Learning From Israel’s Approach to Caring For the Elderly

In their book, Putting People First: How We Can All Change America, Bill Clinton and Al Gore wrote of older Americans: “The generation that worked its way out of the Great Depression, won the Second World War, and endured the worst of the Cold War has seen harder times than these. But older Americans know that we can do better—by them and by future generations.”

Older Israelis have certainly seen harder times. Many are Holocaust survivors and veterans of Israel’s six wars. Moreover, as in most Western countries, the number of older people in Israel continues to increase: both the disabled elderly, who require some form of long-term care services, and the well elderly, who need assistance and encouragement to continue to lead productive and independent lives. Jewish tradition emphasizes respect for the elderly and Israel has always made meeting the needs of its older Jewish and non-Jewish citizens a priority. Suspecting that the United States could learn valuable lessons from the Israeli experience, the American-Israeli Cooperative Enterprise commissioned a study by the JDC-Brookdale Institute of Gerontology and Human Development to evaluate Israeli approaches to caring for the elderly. The final report identified 16 innovative national and local programs for the elderly that could be imported for the benefit of older Americans in the areas of: Long-term care; voluntarism and productive aging; housing and aging in place; educational programs and planning and development of services.

One program is used to monitor and improve care in nursing homes by using a set of well-defined and frequently occurring problems that serve as “tracers” for the evaluation of care. Several others are aimed at avoiding institutionalization and incorporating the elderly into the community. At the national level, for example, Israel provides benefits for seniors that are supplements to family care, which have delayed or prevented institutionalization of the less severely disabled by reducing the burden on the family and increasing the well-being of the older person.

Day care centers have also been established at a lower cost than in the United States. These centers are based on a social rather than medical model and emphasize care by the community rather than institutions. They also provide special assistance for the cognitively impaired (e.g., people with Alzheimer's). Israel has also developed intergenerational housing arrangements that do not separate older people from the rest of the population, but rather encourage young and old to develop stronger bonds and assist each other.

With a population that includes a disproportionate number of people over 75, the cost of care might exceed the nation's means if it had not successfully developed innovative models of volunteer assistance, including networks that provide medical supplies, equipment and services, counseling centers and monitors of the condition of older citizens and the quality of their care. Yad Sarah is a volunteer service organization that provides rehabilitative, medical and para-medical equipment and some 20 additional supportive services at no cost to recipients. Since its establishment in 1976, Yad Sarah has grown from a home-based service lending humidifiers to neighbors to a nationwide organization providing a range of home-care equipment and services to meet the needs of the homebound. This spirit of voluntarism is shared by Americans, but has not yet been mobilized for the benefit of our older citizens to the extent it has in Israel.

Israel also believes its older citizens can make significant contributions to the nation. Programs encourage them, for example, to volunteer for activities such as aides at preschools. They also are given opportunities to work as craftspeople in workshops that are adapted to their needs. Special programs have been created to allow older Israelis to attend college, and to take special courses in areas like basic computing, so they can continue their educations and learn new skills. One university program was designed to utilize their expertise and experience to conduct research on issues of particular interest to the aged.

Most of the programs described in the report can be adapted for use in the United States at minimal cost. Some programs cannot be transferred without being modified and others may have elements that are more innovative than others. The study offers policymakers, care-givers, professionals and advocates ideas of how we can do a better job of caring for older Americans. This is yet another example of how a value shared by the two nations—respect for the elderly—can be translated into a benefit for America.