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4 lowenstein prague with mary mc call may 2012


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4 lowenstein prague with mary mc call may 2012

  1. 1. Planning and DevelopingIntegrated Communities in Israel Lecture, IFA Global Conference, Prague, May 2012 Prof. Ariela Lowenstein, Gerontology Dept., Center for Research and Study of Aging, University of Haifa Head, Dept. of Health Services Management, Yezreel Academic College, Israel 1
  2. 2. Lecture OutlineFactors related to service planningAging populationsThe socio-demographic picture of IsraelPolicy and Legislation in IsraelContinuum of CareDifferent service modelsIssues and changes neededImplications for Policy 2
  3. 3. Factors Affecting Service Planning and DesignDemographic DevelopmentsComposition of Various Aged GroupsGlobal Perceptions – Ageing in Place, Active AgeingSocietal Norms and Culture, ReligiositySocial and Political Fabric – Policy & LegislationExamples of integrated services 3
  4. 4. Population AgingThe new millennium of the 21st century confronts us withnumerous challenges regarding the aging societies of themodern world. 4
  5. 5. Population Aging In developed nations – phenomenon of global aging More elders aged 75+, thus more dependency and need for care Need for more support from state and family Center for Research & Study of Aging IAGG 5 collaborating Center
  6. 6. Composition of Aged Cohorts Young – old: 65-74 Old-old: 75-84 Oldest –old: 85+ Centenarians: 100
  7. 7. Changing DemographicsPopulation aging is not necessarily apocalypticfor individuals, families, societiesChanged balance between generations –challenge for social inclusion and integrationAging can be a risk factor, or an opportunity 7
  8. 8. Vienna Int’l Plan of Action on Ageing (1982) Vienna Conference logo‘A longer life provides humans with an opportunityto examine their lives in retrospect, to correctsome of their mistakes, to get closer to the truthand to achieve a different understanding of thesense and value of their actions.’ 8
  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’. 9
  10. 10. Elder Care Networks in Israel – Norms, Culture and ReligiosityIsrael is multi-cultural, pluralistic, and democratic, including avariety of national, religious, and ethnic groupsIsrael an urbanized welfare state, relying on a mixture of govt. andmarket forces that shape its welfare policies and servicesPopulation diversity affect needs, expectations, and patterns of supportThus, Israel serves as a natural laboratory for understanding effectsof culture and ethnicity. 10
  11. 11. DemographyIn 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 Jewishsector, elders’ percentage is close to 12%. Among non-Jews, elderscomprise only 5.2%, due to higher fertility ratesClose to 19% of Jewish elders are disabled in ADL. Among non-Jews –close to 31% 11
  12. 12. ‫% 56+ (0302 – 5591) – ‪Israel‬‬‫מקור: זקנים בישראל, עובדות ומספרים, 9002‬
  13. 13. Family status and living arrangementsMost aged have an informal support network, withspouses the main source, followed by childrenThere is a strong emphasis on family role in elder care,reflected, for example, in the low institutionalization rate:4.4%; The Alimony Law, 1958. 13
  14. 14. The Israeli Welfare State - Aged PolicyA country’s social system and professional practice areaffected by historical, religious, and cultural forces - placegreat emphasis on social and familial responsibility .Political structure and population heterogeneity also shapeservice planning and delivery - the principle of culturaland ethnic pluralism 14
  15. 15. Policy and the Service SystemBasic 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. 15
  16. 16. The ageing policy challengeDependency ratioLabour supplyMeaning and purpose- being retired is notbeing adultWhat is the social contract for olderpeople? – How could we empower andhelp them stay active and involved? 16
  17. 17. Social capitalImportant 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 17
  18. 18. Policy and the Service System in IsraelFour major sectors are involved in service provision:Government agenciesTrade unionsVoluntary organizationsThe private sector 18
  19. 19. Policy and the Service SystemIn each local authority the local welfare office has toprovide services to needy, including elders.Major community services: pensioner clubs; day carecenters for frail and mentally frail elders; supportiveneighborhoods; meals on wheels; activating volunteers 19
  20. 20. Policy and the Service SystemPrimary and acute health care are provided by 5 SickFunds )HMO’s( through primary health clinics in everyneighborhood, and activate home-nursing programs.Currently an attempt to develop an integrated servicemodel – with strong collaboration between the clinics, daycare centers, hospitals, social services and informal carers 20
  21. 21. Policy and the Service SystemIn 1969 the Ass. for Planning and Development of Servicesfor the Aged (ESHEL) was created to: coordinate activities ofthe various ministries; to promote service planning on anational level; to develop partnerships between public andvoluntary sectors.In each community Local Associations for the Aged werecreated, with representation of local service providers andelders 21
  22. 22. What Should be the Appropriate ? Balance Formal Service CareInformal Family Care 23
  23. 23. Changing family preferences for careSocieties unable or unwilling to continue support forolder cohorts, alters family-society elder care balance(Lowenstein & Daatland, 2006; Walker, 2000)Socio-political & policy challenges to social integrationA new generational contract is needed on individual,familial, & societal levels - should be further studied 24
  24. 24. Models for Service DevelopmentThere are several models for service provision tofamilies with elder membersThe substitution approach - A Scandinavian model,favoring direct govt. involvement, supplying rathergenerous services, mostly public 25
  25. 25. Models for Service DevelopmentThe conservative model of continental Europe, leaningheavily on insurance-based arrangements.US liberal regime, limited residual state responsibility.Countries with a more traditional-familial view and afamily-based social policy, like Israel, a complementaryapproach - responsibility is shared and services aredeveloped to assist caring families 26
  26. 26. Complementarity versus substitutionData 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 27
  27. 27. Policy ImplicationsIn 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 familyculture that guides readiness to use public services;(b) availability, accessibility, quality, and cost ofservices.Thus, services must help families define theirwillingness; Families should be compensated for thecare they provide. 28
  28. 28. Thank You 29