The year is 2030. The place is a neighborhood in Be’er Sheva. An 84-year-old grandfather wakes up in his home to the sounds of a computer alarm clock and a message on the screen reminding him of the medicines he needs to take. He places his hand on a home-based blood pressure monitor, with the results automatically uploaded to the central database of his Kupat Holim. An hour later, a home-care nurse comes by for her weekly visit, bringing with her a small computer to record the vital signs and other information on how the grandfather is doing.
The next day, his daughter comes by to take him to an art therapy program for seniors with preliminary symptoms of Alzheimer’s. In a meeting room down the hall from the art program, the daughter attends a support group for adult children caring for elderly parents, facilitated by a geriatric social worker.
In 2012, such a scenario is a long way off, but it could become a reality in Israel over the next two decades if the participants at the recent Dead Sea Conference, the annual gathering of leaders from Israel's health system, government, and academia, have their way.
The urgency for change lies in the projected 84 percent increase in the elderly population in Israel over the next 20 years (Figure 1). This growth from 742,000 to over 1.3 million people over age 65 is poised to be one of the most dramatic demographic transformations in Israel’s history.
For Israel just to keep up with this growth will require rapid expansion of the service infrastructure for the elderly. But as the participants emphasized, Israel must not merely respond to the coming trends, but must actively make efforts to try to shape them. What is needed, they say, is a national commitment to transforming the health and social system so that Israel’s growing elderly population is cared for in the most effective way possible.
Much of the Institute’s work in recent years has been dedicated to assisting in this change. As part of this commitment, the Institute played a key role in this year’s conference, which focused on aging and health, with senior Institute staff helping to organize the conference and produce the background position papers used in the discussions.
Prior to the conference, the Institute actively assisted in the preparation of three national reports on aging and health that provided the information base of the conference:
Planning for the National Geriatric System for 2010-2030, analyzing long-term population trends and the projected impact on the health service system and the health workforce.
The Reform of the Provision of Long-term Care: Finance and Delivery, offering recommendations for significant change.
Health 2020: Guidelines for Health Promotion for the Elderly, laying out concrete high-priority and effective strategies.
One of the Institute’s key contributions throughout all of these activities was its detailed analysis of the implications of the growth of Israel’s elderly population. Through our work, we identified the “story behind the story” of projected demographic changes—a story with important policy implications.
The rapid increase in Israel’s over-65 population will be uniquely distributed across age groups and time. (Figure 2.) Between now and 2020, the “young-old,” or those between ages 65 and 75, is projected to grow by 66 percent. In contrast, the “old-old” (over age 75) group will only increase by 22 percent in the same period.
The trends are reversed in the following decade, however. Between 2020 and 2030, the young-old will grow by only 8 percent, but the “old-old” population will expand by 60 percent.
These changes have important policy implications, as they reinforce the necessity of taking clear policy steps now so that the young-old of today will be in better health when they move into the old-old period, a period where service needs typically are much higher.
To point the way forward, conference participants issued a series of policy recommendations for transforming Israel’s health system and putting it in a position to properly serve Israel’s elderly in the coming years.
Make the promotion of healthy lifestyles and preventive care a priority of the health and social services.
Develop new approaches to management of chronic illness to prevent deterioration and disability.
Strengthen support for family caregivers who are facing greater demands and challenges as people live longer and need care for longer periods of time.
Expand community-based support services, with new paramedical roles to coordinate and integrate care within the health services and with other social services.
Take advantage of new technologies to monitor the health status of the elderly in the community and to coordinate care.
The role of technology will play a particularly important role, especially when we consider the changing educational backgrounds of Israel’s elderly. In fact, the levels of education among Israelis over age 65 have steadily increased, as the proportion of people with post-secondary school education jumped from 15 percent in 1990 to 34 percent in 2010. (Figure 3.)
As well, as shown in Figure 4, today’s 45-64-year-old age group has even higher education, which means that the next generation of elderly will be even more educated than those today.
It also means that they will likely be far more comfortable with—and interested in—adopting new technologies to help with their health care. There are, in other words, exciting opportunities to use new technology to engage seniors more deeply in taking responsibility for their own health and in being a more active partner in their health care.
Though they felt that there is much to improve within Israel’s health care system as it relates to the elderly, the Dead Sea Conference participants emphasized that Israel has a number of strengths to build on, including:
Relatively low rates of hospitalization and institutionalization (Israel’s cultural tradition of community based care has led to one of the lowest rates of hospitalization among developed countries)
Relatively high rate of investment in community care
Family availability and willingness to care for their elderly parents
Strong inter-generational solidarity among the young and the old
Significant experimentation with innovative programs that are ready to be introduced across the wider system, in which JDC-ESHEL and the Institute have been very much involved
At the conference both the Deputy Minister of Health Yaakov Litzman and the Ministry’s Director General Dr. Ronni Gamzu responded very positively to the proposed recommendations. The Ministry has since followed up with the formation of a high-level working group to develop concrete plans to implement the recommendations. As with the earlier committees, the Institute is actively participating in this working group.
In the end, it is clear that Israel has a narrow window to effect change now—as the demographic storm is already upon us. By combining policies to promote healthy and active aging, a more integrated approach to chronic disease management and home care, smarter uses of technology to enhance coordination of care, and changes in health care workforce training, Israel can become a world leader in transforming its health care system in the face of a rapidly aging population.