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