email: zissieg@walla.com
PART 1
ADJUSTING TO THE INITIAL SHOCK
No matter how hard we try to deny it, with every day that passes we and our loved ones get older, and with the blessings of old age come the not so welcome aches, pains, and limitations that make us dependent on help, whether it be in the form of equipment, transportation, food, financial aid or personal caregivers.
The elderly are not the only ones subject to these needs. In the blink of an eye any one of us can be transformed from a vibrant, active, independent member of society into one totally in need of outside help. We cannot predict if and when, G-d forbid, tragedy will strike, but when faced with adversity, if we are armed with the necessary information of where to go for help and how to navigate the bureaucratic maze, we can more easily deal with crisis.
I hope in this series of articles chronicling my experiences with coping with the nitty-gritty of bureaucracy, the court system, the medical system and the emotional upheaval brought about by the seemingly overwhelming demands placed on me as a primary caregiver, I will be able to help you in some small measure. Bear with me as I describe my frustrations, cheer along with me as I claim my victories, and most of all keep your chin up and maintain your sense of humor. We can get through this together. So let’s get started.
MISSION POSSIBLE:CUTTING THROUGH THE MAZE OF RED TAPE
Israel society is a particularly caring one. Many government agencies cater to the needs of the disabled, ill and elderly—ranging from the municipal to the national level. Likewise, non-profit organizations abound with services such as transportation, meals-on-wheels, equipment loans, legal counseling, therapy services and day-care centers. But where do you start? If you are "lucky" your situation will slowly deteriorate and enable you to gradually wend your way through the system. Those of us who have been forced into the situation through a sudden unexpected illness or accident, have had to learn the system in a crash course.
In my case, one moment I was planning an 80th birthday party for my parents to take place in three days time, and the next moment I was in the emergency room with my father who had suffered a sudden stroke, paralyzing him on his right side and affecting his speech. As if that weren't enough, shortly after my father was released to my care from rehabilitation, I found that my mother would herself require medical procedures to be performed by me every few hours of every day at their home.
I felt like the proverbial carpet had been pulled out from under my feet, I'd been run over by a bulldozer and my whole world had crashed down on me, to put it mildly. None of the platitudes offered to help me cope were useful, and, believe me, I've heard them all. I knew that I just had to put one foot in front of the other and step by step take care of all my parents' needs. And that's how I learned the system. I am by no means an expert, but I hope my experience will serve to help others who have to go through similar circumstances.
In my case, one moment I was planning an 80th birthday party for my parents to take place in three days time, and the next moment I was in the emergency room with my father who had suffered a sudden stroke, paralyzing him on his right side and affecting his speech. As if that weren't enough, shortly after my father was released to my care from rehabilitation, I found that my mother would herself require medical procedures to be performed by me every few hours of every day at their home.
I felt like the proverbial carpet had been pulled out from under my feet, I'd been run over by a bulldozer and my whole world had crashed down on me, to put it mildly. None of the platitudes offered to help me cope were useful, and, believe me, I've heard them all. I knew that I just had to put one foot in front of the other and step by step take care of all my parents' needs. And that's how I learned the system. I am by no means an expert, but I hope my experience will serve to help others who have to go through similar circumstances.
I CAN HANDLE THIS...
PREPARATIONS FOR HOMECOMING
My first piece of advice is not to delay. As soon as you can, begin making preparations for the patient’s return home. My father spent about 10 days in the hospital, during which time several employment agencies approached us to describe their home-care services. My initial reaction was that these companies were in competition with each other to attract my business, and I would wait until things quieted down before making a rational decision on which company to choose. With 20-20 hindsight I now realize that that was when I should have already begun the process of hiring a caregiver.
When the time came to transfer my father to a rehabilitation center, most of the facilities in the area of his home were either full to capacity or undergoing renovation, and we were not given a choice of facility. Through my volunteering at Yad Sarah I had learned of the YadSaraVan service, and promptly ascertained that the minimal charge for the service was well below that of an ambulance. With my husband (without whom I could never have gotten through this continuing ordeal) trailing behind the van in our car, and me in the van with my father safely buckled into his wheelchair (also borrowed from Yad Sarah), we made our way to the rehab center. Only when we got my father to the correct building for admission to a bed did the driver leave. Although it was nearing evening, he acted as though he had all the time in the world to help us. We waited a little longer than we would have for ambulance transport, but the friendliness of the driver and his readiness to help us get my father to his destination with a minimum of hassle was well worth the wait.
Although I was of the opinion that he required more time for rehabilitation, the powers that be determined that after two weeks of physical and occupational therapy at the rehab center, my father was ready to return home. So, armed with the discharge summary from the hospital, the discharge summary from the rehab center, and forms detailing his disabilities and need for 24-hour care and continuing physical, occupational and speech therapy, we piled into our car to head home.
My first piece of advice is not to delay. As soon as you can, begin making preparations for the patient’s return home. My father spent about 10 days in the hospital, during which time several employment agencies approached us to describe their home-care services. My initial reaction was that these companies were in competition with each other to attract my business, and I would wait until things quieted down before making a rational decision on which company to choose. With 20-20 hindsight I now realize that that was when I should have already begun the process of hiring a caregiver.
When the time came to transfer my father to a rehabilitation center, most of the facilities in the area of his home were either full to capacity or undergoing renovation, and we were not given a choice of facility. Through my volunteering at Yad Sarah I had learned of the YadSaraVan service, and promptly ascertained that the minimal charge for the service was well below that of an ambulance. With my husband (without whom I could never have gotten through this continuing ordeal) trailing behind the van in our car, and me in the van with my father safely buckled into his wheelchair (also borrowed from Yad Sarah), we made our way to the rehab center. Only when we got my father to the correct building for admission to a bed did the driver leave. Although it was nearing evening, he acted as though he had all the time in the world to help us. We waited a little longer than we would have for ambulance transport, but the friendliness of the driver and his readiness to help us get my father to his destination with a minimum of hassle was well worth the wait.
Although I was of the opinion that he required more time for rehabilitation, the powers that be determined that after two weeks of physical and occupational therapy at the rehab center, my father was ready to return home. So, armed with the discharge summary from the hospital, the discharge summary from the rehab center, and forms detailing his disabilities and need for 24-hour care and continuing physical, occupational and speech therapy, we piled into our car to head home.
HOME SWEET HOME? GET READY 
FOR ALTERATIONS!
FOR ALTERATIONS! But his home was not ready for him. He now required a variety of assistive items. In addition, issues we had never before needed to consider—such as the width of the doorways in his apartment, the height of chairs (for ease in sitting and standing), and the tripping hazard posed by carpets—had to be addressed, and we desperately needed to find some outside help to assist us in remodeling our lives to this new challenging situation.
Help was not far away. First of all I turned to (Surprise!) Yad Sarah. At the lending center we were able to borrow many of the necessary assistive items. At a local medical supply store we were able to purchase the remainder of the items we needed to install. Again I must emphasize that time is of the essence. These items should be installed before the patient is released home. The consultant at the Yad Sarah Guidance and Exhibition Center was able to make several suggestions to help us get started. These solved our immediate problems. But there was much more involved before we could heave the first of many well-deserved sighs of relief.
APPLYING FOR CARE SERVICE IN THE HOME
The hospital or rehabilitation center can supply you with a list of local agencies that deal with providing home-care. Check out several from the list to ascertain if they have workers that meet your needs. In our case we needed a male who spoke English. The day following my father’s arrival home (to my cottage which had wider doorways and where I could supervise the initial care) the agency sent out a social worker to evaluate the situation. She helped us fill out the necessary forms to apply for “Chok Bituach Siyud” (the law that determines qualification for nursing care) through Bituach Leumi, and showed us which portion of the application needed to be filled out by the family doctor. Until a definitive answer was received from Bituach Leumi as to how many hours a week they would allot, the agency would provide, free of charge, a caregiver for the minimum amount of time (six hours a week). Once we got the response from Bituach Leumi, the caregiver’s hours would be paid retroactively by Bituach Leumi and we could then set up a schedule based on the actual number of hours they would allot. If Bituach Leumi denied the claim, we still were not required to pay for the services utilized for this interim period.
Bituach Leumi has a committee that meets periodically and determines the degree of home care needed by applicants based on a point system defined by the lack of ability of the patient to perform certain daily activities (known as ADLs), namely: being able to stand up and sit down unassisted, dressing oneself, feeding oneself, getting in and out bed unassisted, bathing oneself, ability to control excretions and utilize toilet facilities. The fewer activities the patient can perform, the higher his score. If the patient is a holocaust survivor, he/she is awarded additional points. The higher the score, the more hours of care allotted by Bituach Leumi, anywhere from 6 hours to 15 hours per week (from my experience).
And now it’s time for another word of advice. I cannot overemphasize the importance of photocopying everything before you submit the originals to the service provider with whom you are dealing. Numerous times representatives from various agencies arrived to examine my parents and were grateful that I had photocopies of relevant documents—every doctor’s letter, recommendation, hospital discharge summary, documentation of diagnoses, physical limitations etc. You can never be too careful in this respect.
Help was not far away. First of all I turned to (Surprise!) Yad Sarah. At the lending center we were able to borrow many of the necessary assistive items. At a local medical supply store we were able to purchase the remainder of the items we needed to install. Again I must emphasize that time is of the essence. These items should be installed before the patient is released home. The consultant at the Yad Sarah Guidance and Exhibition Center was able to make several suggestions to help us get started. These solved our immediate problems. But there was much more involved before we could heave the first of many well-deserved sighs of relief.
APPLYING FOR CARE SERVICE IN THE HOME
The hospital or rehabilitation center can supply you with a list of local agencies that deal with providing home-care. Check out several from the list to ascertain if they have workers that meet your needs. In our case we needed a male who spoke English. The day following my father’s arrival home (to my cottage which had wider doorways and where I could supervise the initial care) the agency sent out a social worker to evaluate the situation. She helped us fill out the necessary forms to apply for “Chok Bituach Siyud” (the law that determines qualification for nursing care) through Bituach Leumi, and showed us which portion of the application needed to be filled out by the family doctor. Until a definitive answer was received from Bituach Leumi as to how many hours a week they would allot, the agency would provide, free of charge, a caregiver for the minimum amount of time (six hours a week). Once we got the response from Bituach Leumi, the caregiver’s hours would be paid retroactively by Bituach Leumi and we could then set up a schedule based on the actual number of hours they would allot. If Bituach Leumi denied the claim, we still were not required to pay for the services utilized for this interim period.
Bituach Leumi has a committee that meets periodically and determines the degree of home care needed by applicants based on a point system defined by the lack of ability of the patient to perform certain daily activities (known as ADLs), namely: being able to stand up and sit down unassisted, dressing oneself, feeding oneself, getting in and out bed unassisted, bathing oneself, ability to control excretions and utilize toilet facilities. The fewer activities the patient can perform, the higher his score. If the patient is a holocaust survivor, he/she is awarded additional points. The higher the score, the more hours of care allotted by Bituach Leumi, anywhere from 6 hours to 15 hours per week (from my experience).
PHOTOCOPY EVERYTHING!!!
And now it’s time for another word of advice. I cannot overemphasize the importance of photocopying everything before you submit the originals to the service provider with whom you are dealing. Numerous times representatives from various agencies arrived to examine my parents and were grateful that I had photocopies of relevant documents—every doctor’s letter, recommendation, hospital discharge summary, documentation of diagnoses, physical limitations etc. You can never be too careful in this respect.
AVOID LONG LINES:
USE THE MAIL!!
Bituach Leumi offices are not open to the public every day, but they do have a mailbox outside their offices where you can deposit your completed application. There is a special envelope for this purpose near the mailbox outside the Bituach Leumi offices. Put your completed original application, with all the documentation required attached to it, into this envelope and seal it. On the outside of the envelope fill out the required information identifying the patient and whom to contact by phone, check off the appropriate box to direct the envelope to the proper department for processing (in this case: “siyud”), and place the sealed envelope into the Bituach Leumi mailbox. In my experience, this was the most efficient way of handling the situation. Within a day or two, Bituach Leumi contacted me to set up an appointment for sending a nurse to come evaluate the situation. The nurse’s report would then be sent to committee for consideration (this can take several weeks).
THE IMPORTANCE OF KNOWING HEBREW 
Now another word of advice: It is wonderful to speak English as a mother-tongue. It gives you advantages in the marketplace, in educational venues and international forums, but when it comes to dealing with government forms and clerks in Israel, nothing compares to being able to speak, write and understand Hebrew. I know your Aliyah representative told you you'd have no problem getting along in English when you move to Israel. What he left out is that you can get along in English only until you need to know Hebrew. Although my father understands the language in a biblical sort of way, my mother neither speaks nor understands Hebrew. With all the good will and intentions of the Israel government in attempting to help all its citizens, the misunderstandings that can derive from insufficient knowledge of English on the side of the clerks and insufficient knowledge of Hebrew on the side of Anglo-Saxons can mean the difference between getting your problem processed efficiently and expeditiously or not at all. Get a handle on the language. If you cannot understand and communicate in Hebrew, you will not be able to fill out all the necessary forms or find your way to the right clerks to take care of your specific problem, unless you have an interpreter at your beck and call. Precious time is lost and frustration only mounts. Should the time ever come when you yourself have to be institutionalized—you should live so long—you will not be able to communicate with your caregivers.
But more on that later.
I welcome your input, comments and suggestions and look forward to our next chat.
Guide to Services for the Aged and Disabled in Israel
©Copyright-2008
This work is protected by copyright law. Use of this work or any portion thereof, including photocopying, publication, public production, distribution, translation, broadcast, allowing public access to it, and utilizing portions derived from it for composing other written works, without prior written permission from the author is prohibited.
THE IMPORTANCE OF KNOWING HEBREW 
Now another word of advice: It is wonderful to speak English as a mother-tongue. It gives you advantages in the marketplace, in educational venues and international forums, but when it comes to dealing with government forms and clerks in Israel, nothing compares to being able to speak, write and understand Hebrew. I know your Aliyah representative told you you'd have no problem getting along in English when you move to Israel. What he left out is that you can get along in English only until you need to know Hebrew. Although my father understands the language in a biblical sort of way, my mother neither speaks nor understands Hebrew. With all the good will and intentions of the Israel government in attempting to help all its citizens, the misunderstandings that can derive from insufficient knowledge of English on the side of the clerks and insufficient knowledge of Hebrew on the side of Anglo-Saxons can mean the difference between getting your problem processed efficiently and expeditiously or not at all. Get a handle on the language. If you cannot understand and communicate in Hebrew, you will not be able to fill out all the necessary forms or find your way to the right clerks to take care of your specific problem, unless you have an interpreter at your beck and call. Precious time is lost and frustration only mounts. Should the time ever come when you yourself have to be institutionalized—you should live so long—you will not be able to communicate with your caregivers.
But more on that later.
I welcome your input, comments and suggestions and look forward to our next chat.
Guide to Services for the Aged and Disabled in Israel
©Copyright-2008
This work is protected by copyright law. Use of this work or any portion thereof, including photocopying, publication, public production, distribution, translation, broadcast, allowing public access to it, and utilizing portions derived from it for composing other written works, without prior written permission from the author is prohibited.
Part 2
I Think I Need a Secretary
Arranging for Home Care Through Kupat Cholim
Just when I thought things would start to calm down, the fun really began. Our arrival home from the rehabilitation center heralded an unending chain of phone calls and appointments to continue the process of physical and occupational therapy. I have had personal experience with only two of the kupot cholim, but I would venture to say that all of them have a division devoted to what in Hebrew is called hemshech tipul—“continuing care” in English. If the patient is housebound, arrangements can be made to have a physical therapist and occupational therapist come to the home.
TAKE ADVANTAGE OF HOME SERVICES.
Keep the patient’s personal physician and staff apprised of the situation. Ideally, they should be able to provide you with information on how to arrange for home therapy. As I am not familiar with all the kupot cholim, I am attaching links to the site of each kupah with the closest information I could locate on either how to contact a social worker or find out how to arrange for home care in your area: Clalit, Leumit, Maccabi (you will have to search for the yechida l’tipulei bayit to open a list of phone numbers to contact for home care according to region), Meuhedet (open the menu under sheirutim refuiim and choose ovdim socialiim to find a social worker in your area).
HELP! I CAN’T KEEP TRACK OF EVERYTHING!
My calendar was starting to look like I was running a major industry. Social workers from everywhere (the municipality, the kupat cholim, the caregiver agency, Bituach Leumi) were coming and going. Physical and occupational therapists were scheduled at varying times of the day, the caregivers were arriving at different hours (one for my mother, one for my father), and I had my own personal schedule to worry about. Those little boxes on the calendar that used to be large enough to write down an appointment here and there began to look like a nightmarish maze with scribbles on the side and arrows pointing in all directions to indicate where I had to squeeze yet another appointment into an already bulging schedule.
I needed a secretary. Since that was out of the question, my husband presented me with the next best thing: a Palm Pilot. Now I was ready to take on the world. I have finally gotten used to hearing the alarm go off every couple of hours to remind me of either an imminent appointment, or a looming deadline that has to be met—like my colonoscopy or dinner (not necessarily in order of preference). If you can’t afford a Palm Pilot or some similar electronic gadget, get yourself an office-type diary with plenty of room to keep track of appointments and space to set reminders for things you need to take care of before time runs out.
ORGANIZATION IS THE KEY TO EFFICIENCY.
Another useful item is an accordion type folder for filing doctors’ letters by specialty, test results, hospital summaries, insurance information, etc. It goes without saying the more orderly you are, the quicker you can locate needed documents when the time comes.
LEARNING ABOUT BENEFITS AND SERVICES
Although each situation differs, there are some basic facts that are valuable for everyone to know. The patient’s municipality (iriya) should have a social worker available through its welfare department (agaf harevachah). Actually, in our case, the social worker contacted us, as she had already been informed by the kupat cholim of my father’s condition upon discharge and knew that the family required guidance. She also happened to be the liaison with Bituach Leumi (the National Insurance Institute) and was extremely helpful in providing information on services available though the municipality, such as discounted meals on wheels (for those who qualify financially), reduction on arnona (property tax) costs for the disabled, and general information on services for the disabled. Check your local phone book under the iriya listing for agaf harevachah or call your local moked for the correct phone number, if a social worker from the municipality has not contacted you.
YOU MAY BE ELIGIBLE FOR MANY BENEFITS.
To mention a few items that may be available at reduced cost (often there are financial forms and statements that must be provided to determine eligibility): meals on wheels, disposable diapers, wheelchairs, emergency alarms, nutrition supplies for patients being tube-fed. The Ministry of Health will subsidize certain items of equipment for eligible patients and may even assist in altering the home to accommodate qualified patients. Your kupat cholim will often reduce the cost of certain medications for chronic illnesses, and may forego payment of the deductible for certain tests and doctors’ visits. Some of the items listed above can be acquired through Bituach Leumi in lieu of caregiver hours. In other words, you may choose to utilize only a portion of the hours allotted by Bituach Leumi towards a personal caregiver and the remaining portion towards purchasing diapers at a reduced cost or installation of an emergency alarm system. Weigh the pros and cons. This obviously will cut down on the amount of time the caregiver will be spending in the home, on the one hand, but, on the other hand, will reduce your out of pocket costs for a potentially expensive item. Your are not required to limit yourself to the number of hours allotted by BituachLeumi, but keep in mind that you will have to bear the cost for any hours over and above those paid by Bituach Leumi.
ASSURANCE AND INSURANCE ISSUES
Are you familiar with the patient’s insurance coverage? If not, now is the time to do some investigation. Many patients, in addition to the basic health package provided by their kupat cholim, have supplemental insurance available through the kupah. They may also have a disability insurance policy and/or a policy to cover extended nursing care.
Did you know that you can purchase “falling” insurance? I found out about this the hard way.
LIFTING CAN BE DANGEROUS TO YOUR HEALTH.
My father, G-d bless him, is a big man. When he falls it is not easy to get him up from the floor (and in some cases is even contra-indicated). We tried to lift him ourselves on several occasions. This was causing damage to our backs and also possibly my eyes (my doctor really scared me when he told me I had possibly torn my retina from straining to lift my father). That’s when we started phoning Magen David Adom (101) for an ambulance crew to examine him and lift him up. The bills started piling up. After we had an emergency alarm installed in parents’ bedroom (through the Yad Sarah Emergency Alarm Center), we summoned Magen David Adom via the alarm center. From Yad Sarah we learned of relatively inexpensive insurance we could purchase in order to have someone come to the home and physically lift my father for us in the event he fell. The insurance also provided for home doctor visits at a token fee at all hours of the day and night. Unfortunately we had to utilize this service more often than we anticipated and under circumstances that were literally life-threatening. I have only praise for the speed and efficiency of the alarm center and the insurance company in coming to our aid.
WEIGH THE PROS AND CONS OF WHEN TO CASH IN ON YOUR INSURANCE.
When it comes time to consider utilizing extended-care nursing insurance, you have to make some tough decisions. How do you time it for maximum effectiveness to meet your financial and physical needs? Although policies differ, extended care nursing insurance will at least partially cover home-care costs (or costs at a nursing home facility), if the patient meets the criteria set by the insurance company (again ADLs come into the picture and more visits from nurses to make evaluations, forms to be completed and documentation sent to support the claim). My parents’ policy has a four-month waiting period between the time the patient applies for the insurance benefits and the time the payments actually arrive to his/her bank account. We were astounded to find out that although my parents did qualify for the insurance coverage (which we did not activate until the situation deteriorated both physically and financially), they would still have to continue paying the monthly premium on the policy. And the coverage is good for a limited time only. After that, you’re on your own again. So consider your options and the consequences of postponing activation of such insurance policies. Is it better to take the benefits now, or put them off until things really get worse, at which time you may have to wait a few months before seeing any financial assistance?
FINDING TIME FOR YOURSELF
I’ve touched on only a few of the issues that will come up when you first get home from the hospital with your loved one, and I’m feeling exhausted just from re-reading it all, let alone having to do it—so you most probably are feeling that the task is daunting, too. As you can tell, I am here to write about it, testimony to the fact that I survived the experience, and so can you. Don’t despair. And above all, make time for yourself.
As I wrote that last sentence I am reminded of the saying, “Do as I say, not as I do.” For the longest time I kept pushing myself to the extreme to make sure that everything was taken care of properly. It took a toll on my physical and mental health—not to mention family relations. At the end of the day (as well as during the day) I was a basket case, frustrated by setbacks, worn out from dealing with pressing problems, and concerned that I was not doing enough to care properly for my parents. But, you know? We are only human and can only do so much, and life is too short to spend it in a constant state of depression. So, do what you can to give yourself a break—it could be something as simple as stepping outside for awhile and breathing the fresh air, clearing your mind and smoothing out your wrinkled forehead. Go for a massage—I
particularly fell in love with reflexology as a means of relaxation. Pick up the phone and talk to a friend. Watch a hilarious comedy and have yourself a hearty laugh. And, when all else fails, I have found that a good cry releases a lot of tension and gives you the strength to keep on going.
Guide to Services for the Aged and Disabled in Israel
© Copyright-2008
This work is protected by copyright law. Use of this work or any portion thereof, including photocopying, publication, public production, distribution, translation, broadcast, allowing public access to it, and utilizing portions derived from it for other purposes, without prior written permission from the author is prohibited.
I Think I Need a Secretary
Arranging for Home Care Through Kupat Cholim
Just when I thought things would start to calm down, the fun really began. Our arrival home from the rehabilitation center heralded an unending chain of phone calls and appointments to continue the process of physical and occupational therapy. I have had personal experience with only two of the kupot cholim, but I would venture to say that all of them have a division devoted to what in Hebrew is called hemshech tipul—“continuing care” in English. If the patient is housebound, arrangements can be made to have a physical therapist and occupational therapist come to the home.
TAKE ADVANTAGE OF HOME SERVICES.
Keep the patient’s personal physician and staff apprised of the situation. Ideally, they should be able to provide you with information on how to arrange for home therapy. As I am not familiar with all the kupot cholim, I am attaching links to the site of each kupah with the closest information I could locate on either how to contact a social worker or find out how to arrange for home care in your area: Clalit, Leumit, Maccabi (you will have to search for the yechida l’tipulei bayit to open a list of phone numbers to contact for home care according to region), Meuhedet (open the menu under sheirutim refuiim and choose ovdim socialiim to find a social worker in your area).
HELP! I CAN’T KEEP TRACK OF EVERYTHING!
My calendar was starting to look like I was running a major industry. Social workers from everywhere (the municipality, the kupat cholim, the caregiver agency, Bituach Leumi) were coming and going. Physical and occupational therapists were scheduled at varying times of the day, the caregivers were arriving at different hours (one for my mother, one for my father), and I had my own personal schedule to worry about. Those little boxes on the calendar that used to be large enough to write down an appointment here and there began to look like a nightmarish maze with scribbles on the side and arrows pointing in all directions to indicate where I had to squeeze yet another appointment into an already bulging schedule.
I needed a secretary. Since that was out of the question, my husband presented me with the next best thing: a Palm Pilot. Now I was ready to take on the world. I have finally gotten used to hearing the alarm go off every couple of hours to remind me of either an imminent appointment, or a looming deadline that has to be met—like my colonoscopy or dinner (not necessarily in order of preference). If you can’t afford a Palm Pilot or some similar electronic gadget, get yourself an office-type diary with plenty of room to keep track of appointments and space to set reminders for things you need to take care of before time runs out.
ORGANIZATION IS THE KEY TO EFFICIENCY.
Another useful item is an accordion type folder for filing doctors’ letters by specialty, test results, hospital summaries, insurance information, etc. It goes without saying the more orderly you are, the quicker you can locate needed documents when the time comes.
LEARNING ABOUT BENEFITS AND SERVICES
Although each situation differs, there are some basic facts that are valuable for everyone to know. The patient’s municipality (iriya) should have a social worker available through its welfare department (agaf harevachah). Actually, in our case, the social worker contacted us, as she had already been informed by the kupat cholim of my father’s condition upon discharge and knew that the family required guidance. She also happened to be the liaison with Bituach Leumi (the National Insurance Institute) and was extremely helpful in providing information on services available though the municipality, such as discounted meals on wheels (for those who qualify financially), reduction on arnona (property tax) costs for the disabled, and general information on services for the disabled. Check your local phone book under the iriya listing for agaf harevachah or call your local moked for the correct phone number, if a social worker from the municipality has not contacted you.
YOU MAY BE ELIGIBLE FOR MANY BENEFITS.
To mention a few items that may be available at reduced cost (often there are financial forms and statements that must be provided to determine eligibility): meals on wheels, disposable diapers, wheelchairs, emergency alarms, nutrition supplies for patients being tube-fed. The Ministry of Health will subsidize certain items of equipment for eligible patients and may even assist in altering the home to accommodate qualified patients. Your kupat cholim will often reduce the cost of certain medications for chronic illnesses, and may forego payment of the deductible for certain tests and doctors’ visits. Some of the items listed above can be acquired through Bituach Leumi in lieu of caregiver hours. In other words, you may choose to utilize only a portion of the hours allotted by Bituach Leumi towards a personal caregiver and the remaining portion towards purchasing diapers at a reduced cost or installation of an emergency alarm system. Weigh the pros and cons. This obviously will cut down on the amount of time the caregiver will be spending in the home, on the one hand, but, on the other hand, will reduce your out of pocket costs for a potentially expensive item. Your are not required to limit yourself to the number of hours allotted by BituachLeumi, but keep in mind that you will have to bear the cost for any hours over and above those paid by Bituach Leumi.
ASSURANCE AND INSURANCE ISSUES
Are you familiar with the patient’s insurance coverage? If not, now is the time to do some investigation. Many patients, in addition to the basic health package provided by their kupat cholim, have supplemental insurance available through the kupah. They may also have a disability insurance policy and/or a policy to cover extended nursing care.
Did you know that you can purchase “falling” insurance? I found out about this the hard way.
LIFTING CAN BE DANGEROUS TO YOUR HEALTH.
My father, G-d bless him, is a big man. When he falls it is not easy to get him up from the floor (and in some cases is even contra-indicated). We tried to lift him ourselves on several occasions. This was causing damage to our backs and also possibly my eyes (my doctor really scared me when he told me I had possibly torn my retina from straining to lift my father). That’s when we started phoning Magen David Adom (101) for an ambulance crew to examine him and lift him up. The bills started piling up. After we had an emergency alarm installed in parents’ bedroom (through the Yad Sarah Emergency Alarm Center), we summoned Magen David Adom via the alarm center. From Yad Sarah we learned of relatively inexpensive insurance we could purchase in order to have someone come to the home and physically lift my father for us in the event he fell. The insurance also provided for home doctor visits at a token fee at all hours of the day and night. Unfortunately we had to utilize this service more often than we anticipated and under circumstances that were literally life-threatening. I have only praise for the speed and efficiency of the alarm center and the insurance company in coming to our aid.
WEIGH THE PROS AND CONS OF WHEN TO CASH IN ON YOUR INSURANCE.
When it comes time to consider utilizing extended-care nursing insurance, you have to make some tough decisions. How do you time it for maximum effectiveness to meet your financial and physical needs? Although policies differ, extended care nursing insurance will at least partially cover home-care costs (or costs at a nursing home facility), if the patient meets the criteria set by the insurance company (again ADLs come into the picture and more visits from nurses to make evaluations, forms to be completed and documentation sent to support the claim). My parents’ policy has a four-month waiting period between the time the patient applies for the insurance benefits and the time the payments actually arrive to his/her bank account. We were astounded to find out that although my parents did qualify for the insurance coverage (which we did not activate until the situation deteriorated both physically and financially), they would still have to continue paying the monthly premium on the policy. And the coverage is good for a limited time only. After that, you’re on your own again. So consider your options and the consequences of postponing activation of such insurance policies. Is it better to take the benefits now, or put them off until things really get worse, at which time you may have to wait a few months before seeing any financial assistance?
FINDING TIME FOR YOURSELF
I’ve touched on only a few of the issues that will come up when you first get home from the hospital with your loved one, and I’m feeling exhausted just from re-reading it all, let alone having to do it—so you most probably are feeling that the task is daunting, too. As you can tell, I am here to write about it, testimony to the fact that I survived the experience, and so can you. Don’t despair. And above all, make time for yourself.
As I wrote that last sentence I am reminded of the saying, “Do as I say, not as I do.” For the longest time I kept pushing myself to the extreme to make sure that everything was taken care of properly. It took a toll on my physical and mental health—not to mention family relations. At the end of the day (as well as during the day) I was a basket case, frustrated by setbacks, worn out from dealing with pressing problems, and concerned that I was not doing enough to care properly for my parents. But, you know? We are only human and can only do so much, and life is too short to spend it in a constant state of depression. So, do what you can to give yourself a break—it could be something as simple as stepping outside for awhile and breathing the fresh air, clearing your mind and smoothing out your wrinkled forehead. Go for a massage—I
particularly fell in love with reflexology as a means of relaxation. Pick up the phone and talk to a friend. Watch a hilarious comedy and have yourself a hearty laugh. And, when all else fails, I have found that a good cry releases a lot of tension and gives you the strength to keep on going.Guide to Services for the Aged and Disabled in Israel
© Copyright-2008
This work is protected by copyright law. Use of this work or any portion thereof, including photocopying, publication, public production, distribution, translation, broadcast, allowing public access to it, and utilizing portions derived from it for other purposes, without prior written permission from the author is prohibited.
1 comment:
Very interesting and worthwile resource - recommend to all with aging parents
Post a Comment