Israel

Despite this rich network of services, at the beginning of the twenty-first century Israel has to find responses to a number of emerging issues. Because of the growing number of elderly persons who are healthy and independent, programs must be developed to increase their involvement in the workplace, community, and family life in order to improve their health and quality of life and to reduce their needs for social and health services. Israel must also address the challenge of providing appropriate services for a large number of elderly people with diverse cultural backgrounds and languages who live in the same communities. Developing and expanding training programs for formal care providers in order to ensure the quality of services is another important social challenge.

The multiple various services which differ in ownership, responsibility, and financing result in duplications, inefficiency in the provision of services, and fragmentation in the continuity of care. This situation is confusing to the disabled persons, their families, and to formal caregivers. Changes in financing arrangements and the establishment of coordinating mechanisms, which will ensure access to comprehensive, continuous, and efficient care to all are critical (Clarfield et al., 2000).

Families have a dominant role in caring for elderly people in Israel. Most of the main care-givers are women, either spouses or daughters. With the decrease in the number of children per family, and increases in longevity, the number of dependent parents will significantly increase. This load will become heavier with the years, when the middle aged and young-old women, many of whom will be frail themselves and still working outside home, will have to care for a number of older relatives, as well as for their husbands, children, and grandchildren. In 1999 about 10 percent of the Israeli population over age sixty-five had older parents, and 42 percent of them took care of their parents on a daily basis. The parent support ratio (persons eighty and over divided by population age fifty to sixty-four) increased from 57 per thousand in 1961 to 192 in 1997. The development of supportive services for family and other informal caregivers will become one of the goals of the future. The increasing ratios of dependency on the national level will also have economic implications for the whole society, which will require such changes as raising the age of retirement and revisions in the pension system.