Part 5: Be Careful What You Wish For

by Shari (Zissie) Gitel
zissieg@walla.com

Those dreams for more help were realized, but at what a price! Now both my parents were awarded hours by Bituach Leumi—each at 9.75 hours per week. As time progressed so did their disabilities, and about two years ago, after several appeals for more caregiver hours, they both eventually reached the maximum number of hours that Bituach Leumi allowed (at that time 15.5 hours per week apiece). I finally had a lot more help. The flip side of the coin was the degree of how incapacitated my parents had become. If they were in bad condition before, now they were defined as totally house-bound (merutakei bayit) and requiring care for almost all their ADL’s.

This did come with several “perks”, though. It is indicative of my new perspective on what was important in life that I reached the point where I considered free house calls by the doctor and blood tests performed in the home by visiting nurses “perks”. My chauffeur services were somewhat reduced—though I was still making frequent trips to the kupat cholim to arrange for tests and get the proper paperwork done, not to mention regular visits where I met with the doctor and reviewed the medical situation with her to get medical advice, referrals and prescriptions. At least, I didn’t have to “schlep” my parents to the clinic—an ordeal neither they nor I enjoyed.

And now I would like to express a personal thank you to whoever invented the fax machine. This modern day device has been a Godsend. Many transactions with the kupat cholim (as well as other entities) can be conducted by this method, saving time both in travel and waiting in line. It is music to my ears when I hear the clerk tell me over the phone to fax the information to them for processing.

USE THE FAX TO SAVE PRECIOUS TIME

But what did this mean when you get down to brass tacks? Before my parents had been awarded the maximum allotment of hours, the caregivers (now we had a man coming several hours a week for my father, as well as a woman coming several hours a week for my mother) had been arriving early in the morning to take care of getting my parents breakfast and lunch, and getting them into bed for a nap. Then help arrived in the evening for bedtime. I set up a complicated schedule to make sure the hours did not overlap and to provide the best daytime coverage I could arrange for my parents during their waking hours. Once they received the maximum allotment of hours they were in no condition to be left alone. Great! Now what?

Advantages of staying at home
When we moved to Netanya to be closer to my parents (after having cared for my mother-in-law in Jerusalem for 10 years) we took into consideration the needs of my aging parents (and our own as well—we aren’t getting any younger, either). We purchased a home suited to the needs of the handicapped and elderly, i.e. there were no steps leading to the entrance of the house from our driveway; there was a bedroom on the entrance level as well as a bathroom across the hall from the bedroom. We installed a shower in the laundry room (off the bathroom) as soon as possible after my father had his stroke. For all intents and purposes we were physically set up to have them at our home. Indeed, during the holidays and on Shabbat my sister and I would take turns hosting them. So we got a taste of having them live with us for prolonged periods. Out of concern for their welfare we decided that staying in a home situation was better for them (we felt that individualized care and familiar surroundings were preferable to the more impersonal atmosphere and care afforded by a nursing home), as long as we could manage to continue providing the needed services for them. But the home where they would stay was not going to be ours.

WHAT EFFECT WILL A MOVE HAVE ON THE PATIENT? ON YOU?
Having your parents move into your home ideally should allow for the best supervision of their daily needs. Each person has to consider the risk/benefit factors of such a move. There are many considerations to take into account: invasion of privacy, clashes of temperaments, effect on your marriage, extra chores and meals, to name but a few. After much deliberation and despite the fact that I felt extremely guilty about not moving them in with us, we decided that for everyone’s sake it would be better to hire permanent full-time sleep-in help and keep my parents in their own apartment for as long as feasible.

Enter Foreign Worker Stage Left
Oh, if it were only so easy!! Applying for a foreign worker is a long, involved process and can be initiated only after the applicant has reached a certain number of points on the Bituach Leumi scale of requirements for extended nursing care. My father finally qualified. There are several stages in the application, first of which is acquiring the license for employing a foreign worker through the Ministry of Industry, Trade and Labor, Yechidat HaSemech L’Ovdim Zarim. To do this you have to contact a reputable employment agency that has experience in these matters. These agencies have all the forms necessary and can guide you through the process. Along the way there are many bureaucratic fees to pay, crowned by the fee that is paid to the employment agency itself for its services as intermediary. Until you have the license in hand, you cannot officially apply for the foreign worker.

Needless to say, this takes time. Once you have the license, if you are willing to hire a foreign worker that is already in the country (which generally means paying a higher salary than for a worker who has not yet entered the country), you may be able to find a suitable candidate in a relatively short time. If, however, you wish to hire a worker who has yet to arrive in the country, you could wait several months before this materializes. The contract for foreign workers from the Philippines may vary from company to company, but most of the terms as far as holidays and days off are basically the same. I am not familiar with contracts for workers from other countries.


In addition to the monthly salary for the foreign worker there are other benefits the patient (employer) must provide. These include health insurance, Bituach Leumi payments, overtime, accommodation and food, a weekly allowance, vacation/holiday pay, sick pay, rest and relaxation pay (d’mei havra’ah), severance pay under certain circumstances, and fees for repatriation of the foreign worker for a variety of conditions.

I never promised you a rose garden.

SALARY IS ONLY A SMALL PART OF THE COST FOR A FOREIGN WORKER

While you’re anxiously awaiting the arrival of the mystery foreign worker, you might consider some shortcuts to shopping for medications and groceries—although I myself never took advantage of them. Internet shopping for groceries is an option with delivery to the door of the patient (here is the Supersol link, and I am sure there are other major chains that provide the same service). Some pharmacies and kupot cholim also advertise that they will send a courier to the home to pick up prescriptions and send the medications back to the home of the patient. No doubt there is a fee involved, but it may be worth your while to look into this option.

Don’t believe everything you hear
Well, we filled out the inevitable forms to process the arrival of a foreign worker, and paid the inevitable fees involved. Of course, as luck would have it, our scheduled worker’s flight kept getting postponed for one reason or another. Our original application for a license was made at the beginning of November. We received the license at the end of November and were told that within three weeks or so the worker would arrive. The worker actually arrived in mid-January. According to the employment agency all their workers attend a course in basic spoken Hebrew and are taught the laws of keeping kosher. We found this to be an exaggeration in the extreme. But we did receive a very capable, bright and energetic worker and managed to continue with home care for close to two years.

Be prepared, if you do decide to go this route, that there are many days off (besides the weekly day off) that the worker is allowed, and if the worker agrees to work on those days off you will have to pay a hefty overtime rate for this service. If the worker takes vacation days (highly recommended for the worker’s sanity and well-being), you are left on your own to care for the patient/s or to find alternate help. The website for the Philippine Embassy has a list of the national and religious holidays to which their citizens are entitled. The hours that Bituach Leumi has awarded the patient/s can be used towards the salary of the foreign worker. (Note: Bituach Leumi does not pay the caregiver of a patient during days that the patient is hospitalized. This applies whether the caregiver is a local worker or a foreign worker. Many times, however, it is possible to reassign the hours to a different date in the case of a patient who is cared for by a full-time foreign worker. If all parties agree and there are enough hours left in the month for a part-time caretaker to make up the lost salary, the caregiver may choose to work extended hours to recover the money lost due to the patient’s hospitalization.)

MAKE SURE TO HAVE THE PATIENT'S VITAL INFORMATION READILY AVAILABLE

I must have been doing something right
To ensure proper dosage of medications and performance of medical procedures accurately I prepared many lists. All the medical information relating to my parents was stored in my head, and if I were unavailable for whatever reason, without these lists everyone else would be at a loss for how to deal with them. Among the lists I prepared for each of my parents individually were:
Each of their medications including the strength of the medication, how many times a day and at which hours to take them, as well as whether they were to be taken with a meal or not.
All their diagnoses, lists of their hospitalizations, and answers to frequently asked questions when being admitted to the hospital, e.g. date of birth, date of aliyah, country of birth, Holocaust survivor?, allergies, next of kin and contact information for close family members both in Israel and abroad.
Information on how to reach their family doctor, dentist, barber, pharmacy, supermarket, etc.
Sample menus for their meals.

Can you tell I’m a Type A personality? Born under the sign of Virgo? But knowledge is power, and you never know when the information might come in handy. I’m a little neurotic, so what? When out of the blue my parents’ family doctor sent the district geriatric specialist team to pay a home visit to my parents, they took one look at the organized listing of medications and the set-up in the home and said we had everything under proper control. If only my head felt that way, too, I’d have been in good shape.

So, one more milestone was reached, and another sigh of relief was heaved. But not to worry—the saga continues.

Guide to Services for the Aged and Disabled in Israel
© Copyright-2008
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