1. 1 Planning and Developing Integrated Communities in Israel Lecture, IFA Global Conference, Prague, May 2012 Prof. Ariela Lowenstein, Gerontology Dept., Center Prof. Ariela Lowenstein, Gerontology Dept., Center for Research and Study of Aging, University of Haifa for Research and Study of Aging, University of Haifa Head, Dept. of Health Services Management, Yezreel Head, Dept. of Health Services Management, Yezreel Academic College, Israel Academic College, Israel ariela@research.haifa.ac.il ariela@research.haifa.ac.ilariela@research.haifa.ac.il

2. 2 Lecture Outline Factors related to service planning Aging populations The socio-demographic picture of Israel Policy and Legislation in Israel Continuum of Care Different service models Issues and changes needed Implications for Policy

3. 3 Factors Affecting Service Planning and Design Demographic Developments Composition of Various Aged Groups Global Perceptions – Ageing in Place, Active Ageing Societal Norms and Culture, Religiosity Social and Political Fabric – Policy & Legislation Examples of integrated services

4. 4 Population Aging The new millennium of the 21st century confronts us with numerous challenges regarding the aging societies of the modern world.

5. 5 Population Aging  In developed nations – phenomenon of global aging phenomenon of global aging  More elders aged 75+, thus more dependency and need for care dependency and need for care  Need for more support from state and family and family Center for Research & Study of Aging IAGG collaborating Center

6. Composition of Aged Cohorts Young – old: 65-74 Old-old: 75-84 Oldest –old: 85+ Centenarians: 100

7. 7 Changing Demographics Population aging is not necessarily apocalyptic for individuals, families, societies Changed balance between generations – challenge for social inclusion and integration Aging can be a risk factor, or an opportunity

8. 8 Vienna Int ’ l Plan of Action on Ageing (1982) ‘ A longer life provides humans with an opportunity to examine their lives in retrospect, to correct some of their mistakes, to get closer to the truth and to achieve a different understanding of the sense and value of their actions. ’ ‘ A longer life provides humans with an opportunity to examine their lives in retrospect, to correct some of their mistakes, to get closer to the truth and to achieve a different understanding of the sense and value of their actions. ’ Vienna Conference logo

9. 9 Madrid Int ’ l Plan of Action on Ageing (2002) Article 10: ‘ the potential of older persons is a powerful basis for future development. This enables society to rely increasingly on the skills, experience and wisdom of older persons, not only to take the lead in their own betterment but also to participate actively in that of society as a whole ’.

10. 10 Elder Care Networks in Israel – Norms, Culture and Religiosity Israel is multi-cultural, pluralistic, and democratic, including a variety of national, religious, and ethnic groups Israel an urbanized welfare state, relying on a mixture of govt. and market forces that shape its welfare policies and services Population diversity affect needs, expectations, and patterns of support Thus, Israel serves as a natural laboratory for understanding effects of culture and ethnicity.

11. 11 Demography In 2011 Israel’s population was 7.6 million, 80% Jews and 20% non- Jews. The aged (65+) comprise 10% Differences exist between Jewish and non-Jewish aged. In the Jewish sector, elders’ percentage is close to 12%. Among non-Jews, elders comprise only 5.2%, due to higher fertility rates Close to 19% of Jewish elders are disabled in ADL. Among non-Jews – close to 31%

12. % 65+ (2030 – 1955) – Israel מקור: זקנים בישראל, עובדות ומספרים, 2009

13. 13 Family status and living arrangements Most aged have an informal support network, with spouses the main source, followed by children There is a strong emphasis on family role in elder care, reflected, for example, in the low institutionalization rate: 4.4%; The Alimony Law, 1958.

14. 14 The Israeli Welfare State - Aged Policy A country’s social system and professional practice are affected by historical, religious, and cultural forces - place great emphasis on social and familial responsibility. Political structure and population heterogeneity also shape service planning and delivery - the principle of cultural and ethnic pluralism

15. 15 Policy and the Service System Basic objectives of service delivery to elders: (1) To enable maintaining maximum self-sufficiency and continue living in the community as long as possible - Ageing in Place; (2) To enable active participation in society, considering their diversity and heterogeneity.

16. The ageing policy challenge Dependency ratio Labour supply Meaning and purpose- being retired is not being adult What is the social contract for older people? – How could we empower and help them stay active and involved? 16

17. 17 Social capital Important to use social capital inherent in the growing “ young-old ” population - activating political power. In Israel the Senior Citizens party which caused the creation of a Senior Citizens Ministry Raising retirement age, as one form of preparing for societal aging; has been discussed and suggested in all OECD countries (e.g., Duval, 2004) The state and private sector should develop programs to provide incentives for older workers to stay in workforce

18. 18 Four major sectors are involved in service provision: Government agencies Trade unions Voluntary organizations The private sector Policy and the Service System in Israel

19. 19 Policy and the Service System In each local authority the local welfare office has to provide services to needy, including elders. Major community services: pensioner clubs; day care centers for frail and mentally frail elders; supportive neighborhoods; meals on wheels; activating volunteers

20. 20 Policy and the Service System Primary and acute health care are provided by 5 Sick Funds (HMO’s) through primary health clinics in every neighborhood, and activate home-nursing programs. Currently an attempt to develop an integrated service model – with strong collaboration between the clinics, day care centers, hospitals, social services and informal carers

21. 21 Policy and the Service System In 1969 the Ass. for Planning and Development of Services for the Aged (ESHEL) was created to: coordinate activities of the various ministries; to promote service planning on a national level; to develop partnerships between public and voluntary sectors. In each community Local Associations for the Aged were created, with representation of local service providers and elders

23. 23 What Should be the Appropriate Balance ? Informal Family Care Formal Service Care

24. Changing family preferences for care Societies unable or unwilling to continue support for older cohorts, alters family-society elder care balance (Lowenstein & Daatland, 2006; Walker, 2000) Socio-political & policy challenges to social integration A new generational contract is needed on individual, familial, & societal levels - should be further studied 24

25. 25 Models for Service Development There are several models for service provision to families with elder members The substitution approach - A Scandinavian model, favoring direct govt. involvement, supplying rather generous services, mostly public

26. 26 Models for Service Development The conservative model of continental Europe, leaning heavily on insurance-based arrangements. US liberal regime, limited residual state responsibility. Countries with a more traditional-familial view and a family-based social policy, like Israel, a complementary approach - responsibility is shared and services are developed to assist caring families

27. 27 Complementarity versus substitution Data show:  Welfare state services do not erode family solidarity. Mostly the emphasis was on complementarity  Alongside service provision, the family specializes in forms of support suiting her best – emotional support support suiting her best – emotional support

28. 28 Policy Implications In the future, elder care will be by public-private mix, the exact ratio varying by country. Specifics of the mix will depend on : (a) the family culture that guides readiness to use public services; (b) availability, accessibility, quality, and cost of services. Thus, services must help families define their willingness; Families should be compensated for the care they provide. Thus, services must help families define their willingness; Families should be compensated for the care they provide.

29. 29 Thank You