Recipients of Long-term Care Insurance Benefits: Characteristics, Formal and Informal Assistance Patterns and Unmet Needs

The Community Long-term Care Insurance (CLTCI) Law was enacted 16 years ago. This study provides an updated picture of the extent to which the system of services has been meeting the needs of those eligible for CLTCI, the “division of labor” between the formal and informal systems of care, the burden on the families, and their satisfaction with the services provided in the framework of CLTCI. In addition, it provides findings regarding two issues on the public agenda – cash benefits (cash grants whose use is unrestricted) versus in-kind service benefits, and the employment of foreign workers in home care. It examines the benefit preferences of the families, and the characteristics and needs of those employing a 24-hour-a-day home care worker. In the framework of the study, 503 family caregivers for a representative sample of long-term care insurance benefit recipients were interviewed from mid-2001 until the end of the year.

Selected Findings

Formal Assistance, Informal Assistance and the Relationship between the Two

  • Three-quarters of the benefit recipients received assistance from a home care worker under the law in both personal care and homemaking, and 20% received only homemaking assistance. The percentage receiving only homemaking assistance was higher (36%) among recipients with a low level of disability.
  • Fifteen percent of the recipients employed a 24-hour-a-day home care worker (usually a foreign worker). This phenomenon was more pronounced among older benefit recipients, those with severe disabilities, and those living alone. Those with high income levels tended more to employ a 24-hour-a-day home care worker, although about a third had low-income levels.
  • Most of the family caregivers reported satisfaction with the assistance received by the benefit recipient (56% were very satisfied and 42% were satisfied).
  • Family members were considerably involved in the provision of direct care (almost two-thirds provided assistance in personal care), and most, including those not residing with the benefit recipient, provided help with homemaking. Most of the benefit recipients received assistance in all areas of care from both formal services and family members. We see that even with the development of CLTCI, families still play a central role in the provision of care for the disabled elderly. This is consistent with the findings of Institute studies conducted more than a decade earlier, when the law was first introduced.

Unmet Needs

  • A large proportion of the family caregivers reported feeling heavily burdened (26%) or burdened (41%).
  • Thirty-two percent of the family caregivers of benefit recipients who did not utilize day care centers expressed an interest in the recipient’s participation.
  • Relatively few of the family caregivers received training or counseling in the provision of care. Thirty-eight percent expressed interest in training and 25% expressed interest in emotional support.
  • The Preferences of Family Caregivers Either for a Cash Benefit or for In-kind Services
  • Most of the family caregivers (61%) preferred to continue receiving in-kind services. Nevertheless, 27% preferred to receive the cash benefit, 5% preferred a combination, and 7% had no preference or did not know.
  • The percentage of family caregivers who preferred to receive the cash benefit was higher in instances where the benefit recipient employed a 24-hour-a-day home care worker: 41% versus 30%.

Findings from the current study have been presented before forums of decisionmakers addressing various aspects of the implementation of CLTCI, as well as the care of the disabled elderly in general, such as the Labor and Social Affairs Committee of the Knesset and the Nursing Committee of the National Insurance Institute.

Citations in the professional and academic literature

Shamir, H. (2013). Migrant care workers in Israel: Between family, market, and state. Israel Studies Review28(2), 192-209.

Shamir, H. Migrant Care Workers in Israel.

Shamir, H. (2013). Migrant Care-Workers in Israel: Between Family, Market and State (מהגרי עבודה בתחום הסיעוד בישראל: בין משפחה, שוק ומדינה). Market and State.