http://doi.org/10.31389/jltc.75

  • 3.07.02. Approach to isolation of people with confirmed or suspected Covid-19 infections in care homes

    Several LTC homes set up COVID wards and/or isolation areas within their institutions to limit the number of people in need of ambulatory transfer to hospitals. Medical geriatric centres were also asked to open at least one ward dedicated to mild or moderate COVID-19 cases; if cases became severe, patients were transferred to a general hospital. Due to lack of post-hospital geriatric support, many older people with COVID-19 remained in isolated recovery in hospital.

    References:

    Tsadok-Rosenbluth, S., Hovav, B., Horowitz, G. and Brammli-Greenberg, S., 2021. Centralized Management of the Covid-19 Pandemic in Long-Term Care Facilities in Israel. Journal of Long-Term Care, (2021), pp.92–99. DOI: http://doi.org/10.31389/jltc.75

  • 3.07.03. Care homes: visiting and unpaid carer policies

    Visiting policies in care homes were found to be very inconsistent and restrictive early on, causing confusion for LTCF staff, residents and families. In Summer 2020, the national LTC pandemic taskforce, Shield of the Fathers and Mothers, issued a statement encouraging family visitation under social distancing guidelines, citing psychological health as the primary driver. Many LTCFs however adopted stricter policies and prohibited visitation altogether. The Ministry of Health maintained a pro-visitation policy for LTCFs in low-morbidity areas after the nationwide lockdown during the September second wave, arguing that “To date, there has been no reported cases of COVID-19 infections in LTCFs arising from a family visit”.

  • 3.07.04. Deployment of "squads" or rapid response teams to support care homes with outbreaks or staff shortages

    The Israeli Army Home Front Command was called to assist in LTCF disinfection during three major facility outbreaks in mid-2020 (in a Jerusalem LTCF for older people, in a LTCF for older people in the South, and in a LTCF for disabled adults and children in central Israel) (Sharona Tsadok-Rosenbluth et al, 2020).

    As the pandemic carried on, Israel’s army supplied critical response teams to support care homes and users, providing contract tracing, testing, medics, and vaccination support, and 29 quarantine locations nationwide (Nikkei AsiaThe Telegraph).

  • 3.08. Access to testing and contact tracing for people who use and provide Long-Term Care

    Access to testing in Israel was considered slow in Spring 2020, and ramped up by summer with the promise of 20 million tests by the end of 2020.

    The national task force for managing the pandemic in the LTCFs (‘The Fathers and Mothers Shield’) changed the testing policy in early May 2020 from testing symptomatic staff and residents to regular screening regardless of known COVID-19 presence. Numbers gathered from these screenings were deemed key figures in determining potential outbreaks, and rates of illness decreased dramatically (and proportionally with the nationwide numbers) by early June 2020.

  • 3.09. Access to Personal Protection Equipment (PPE) in the Long-Term Care sector

    Israel faced limited PPE alongside most of the globe during its first lockdown in March/April. Equipment was scarce, especially in hospitals and other health providers treating patients. In April 2020, the LTCF Association submitted an ‘urgent petition’ to the Israeli Supreme Court, which included an emergency budget for protective gear. The petition was rejected but became one of the main objectives of the national task force that organized central purchase of PPE for all LTC institutions and also surpervised the management of the PPE stock in all LTC facilities. (Tsadok-Rosenbluth et al, 2021). Little has been reported on the matter since, except for some coverage in September that indicated a shortage of gloves and robes/protective suits headed into the second wave (source: Times of Israel).

  • 3.10. Use of technology to compensate for difficulties accessing in-person care

    The Administration of Disabilities at the Ministry of Welfare and Social Affairs provides services for people with intellectual developmental disabilities and other cognitive disabilities, individuals with autism, and individuals with sensory and motor disabilities. The initial action plan for COVID-19 included a transition to virtual education and community-building programs, the upstart of a food distribution program, and technology (e.g. tablet) distribution.

    JDC Eshel in collaboration with the Ministry for Social Equality and Digital Israel have put forth the development of digital technology among people over the age of 60 as one of their goals, especially during the pandemic.

  • 3.11. Vaccination policies for people using and providing Long-Term Care

    Israel has been globally recognized for its vaccination rollout. By early February 2021, over 90% of individuals aged 60 years and older had received their first vaccine; by end of March some reports said that almost all nursing home patients have received both doses. According to Ran Balicer, Chief Innovation Officer of Clalit Health Service and Chair of the Ministry of Health’s COVID-19 National Experts Team, much of the success of the scheme was due to its simplicity of prioritization categories.

    Some studies of how successfully the vaccination program is within residents of LTCF and geriatric hospitals as well as the LTC workforce have been published and some are underway. A recent study showed evidence of the high effectiveness of the BNT162b2 COVID-19 vaccine (Biontech/Pfizer) in preventing the acquisition of SARS-CoV-2 infection within the LTCF workfoce. The researchers conclude that the rapid deployment of Covid-19 vaccines among the LTCF workforce and residents of LTCFs should be a high priority globally to reduce fatalities and transmissions of the virus. Another recent study highlighted the key role that Israel’s emergency ambulatory services, Magen David Adom, had in coordinating paramedic-led teams that were focused almost exclusively on vaccinating geriatric hospitals.

    By February 2nd, 2021, Magen David Adom, the national emergency services system in charge of the vaccination rollout in LTCFs, announced it had completed its vaccination of all residents and employees of LTCFs (sheltered housing and nursing homes in Israel) – the first country in the world to do so.

    The Green Passport gives vaccinated people access to most places in society and is seen as an incentive towards vaccination. There was some discussion of mandatory vaccination but this has not been taken forward.

    At the end of July 2021 it was announced that Israel would start offering a third dose of the vaccine to the whole population aged 60 or over. As already noted, currently, 4,056,586 people have received  the third jab.

  • 3.12. Measures to support unpaid carers

    Information on support to unpaid (family) carers is unclear beyond the stipend received by all citizens and increased accessibility of unemployment benefits; an updated January 2021 guidelines document is available, which lists counseling services and call centers as primary measures for support.

    The Ministry of Health also provided a guide for carers of people with dementia.

PART 4 – Reforms to strengthen Long-Term Care systems and to improve preparedness for future pandemics and other emergencies

Printable version of this country profile:

https://ltccovid.org/country/israel/

To cite this report (please note the date in which the report was accessed):

Ayalon L., Brammli-Greenberg S., Lauter S., Tsadok-Rosenbluth, S. COVID-19 and the Long-Term Care system in Israel. In: Comas-Herrera A., Marczak J., Byrd W., Lorenz-Dant K., Pharoah D. (editors) LTCcovid International Living report on COVID-19 and Long-Term Care. LTCcovid, Care Policy and Evaluation Centre, London School of Economics and Political Science. https://doi.org/10.21953/lse.mlre15e0u6s6


Previous LTCcovid report on Israel (May 2020)

https://ltccovid.org/wp-content/uploads/2020/05/The-COVID-19-Long-Term-Care-situation-in-Israel-4-May.pdf

Acknowledgement and disclaimer:

This report has built on previous LTCcovid country reports and is supported by the Social Care COVID-19 Resilience and Recovery project, which is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333) and by the International Long-Term Care Policy Network and the Care Policy and Evaluation Centre at the London School of Economics and Political Science. The views expressed in this publication are those of the author(s) and not necessarily those of the funders.

Copyright: LTCCovid and Care Policy and Evaluation Centre, LSE