Background
In 2016-19, the Supportive Community Program was introduced as a pilot program into the basket of services for people with limited functioning who receive long-term care (LTC) benefits from the National Insurance Institute (NII). The pilot program reflects the intent of policymakers and program developers to diversify the basket of services and make it more flexible for elders whether by force of the Long-Term Care Insurance Law or as part of the Supportive Community Program; it is part of the aging-in-place policy to help elders postpone or avoid moving to a nursing home. The pilot program made it possible for recipients of the LTC benefit to belong to a Supportive Community Program, providing them – in addition to its basic basket – with cleaning services, enhanced social activities, and a delivery service for food and medication – all in exchange for hours of assistance to which the law entitles them.
The pilot program operated in four Supportive Community Program locales: Holon, Kfar Saba, Sakhnin, and Ramla. It was funded and implemented by the NII, the Ministry of Labor, Social Affairs and Social Services (MOLSA), JDC-Israel Eshel, and local authorities. During its implementation, 619 members joined the pilot; on the eve of its termination (December 2019), there were 359 members. The main reasons for members leaving the program were: Death, the need to use the hours of assistance for the services of a formal caregiver, the move to a nursing home, or the receipt of approval for, and employment of, a foreign caregiver. Few members left due to disappointment with the service.
Goals
The main goals of the study were to examine the extent of activity of the pilot program and evaluate its contribution to participants.
Methodology
The study combined quantitative and qualitative research methods and contained the following elements:
- A quantitative telephone survey using structured interviews with 215 members of a Supportive Community Program participating in the pilot program, and 203 members of a Supportive Community Program who were entitled to an LTC benefit and did not join the pilot program. Interviews were conducted twice, at the start of the pilot program and about a year later, close to its end
- Semi-structured interviews with 25 formal caregivers
- 18 semi-structured interviews with officials involved in the pilot program’s implementation (coordinators of the pilot program, coordinators of the NII committees on the Long-Term Care Insurance Law, NGO managers, community facilitators, and social coordinators).
Findings
The pilot program encouraged elders receiving the LTC benefit to join the Supportive Community Program at no extra charge, and to enjoy an expanded basket of services compared with other members of a Supportive Community Program. Thus, more than half of the participants were new members who joined a Supportive Community Program as part of the pilot program.
A comparison of new members with members of a Supportive Community Program who did not join the pilot program but were entitled to the LTC benefit, revealed a higher percentage among the former who were married, had a low level of education, and did not manage to cover their monthly expenses. Similarly, the health status and functioning of members of the pilot program were inferior to that of non-members. On the other hand, the proportion that had a foreign caregiver among the participants of the pilot program was considerably lower than the proportion among non-members of the pilot program.
Participants of the pilot program consumed mainly the service of a community facilitator and the cleaning service. The pilot program helped raise participation in social activities and led to an increase of volunteers visiting elders at home, especially elders with limited mobility. In contrast, little use was made of the delivery service for food and medication. We also found that the general level of satisfaction of participants with the pilot program was higher than among members of a Supportive Community Program who did not join the pilot program.
The interviewees were asked about the contribution of the Supportive Community Program in four areas: To strengthening personal security, participating in social activity, managing to live independently, and easing the burden of care placed on the elders’ relatives. Of the four, the main contribution cited was the sense of security it lent them. Compared with non-members of the pilot program, the contribution to members was greater as regards personal security, management of independent living, and easing the burden of care of their relatives. This contribution is important because the given population is limited in functioning, and its socio-economic status is low. Nonetheless, the high proportion of members of the pilot program reporting loneliness, as opposed to non-members and to the general population, emphasizes the need to develop suitable responses, including activities at the members’ homes.
Conclusions
Given the intent to expand services so that elders with disabilities can age in place and postpone or avoid moving to a nursing home, it is important that the services be well-adapted to their needs. The health status and functioning of most of the participants of the pilot program were poor and virtually none employed a foreign caregiver. The study revealed that the combination of a Supportive Community Program and a cleaning service met an important need for many participants of the pilot program; nearly all consumed the cleaning service and cited it as a main reason for joining the pilot program.
In addition, increased social activities and visits by volunteers to the elders’ homes can help prevent deterioration in their state of health. It was suggested that they be encouraged to participate in social activity by making it accessible to them through organized transportation. According to the study, the response for elders with disabilities in the area of social activity was partial for they experience severe loneliness. There is room for the development and expansion of responses in this area. Finally, few pilot members availed themselves of the delivery service for food and medication. Yet, these services are vital for people who have nobody to assume the chore. We therefore recommend that it continue to be part of the basket of services.