zissieg@walla.com
Caught between a rock and a hard place
It was bound to happen eventually, and indeed it did. One foreign worker was no longer enough help to care for my parents. For a while we were able to manage with a foreign worker plus occasional help from a local caregiver. As time wore on, however, we began weighing the option of either hiring an additional full time foreign worker or admitting my parents to a nursing home. Neither one of the options was attractive: the conflicts that might arise between two foreign workers living together under one roof (one male and one female), although it would be affordable, appeared formidable (and I am not even certain whether by law it would be permitted); the impersonal atmosphere of a nursing home and the indignities it probably afforded were no more palatable. We were caught between Scylla and Charybdis. The cost of the nursing home, itself, was way out of my parents’ reach. Even if we located one that met our needs, how would we be able to afford it? To make matters worse, the foreign worker we had in our employ was seeking to move to Canada. We were faced with retraining someone new, if not two new people. The scales started to tip in favor of care in a protected environment.
What do you call a Jewish Odyssey?
Thus began the Odyssey of searching for an appropriate nursing home and the means to pay for my parents care. In our ongoing epic we became familiar with the Ministry of Health as well as the Ministry of Welfare, who vie against each other in funding of nursing home care—neither one of them wanting to assume responsibility for it. Patients in need of care in a protected facility are categorized in a number of ways. For our purposes the two categorizations that applied to my parents were either tshushi (frail) or siyudi (requiring more extensive nursing care). The Ministry of Welfare funds tshushi care, whereas the Ministry of Health funds siyudi care. Bituach Leumi funds nothing towards nursing home care. And here’s how the process goes:
One must apply to the Ministry of Health through Lishkat HaBriut to see whether the patient qualifies for nursing home care, and whether the patient is considered tshushi or siyudi. The initial forms comprise medical reports completed by the patient’s physician and nurse detailing the patient’s degree of functioning (ADL’s again), as well as additional medical documentation of specific diagnoses by specialists when dementia is present (from my experience). In addition there are forms for the social worker to complete. This information is submitted to the Social Worker at Lishkat HaBriut, who reviews the forms in a meeting with you to ascertain that all the necessary information is available for submission to their medical committee for review. The review committee meets every couple of weeks to render decisions.
NOT ALL NURSING HOMES ARE RECOGNIZED BY MISRAD HABRIYUT FOR FUNDING—IF FINANCIAL AID IS REQUIRED, MAKE SURE THE FACILITY OF YOUR CHOICE IS RECOGNIZED AND HAS A “CODE”.
When we first submitted our forms for the review committee, we were contacted and told that some committee members would have to examine my parents at their home. Apparently it was not clear whether they were siyudi or tshushi. A nurse and social worker from Lishkat HaBriut arrived for the examination and were of the opinion that one of my parents was siyudi while the other was tshushi. I explained how we wanted to keep them together in the same room in a
nursing home, and if they were categorized differently that would be impossible. (Not only that, we would have to deal with two different government entities for financial support, if indeed they did qualify.) The crew informed us that they would make their recommendations to the committee and we would be hearing from them. Then we again played the waiting game.PARDON ME FOR CHANGING
MY GENRE, BUT HERE'S WHERE WE HIT "CATCH 22"
Nursing Home Sweet Nursing Home
While we waited we toured several nursing home facilities in the area, while my sister did the same where she lives. We were in for a rude awakening when the nursing home administrators looked at my parents’ medical records and forms listing their functioning capabilities. They predicted that my parents would fall between the cracks—they actually required siyudi care, but would, from past experience, most probably be classified as tshushim by the Ministry of Health. In that case my parents would fall under the responsibility of the Ministry of Welfare. If the nursing home maintained they required siyudi placement, no government funding would be available. Both bodies—the nursing home and the Ministry of Health—must be in agreement in the categorization for the patient to qualify for financial coverage—be it the Ministry of Health for siyudi patients or the Ministry of Welfare for tshushim. Nevertheless, we plodded on in search of a place suitable to deal with their needs and with a religious atmosphere appropriate to their background and observance. English-speaking staff was also important to us. Proximity to either my home or that of my sister was a priority, and the cost played a major role in our decision making. No one place met all our conditions. Time was running out. We decided to waive some of our preconditions and opted for what we believed was the best choice at the time. We will never know if the choice we made was the right one, but given the time constraints and the condition of my parents we could not be too choosy.
I STRONGLY RECOMMEND STARTING THE NURSING HOME SEARCHBEFORE YOU ARE UNDER PRESSURE TO MAKE A HASTY DECISION
The committee proved to be compassionate and categorized both my parents as siyudi, effectively guaranteeing they could be housed in the same department, and most probably (depending on the availability) in the same room of the facility they chose. Not only did this relieve our anxiety about their transfer to a new place, it also made my parents more receptive to the idea of this drastic change. No matter what difficulties they might have in adjusting to the new situation, at least they would be able to face them together, as they had throughout their lives. Plus we had a definitive answer as to which government body would be in charge of the financial aspects and were able to avert the hassle of a power struggle between two government offices.
I hope you haven’t forgotten about all those forms you always have to fill out. We had only just begun. Now that the medical portion of the application had reached its close, we were faced with the financial reporting. Application forms are available online. There are forms to be filled out regarding the patient and his/her spouse’s finances and property, as well as forms regarding the finances of each of the patient’s children residing in Israel. Monthly salary printouts of children working in Israel must be supplied for the three months preceding the application. When we first applied (and were rejected, because my parents’ finances were just borderline enough to allow them to “get by”), there were fewer forms than what are required now. Recently Lishkat HaBriut has added more forms to those previously requested. The patient and his/her children also have to provide a listing of assets such as property and automobile, bank account information and documentation of property holdings. How do I know this? I have just re-applied for financial support and am still awaiting an answer.
As an aside, what put my parents over the limit financially was the fact that they each had a nursing care insurance policy that we had activated when they started paying for in-home care. This additional monthly income just put them over the edge. If you are considering purchasing nursing home insurance (bituach siyudi), carefully weigh the pros and cons. You may be paying more in monthly premiums than is worth your while. This, of course, depends on your financial situation. For someone who has a limited fixed income and who will require government help for nursing home care, it may not be cost-effective to invest in additional nursing home insurance. Do your own calculations and research to see where you fall in this area. There is an excellent article which appeared in Ha’Aretz describing the pros and cons of investing in this type of insurance.
Epics don’t necessarily have happy endings
To make a long story short, we resettled my parents in a nursing home near my sister. Having been assured by the marketing manager that the staff spoke English and the religious atmosphere coincided with my parents’ traditions, we toured the facility and were favorably impressed with the care and accommodations. It wasn’t the Waldorf-Astoria, and the synagogue didn’t boast any famous cantors, but it was clean, well-staffed and met the physical demands of my parents’ condition.
Soon it became apparent, however, that not all the staff spoke English—in fact very few of them did—and this has been the source of much aggravation. I can speak Hebrew. My sister can speak Hebrew. My father understands Hebrew reasonably well and can make himself understood in the language. My mother neither speaks nor understands Hebrew—no matter how many times you repeat the question or statement or how loudly you say it, she still will not understand it.
Regardless of how many times she tries to express what she needs or wants, the staff is totally baffled by the foreign language she speaks. She is an ulpan (Hebrew classes for new immigrants) dropout and now sorely regrets it. The alternate languages that may have helped her communicate in her current environment are Amharic and Russian, and perhaps some Yiddish. She struck out in all three. So, when I say it is important to learn Hebrew, I mean it. You cannot afford to be reliant on a translator when you have to fend for yourself. If you haven’t learned Hebrew yet, now would be an excellent time to start.BE KIND TO YOUR CHILDREN…
THEY’RE THE ONES WHO WILL CHOOSE YOUR NURSING HOME. 
If you find yourself in need of approaching the Ministry of Health/Lishkat HaBriut for the purposes of financial aid, be aware that the hours of service are quite limited. In my area they receive the public one morning and one afternoon per week, and are available for phone queries three mornings a week for about two hours each morning. See the link for the various offices and their contact information to ascertain the hours applicable to your area. Our experiences with the personnel have been quite positive. They have been caring, informative and helpful. Regretfully, even their willing personalities do not get the bills paid if the patient does not meet the standards dictated by the system. We fell short and for several months have had to bear the burden on our own. Nevertheless, I know that we made the right decision to place my parents under constant medical supervision. As painful and expensive a decision as it was, I can see now that there is no way we could have continued catering to their growing needs in a home environment. It was not fair to them, and it was not fair to us.
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.
No comments:
Post a Comment