The Israeli Experience of Advancing Policy and Practice in the Area of Elder Abuse and Neglect

By Ariela Lowenstein

The WDA-HSG Letters on Demographic Issues

No. 2007 /1

MANAGING EDITORS:

Monika BÜTLER Professor, University of St.Gallen, Switzerland Ilona KICKBUSCH Professor, Graduate Institute of International Studies, HEI, Geneva Alfonso SOUSA-POZA Director, World Demographic Association, Switzerland Professor, University of Hohenheim-Stuttgart, Germany

ADVISORY BOARD OF THE WORLD DEMOGRAPHIC ASSOCIATION

Marcel F. BISCHOF Founder of the World Demographic Association, Spain David E. BLOOM Clarence James Gamble Professor of Economics and Demography, Harvard University, USA David COLEMAN Professor of Demography, Department of Social Policy and Social Work, University of Oxford, UK Joseph COUGHLIN Director and Professor of Technology, AgeLab, Massachusetts Institute of Technology (MIT), US Rogelio FERNANDEZ-CASTILLA Director, United Nations Population Fund, Technical Support Division, USA Monica FERREIRA Professor and Director of Ageing, The Albertina and Walter Sisulu Institute of Aging in Africa, University of Cape Town, South Africa Oliver GASSMANN Director and Professor of Innovation Management, Institute of Technology Management, University of St. Gallen (HSG), Switzerland Patrik GISEL Deputy Chairman of the Executive Board, Marketing & Distribution, Raiffeisen Group, Switzerland Peter GOMEZ Chairman of the Board, Swiss Exchange (SWX), Switzerland Toshihiko HASEGAWA Director, Department of Policy Sciences, National Institute of Public Health, Japanese Ministry of Health, Labour and Welfare, Japan Alexandre KALACHE Head Ageing and Life Course Programme, World Health Organisation (WHO), Brasil Ursula LEHR Professor of Psychology, Former German Minister of Health and Family, founding Director of the German Centre for Research on Ageing, Germany John MARTIN OECD Director for Employment, Labour and Social Affairs, OECD, France Jean-Pierre MICHEL Professor, Director of the Department of Geriatrics, University Hospitals of Geneva, Switzerland Hiroyuki MURATA President, Social Development Research Center, Japan Jeffrey L. STURCHIO Vice President, External Affairs, Europe, Middle East, Africa & Canada, Merck & Co. Inc., USA Philip TAYLOR Professor of Employment Policy, Faculty of Business and Enterprise, Swinburne University, Australia Alan WALKER Professor & Director of ESRC Growing Older Programme, Sheffield Institute for Studies on Ageing, University of Sheffield, UK Erich WALSER Chairman of the Board of Directors and CEO of the Helvetia Patria Group, Helvetia, Switzerland Qin XU Professor and Deputy Director, China Research Centre on Aging, China

Main partners of the World Demographic Association are:

Helvetia Group Raiffeisen Group Merck & Co. Inc. University of St.Gallen

This discussion paper series is kindly supported by the Ecoscientia Foundation The Israeli Experience of Advancing Policy and Practice in the Area of Elder Abuse and Neglect*

Ariela Lowenstein**

*Based in part on apaper presentedatthe 18th WorldCongress of Gerontology, International AssociationofGerontology,Rio de Janeiro, Brazil, June 26-30, 2005

**ArielaLowensteinisprofessoratthe Dept.ofMasterinGerontology andHead of theCenter forResearchand StudyofAging,Faculty of Welfareand Health Sciences,The University of Haifa, Haifa31905 Israel Abstract

Thepaper reviewsand discussesthe advancementofpolicies, research andpracticetomeetthe needsofabused andneglected olderpeopleand theirfamiliesinIsrael. Thepaper briefly presents thedemographicpicturesofthe Israelisociety whichaffectsneeds andoutlines the current welfaresystemand existinglegislationrelevanttoelder abuseand neglect.Thena descriptionofpracticeinterventions in theareaofelder abuseand neglectbased on recent research.Finally severalissues areraisedregarding future developments in this area. Introduction Themajor aimofthispaper is to review anddiscuss theadvancementofpoliciesand practice whichare geared to meet theneeds of abused andneglected elderlyand theirfamiliesinIsrael. Accordingly, this paperpresentsthe following:First,ashortoverviewofdemographicfactors andtrends,reflectingpopulationcharacteristicsand needs. Second, abrief outlineofthe current welfaresystemwill be painted, describing policiesfor olderpeopleand basicservice structures. This will provide abackground forpolicydevelopment in theareaofelder abuseand neglect. Third, developments in practiceexperiences in this area will be presentedasaffected by policy andlegislation.

TheIsraeli National Context This sectiondescribes thedemographicstructure of Israelisociety andthe changing needsof olderpersons andtheir families, focusing on immigration, ethnicity andthe role of thefamily. The2006 census showed thepopulationofIsraeltobeclose to sevenmillion, of whom 80% are Jews and20% non-Jews –Moslems,Christians andDruze.The aged (65+)compriseabout 10% of thepopulation(numbering closeto700,000) (Central Bureau of Statistics, 2006).

Differences existbetween theJewishand non-Jewish olderpopulations.Within theJewish sector,the percentage of olderpeoplehas almost tripledsince thecreationofthe StateofIsrael in 1948 andisnow closeto12%.Among thenon-Jews,however,the elderlycompriseonly 6.1%,due to higher fertilityrates (Brodsky,Shnor &Be’er,2005).However,the proportionof theelderly in theArabpopulationisincreasingmorerapidly than in theJewishcommunity.

Theaging of Israelisociety is relatedtoincreased lifeexpectancy,which is currently 78.3 yearsfor menand about 83 yearsfor women, andtothe compositionand theaging of cohorts fromprevious immigrationwaves.Sixty percentofolder persons areinthe categoryof theyoungaged(65-74),and theother 40%are 75+. Thenumberofthe 80+within thetotal aged populationhas increased considerably,constituting33% of thecurrent aged aggregate. In addition, the1990s immigrationwaves,especiallyfromthe former Soviet Union, have broughta high percentage of olderpeople-16%.

Closeto17% of theJewishelderly aredisabledinactivitiesofdaily living(ADL).The percentage is higher among newimmigrants(closeto20%)and even higher among non-Jews, nearing23% (Central Bureau of Statistics, 2006).Thisiscongruent with data from theUS indicatingthatsocio-culturalfactorsare relatedtothe incidenceofchronicdiseaseamong elders.Thisportionofthe populationneedsclosercareand assistance, whichisstillmostly providedbyfamilymembers andincertain casesmight cause incidences of abuseand neglect.

Regardingfamilystatusand livingarrangements,almost twiceasmanyelderly men(81%) than women(44%)are married.Among immigrants, overthree timesasmanywomen (52.2%) than men(14.8%)are widowed.However,the majority of olderpeoplelivewith aspouse, and thepercentage of thoselivingalone is 28%. Among thepopulationofolder newimmigrants, closeto70% livewith theirchildrendue to housingand financialdifficulties, especially during thefirst yearsafter immigration(Katz &Lowenstein, 1999).The rate of multigenerational households is similaramong theArabcommunity due to thestillstrong emphasisonthe role of theextendedfamily. In general, though,there is astrongemphasisonthe role of thefamilyin caringfor its elderly. This is reflected, forexample,inthe lowrateofinstitutionalization-4.4%. Most olderpeoplehaveaninformalsupportnetwork,with spouses as themainsource, followed by children(Habib&Tamir,1994).

Forthe future,wecan anticipatethatchanges in thecompositionofthe olderpopulation will result in continuing increaseofthe “high-risk”groups:the 75+ elderly, women, thoseof Easternorigin, andnew immigrants. Theseprojections mean that needsfor long-termcare services will rise andthatmoreresources will have to be allocated to developcommunity services andtosupportfamilycaregivers. Thus,Israelfaces thedualchallengeofmeeting current needsmoreadequately, while keepingpacewith anticipated needs.

TheWelfare StateinIsrael–PolicyBackground andServices forthe Aged Israel is apluralistic societyand an urbanizedwelfare statethatreliesonamixture of governmental andmarketforces that shapeits welfarepolicies. Thesociety represents aunique blendoftraditionalismand modernismreflectingits early socialistunderpinnings. Acountry’s social system andprofessionalpracticeare affected by theparticular society in whichtheyoperate andreflect historical,religious,and culturalforces. Political structureand populationheterogeneity also shapethe form of servicedelivery. Thus,any analysis of thesocial servicesystemmustbebased on theprinciplesand values that guided its development. In the caseofIsrael, theseare mainly threefold: First, Jewish values,religious laws,traditions,and ethics place great emphasisonsocialand familialresponsibilityand thecommitment of Israeli societytowards olderpeoplestems fromsuchJudaic sources regardingfilialresponsibility (Lowenstein, 1998).Second, theprinciple of unlimitedimmigrationfor allJewsisnodoubt a central determinantofIsrael’s existence(Bergman&Lowenstein,1988).Third,the principleof culturaland ethnicpluralismstemmingfromthe ongoing wavesofimmigrationcreates a diversityofcultural, ethnic, andreligious groups (Lowenstein&Bergman, 1988).The cultural component,with its varyinginterpretations of theroleofthe aged,the family, andthe formal network, is thus an important factor in servicedelivery(Litwin,1994).

Policyand theService System In recentyears,abasicnationalpolicygoalinservice provision to oldpersons in Israel hasbeen to move away fromthe useofresidentialfacilitiestowardthe developmentofadiversified community-based servicenetwork (Katan &Lowenstein, 1999).Community-based services are geared to assist frail andhomebound elderlytoremainintheir homes as long as feasible.

Four majorsectorsare involvedinservice provision: government agencies,trade unions, voluntaryorganizations,and theprivate sector.The threemajor governmental providers arethe Ministry of Social Affairs, theMinistryofHealth,and theNationalInsurance Institute.Minor servicedeliveryroles areplayedbythe Ministry of Absorption, whichprovidesservicesfor a definedperiodtoolder immigrants; theMinistryofHousing, whichisinvolvedinspecial housingfor theaged; andthe Ministry of Education, whichoffersadulteducation. TheNational InsuranceInstitute (Israel’ssocialsecurity system)has become thecorepolicyinstrumentfor social protection. Currently,the system includesthe following programs forthe aged:old age andsurvivorsinsurance,disabilityinsurance, andthe Long-TermCareInsurance Law.

Social andwelfare services forthe elderlyare not basedonspecificcategorical legislation. They arecovered throughthe GeneralWelfare Services Lawof1958, underwhich each local authorityischarged with establishing alocal welfareoffice to provide services to theneedy, including olderpeople. Thus,the local welfareoffice is themajor providerofservicesfor the elderlyinthe community.Itwas found that in many local welfareofficesthe aged compose closeto40% of theclient population(Litwin 1993/94).The Ministry of Social Affairs, through its Services forthe Aged Department,establishesnationalpolicyprinciples, sets eligibility guidelines andnationalprioritiesfor servicedevelopment, providesprofessionalsupervisionand budgetaryparticipation, andconducts surveillanceand supervisionofindependent andfrail elderlyinresidentialsettings (Lowenstein, 1994, 1998).The Ministry of Health,through its Department of GeriatricMedicine, is in charge of public health services in thecommunity and familyhealth clinics, mental health clinics, institutionalplacement, surveillanceand supervision of nursing andmentallyfrail elderly. Primary andacute health careisprovidedbyfivedifferent Sick Funds (HMO’s)throughprimary health clinicsthatare located in everyneighborhood.

Formanyyears,there wasnoofficial structurefor coordinatingthe activitiesofthe different Ministries.Consequently,there wasnonational-levelplanning bodytoevaluateneeds andservicesortoprepare blueprints forfutureservice developments.Thiswas remedied in 1969 throughthe creationofESHEL,the Associationfor Planning andDevelopmentofServicesfor theAgedinIsrael. ESHELrepresentsapartnershipbetween theIsraeli government (three Ministries –Health,Finance andSocialAffairs) andthe American JointDistributionCommittee (JDC). ESHELwas chargedwith thepromotionofservice planning,onanationallevel,and with theencouragement of partnerships between thepublic andvoluntarysectors. Othertasks that ESHELundertook were in theareas of manpower development, facilitatingthe creationof newinnovativeservices, advocacy, andqualityassurance. Aseriesof5-yearplans were introduced whichresultedinthe rapiddevelopmentofnew services forolder persons.The unique form of partnershipofESHEL,involving bothgovernment andvoluntaryorganizations, hasfiltereddowntothe leveloflocal andregionalassociations forthe aged (Guttmann & Lowenstein,1991, 1993).These local associations areinstrumentalinthe creationofnew community services forthe aged,and take part in shapingpolicyand programdevelopmenton behalf of theolder population.

As fornon-governmental participation, theGeneral FederationofTrade Unions has played an important role in bothdirect andindirect serviceprovision. It operates severalmajor pensionfunds,the GeneralSickFund, anetwork of social clubs that areneighborhood based, shelteredhousing, andresidentialfacilities. Thevoluntarysector operatesdirect social services fortheir oldermembers,throughimmigrants associations (Landsmanschaften) andother agencies,providing mainly social clubs andhomes forthe aged.The privatesectorusedtobe involvedmainlyinthe provision of institutionalcare, recently, this sector hasseen a proliferationofshelteredcaresettings,life- saving communities, andhomecareservices.

Legislationand itsImpactonthe Care of theAged In recent years, therehas been amajor conceptual shiftinthe grouping of services.Abasic policygoalhas been to move away fromthe useofresidentialfacilitiestowards thedevelopment of adiversified community-based servicenetwork (Lowenstein&Yakovitz,1995).The point of departurenow is thehomeofthe olderperson, followedbythe community andthenby residentialservices. To this end, thecommunity Long-TermCareInsurance Lawwas enacted in 1980 and implemented in 1988, underthe auspices of theNationalInsurance Institute. More recently, in 1995, theNationalHealth InsuranceLaw wasenacted to provide health insurancecoveragefor allIsraeli residentswith no discriminationfor ageordisability. This lawinstitutedauniversal program of health coverage that guarantees hospitalizationand deliversadefinedbasketof community-based medicalservices throughthe voluntarySickFunds. Regardinginformal-familyresponsibilityfor care of theageditisbased on religious Jewish laws.Mostrelevantisthe commandment“Honor thyfatherand thymother” whichisthe only one of theTen Commandments that contains arewardfor its fulfillment.Thus,contrary to most Westerncountries,inwhich care andsupportfor olderpeopleisvoluntary, thereare laws which outlinethe obligations of adultchildrentoprovide at leasteconomic supportfor olderfamily members-the“Alimony Law–1958”. In conclusion, Israel hasmaintainedacommitmenttothe welfareofits oldercitizens, whichisdemonstrated by an arrayofprogramsand services andthe operationofthe different sectors–government,public andprivate.The system is unique in its philosophyofcommunity careand community responsibilityfor dependentelderly.

Theaging of theIsraelipopulationhas recentlyraisedthe awarenessofresearchers, practitioners andpolicy-makers to thephenomenon of familyviolenceingeneral andelder abuseand neglect in particular.Since thelaw is one of theprimary meansinshaping policy, looking at thedevelopmentsinthe Israelilaw regardingelder abusemight be helpfulin understanding theway theState of Israel responds to such aphenomenon.

ElderabuseinIsrael–legislation, policy, andservices By analyzingthe legislativedevelopments in relationtoelder abuseinIsrael,Doron, Alon & Offir(2005) identifiedfour "legislativegenerations": Thefirst generation, calledbythe authors "paternalismand social intervention",ischaracterized by theintroductionoflawsunderthe implications of theestablishment of theIsraelistate.During1950s-1960s many social laws were enacted,and twoofthemare of relevance: TheLaw of LegalCompetenceand Guardianship, 1962,was originated by lawyersand academicsinorder to createageneral civilcode of the Israelilaw.Thiswas thefirst Israelilaw that referred to olderpersons (aswellasother individuals)who might lose theirlegal competence. In such cases thereisjustificationfor legal interventionbyappointingaguardian.The second lawisThe Lawfor theDefense of Protected Persons,1966,which explicitly mentionedolder persons underthe definitionof"protected persons".

Thesecond generationoflaws, definedbyDoron et al.(2005) as "criminal lawand mandatory reporting",was influenced primarily by acriminal approach.Organizations for children'srightspromotedthe Amendment26tothe PenalCode,1989,entitled"Injury to the helpless".The amendmenttothe lawalsoidentifiedolder persons as susceptible to injury, because of beinghelpless. TheAmendmentassertsexplicitlythatabuseof"helpless persons"is acriminal offence, andfor thefirst time,typical behaviorsofelder abuseweredefined clearlyin criminal law. Anotherimportant issueofthe Amendmentwas theobligationtoreportany type of abuse, or even suspicionofabuse. As aresultofthese developments theMinistryofSocial Affairsdevelopedspecial coursestotrain thewelfare officers whoweremandatedunderthe laws to work in this area.

Thethird generationoflegislation, "protectionand therapywithin familyviolence", emergedasaresponsetothe accumulatingempirical data on violence in thefamilyand the failure of theauthoritiestodeal with theproblem (Doron et al., 2005).Organizations struggling forwomen's rightstood behind theenactment of theLaw forthe Prevention of Violence in the Family, 1991.Asaresult thelaw also enablesustoconsider olderpersons whosufferfrom violence within thefamilysystem. Thelaw provides thevictim and/or hisrelatives with the opportunity forquick operation, andprovidesdefensive andpractical relief(e.g. removalofthe offenderfromthe victim). Anotherissueisthatthe lawrecognizes theimportanceoftreatment rather than punishment andallows thecourttorecommend treatment andtoforce it on the offender

While thelawsofthe second andthird generations arestill in aprocess of development, thereare some cues forthe emergenceofnew legislativeapproacheswhich encouragethe awareness, knowledge, training andempowerment of professionals workingwith abused older persons (Doron et al., 2005).For example, Amendment7of theLaw forthe Preventionof Violence in theFamily, 2001,isemphasizing theobligationofprofessionalstoprovide victims of abuseand neglect with therequiredinformationinorder to gethelpand care.

Thesebasic legislativedevelopments reflect theunderstandingthatthere arecertain segments amongthe olderpopulationwho mightbevulnerabletoexperienceabuseand/or neglect.The questionthenarisesashow were thedevelopments in thelegislativearena translated into advocacyand practice.

Policyimpactonadvocacy, research,educationand practice developments Themainthrusttodeal with elderabusecamethroughadvocacybyEshel andthe relevant Ministries. In 2001 Eshel, workingonits five year plan, decidedtoplace theissue of elderabuseand neglect on theagendaasone of its priorities, andtoallocateresourcestowards activating research,trainingand developing models of serviceprovision. Laterthatyear "The Committee on themeansrequiredtoprevent anddealwith elderabuseand neglect"was establishedand presentedits report in 2002 (Eshel,2002). So far, some of therecommendations have alreadybeenimplemented.First,anational survey,conducted by theCenterfor Research andStudy of Agingatthe University of Haifa revealed thescope andthe characteristicsofthe phenomenon of elderabuseand neglect (Eisikovits,Lowenstein&Winterstein, 2005).The main data,obtainedbypersonalinterviews fromarepresentativesampleofthe urbanolder population, indicated that about 18.4% of the respondentswereexposed to at leastone kind of abuse(physical,emotional, sexual,limitation of freedom andfinancial exploitation) duringthe 12 months precedingthe study. Relatively high were verbal abuse(closeto4%),and economic exploitation(about 6%).Also,avery high rate of neglect(about 18%)was reported.The findingsofthe survey were presentedtothe PresidentofIsraelinahighly publicized meeting, receivedwidepress coverage andwerelater discussedinameetingofthe ParliamentaryCommitteeofLabor,SocialAffairs, andHealth (ProtocolNo. 364, 28 February 2005).Currently thenextstage of collectionqualitativedataon 50 familiesofvictims andperpetratorswithin thesamefamily, fundedbythe NationalInsurance Institute,was finished (Eisikovits,Winterstein,&Lowenstein (2007). Alarge workshop was organizedtopresent theresults of thestudy as well as to bringforward theactivitiesinthe field, whichattracted closeto200 professionals fromall overthe country.

Second, Esheland theMinistriesofSocialAffairs aresupportingvarious programsof interventionand prevention in 17 local authorities, throughtheir welfareoffices, by creating special units on elderabuse, staffedbysocialworkers trainedinthe areas of gerontology with a special emphasisonelder abuse. Theprogramscomprisevarious models of individualand interdisciplinaryteam work as well as illuminationand training activity in thecommunity, raisingawareness amongthe public in generaland among various professionals.Insomeofthe municipalitiessupportgroups forelderly abusewomen,are activated.Third,asaresponsetothe Director-General Directiveregarding identificationand reportingofelder abuseand neglect cases in thehealth system (2003d),Eshel andthe Ministry of Health cooperate in orderto developand implement special guidelines andtrainingfor hospitals staffand health professionals.Forth,ahot-linefor elderlypersons exposed to abusehas been established, and thevolunteersthatoperate it hadbeen especially trainedonthese issues.The organizationisalso training professionalworkers to identifyand recognizeabuse, andisactingtorecruitpartners fromwithin thecommunity forthe preventionand thetreatment of abuse. Finally, anational committeewas establishedwith representatives fromall therelevantgovernmentalministries (welfare,health andthe police) andNGOs. Itsgoals aretopromote changesinlegislation, to furthercollaborativeand more coordinatedworkbetween thevarious serviceproviders andto advanceadditionalinnovativeservices.

Along with theactivitiesofEshel andthe Ministries of Social Affairsand Health,there aresomeother voluntaryorganizations that operate in ordertomeet theneedsofthe older populationgenerally,and as part of theabove advocacyefforts starttoworkalsointhe areas of elderabuseand neglect. Thenon-profit organizationYad-Rivawas establishedin1984 in order to provide legalaid forolder persons.The serviceprovidedbyYad-Rivaisnot onlyalegal service, but also includessocialaid andemotionalsupportbysocialworkers.Suchservice is directed to provide legaland emotionalhelpfor theagedbyrecognizingand defending their legalrights(Yad-Sarahinternetweb page).

"Ken Lazaken" ("Yesfor theElderly") is anothervolunteer organization whichis managedbyprofessionals fromthe geriatric, social work,legal,nursing,and occupational therapyfields. Itsaim is to fightagainst infringementofelders' rights anddignity,toidentify needsand to consolidateappropriate answerstothoseneeds. Theproject is focusedonelders' rights utilizationthatwill be handled by acomplaint officerand adefense attorney.Aspartofits activity, theorganizationisoperatingtoformalobbyfor theagedinorder to promotelegislation in therealmofelders’ rights including elderabuse andneglect (Jerusalem on theWeb,02net internet webpage).

"Law in theService of Elderly" is an organizationestablishedin2002, whichoperatesto promotethe rights of theolder populationinIsraelthrough advocacy andlegal activities. It aims to establishalegalresource centerinIsrael on elders’rights, to change andcreatelegislationin this field, to educateand advocateonbehalfofthe olderpopulation, to publishpopular and professionallegal materialsinthe fieldofelders’ rights,and to cooperate with nationaland internationalorganizations with similargoals (Law in theService of Elderly, internet webpage)

TheGeneral FederationofTrade Unions in Israel ("HistadrutHa'Gimlaim)isasocial movement whichisunionizing senior andpensioners across thecountry.Their main goal is protectingthe rights andbenefits of pensioners,obtaining an appropriate pension, healthcareand lifequality. Theactivityisprovidedvoluntarilybypensioners (The NewHistadrut,internetweb page). Recentlytheyenticed thePresident of Israel to work towardscreatingaNationalCouncil on issues of ElderAbuseand Neglect.

To sum, threemainpolicyissues emerge while legislativeeffortsinthe area of elder abuseand neglecthad been developed: first, howmuchshouldthe criminal-legal approach be thedominantapproach?Ifthe answer is positivethenmoreresources shouldbeallocated for enactingthese laws.Suchresourcesshouldinclude providing more training andknowledge disseminationwithin thepoliceand courtsystems andintroducing more coordinatedand collaborativeprofessional work between thesesystems andthe health andsocialservice professionals.Aneffort in this directionisthe creationbyEshel of thenationalcommittee. The second issueiswhattypes of professionalinterventions shouldbedevelopedand implemented? An examplewas presentedabove of certain specialunits created within thelocal authoritiesto enhancedifferent workingmodels in this area.Third,whatshouldbethe division of responsibilitybetween thehealth andwelfare systemsofcare? Again, theemphasisshouldbeon more coordinatedand interdisciplinaryworkand jointprojectswhereverpossible. This is startingtobethe normasmoreand more professionals in thesesystems aretrained jointlyand learntocollaboratefor thebenefit of theabused elderly.

Within thespecificcontextofthe Israelisociety it wasshownthatpolicyand legislation couldbetranslatedintoadvocacyand practiceprogramsonthe local community level, wherea more integrated approach shouldbeundertaken betweenthe criminal-legal system andthe health-welfare systems. Allocationofresources bothfor research,trainingand experimenting with different strategies andpracticeinterventions will help combat elderabuse andneglect.

Mailingaddress: Prof.ArielaLowenstein, Head TheCenterfor Research &Study of Aging, Prof., Department of Masters in Gerontology FacultyofWelfare andHealthStudies, UniversityofHaifa,Haifa,31905 Israel [email protected] References

Bergman, S. &Lowenstein, A. (1988).Careofthe aginginIsrael:Socialservice delivery. Journal of GerontologicalSocialWork, 12(1/2), 97-117.

Brodsky,J., Shnor,Y.&Be’er, S. (2003, 2004). Aged in Israel –Statistical Yearbook,1998. Jerusalem: JDCBrookdale andESHEL.(Hebrew)

CentralBureau of Statistics(2003, 2004). Statistical Yearbook. Jerusalem: CentralBureau of Statistics(Hebrew).

Doron, I.,Alon, S.,&Offir, N. (2005).Time forpolicy: legislativeresponsetoelder abuseand neglect in Israel.

Director-General Directives.(2003a). Regulations regarding thepreventionof domestic violence –providing informationinthe field of health.Jerusalem:Ministry of Health (InHebrew).

Director-General Directives.(2003b). Informationtransferbetween medicalinstitutions regarding minorsand helpless persons victimsofdomestic violence. Jerusalem: Ministry of Health (InHebrew).

Director-General Directives.(2003c). Permanent committees fordomestic violence and sexual abuseofminorsand helpless persons. Jerusalem: Ministry of Health (In Hebrew).

Director-General Directives.(2003d).Jerusalem:MinistryofHealth (InHebrew).

Eisikovits,Z., Lowenstein,A.,& Winterstein, T. (2005). Reportofthe first national survey on elderabuseand neglectinIsrael. Haifa: TheCenterfor Research andStudy of Aging, The University of Haifa, Israel (Hebrew).(PresentedtoESHEL andthe NationalInsurance Institute).

Eisikovits,Z., Winterstein, T.,&Lowenstein,A.(2007). Understanding thephenomenologyof elderabuseand neglect–areportofthe qualitative study. Haifa: TheCenterfor Research and StudyofAging,The University of Haifa, Israel (Hebrew).(PresentedtoESHEL andthe NationalInsurance Institute).

ESHEL(2002). ActivitiesReport. Jerusalem, ESHEL.

Eshel. (2002). Reportofthe Committeeonthe Means RequiredtoPreventand Deal with ElderAbuseand Neglect.Availableat: http://www.justice.gov.il/NR/rdonlyres/8D765737- 48A3-4BC6-AA03-59F9EFB30FEC/0/dohvadalnisulskenim.pdf

Guttmann, D. &Lowenstein, A. (1991).Demographicchanges in Israel andtheir implications forprofessionaleducationinaging forthe 21st century. TheJournal of Agingand Judaism,5(3), 215-226. Guttmann, D. &Lowenstein, A. (1993).The “graying”ofIsrael. In L.K. Olson(Ed.), Grayingof theworld:Who will care forthe frailelderly. NewYork: TheHaworth Press.

Habib, J. &Tamir,Y.(1994).JewishagedinIsrael: Sociodemographicand socioeconomic status.InZ.Harel,D.E.Biegel&D. Guttmann (Eds.), JewishAgedinthe UnitedStatesand Israel (pp. 47-61). NewYork: Springer

Katan, J. &Lowenstein, A. (1999). Adecade of implementationofthe Long-Term Care InsuranceLaw –Meaningsand Implications. Jerusalem: TheCenterfor Social andPolicy Planning in Israel.(Hebrew).

Katz,R.&Lowenstein,A.(1999).Adjustment of olderSoviet immigrant parentsand theiradult childrenresidinginsharedhouseholds:Anintergenerationalcomparison. Family Relations, 48(1), 43-50.

Labor, Social Affairs, andHealth Committee. Protocol No.364 of Committee meeting, 28 February 2005. From:http://www.knesset.gov.il/protocols/data/html/avoda/2005- 02-28.html

Litwin,H.(1994). Factorsshaping care andservicesfor theJewishagedinIsrael..In Z. Harel, D.E. Biegel &D.Guttmann (Eds.), JewishAgedinthe UnitedStatesand Israel (pp. 141-161). NewYork: Springer.

Lowenstein,A.&Bergman, S. (1988).Socialworkpracticeingerontology in Israel. Journal of GerontologicalSocialWork, 12(1/2), 118-130.

Lowenstein,A.(1994).Socialservice deliveryfor theJewishAgedinIsrael.InZ.Harel,D.E. Biegel &D.Guttmann (Eds.), JewishAgedinthe UnitedStatesand Israel (pp. 239-261). New York:Springer.

Lowenstein,A.&Yakovitz,A.(1995). Theelderly,the family and theresidentialfacility:Issues and methods of intervention. Tel-Aviv:Ramot (Hebrew).

Lowenstein,A.(1998).Socialworkwith theaged. In F. M. Loewenberg (Ed.), Meetingthe challengesofachanging society(pp. 135-164). Jerusalem: TheMagnesPress.

Ministry of Welfare,(2004). TheEldersinIsrael –Trends and Challenges. Areviewfrom theMinisterofWelfare in thegovernment meeting, 20/4/2004. From:http://www.molsa.gov.il/Docs/News/2_2004-7-26_4185.pdf SteeringCommittee–TheProject of Interventioninthe Community.Protocolof meeting, 13/9/04. SteeringCommittee–TheProgram forTreatment andPreventionofElder Abuseand Neglect in theCommunity.Protocolofmeeting, 25/1/05. WebPages

Yad-Sarah: http://www.yadsarah.org.il/

Jerusalemonthe Web: http://02net.co.il/

TheNew Histadrut: http://www.histadrut.org.il/

Lawinthe Serviceofthe Elderly: http://research.haifa.ac.il/~doronfam/ http://www.knesset.gov.il/protocols/data/html/avoda/2005-02-28.html

C:\My Documents\ARIELA\Carenetworksfor the elderlyinIsrael.doc