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Bituach Leumi – National Insurance Institute of Israel Long-Term Care Benefit: an Explanation

Persons elgible for Bituach Leumi’s Long-Term Care Benefit will receive nursing services assisting them in daily functions and household management

Author:  Tali Kadmon Stern / Family Care
Last update15/06/16
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Intro:Bituach Leumi - The National Insurance Institute provides, to those who are eligible according to the Long-term Care Insurance Law (Long-Term Care Benefit), services which assist them in day-to-day activities and management of their household

Who is eligible for Bituach Leumi’s Long-Term Care Benefit ?

A resident of Israel, who have reached retirement age, and are dependent on others for assistance in daily living activities, or needs supervision, is eligible for the long-term care benefit of Bituach Leumi.

Eligibility requirements for Bituach Leumi’s Long-Term Care Benefit

* Residing in the community – the benefit is intended only for elderly people living in their own home or in a retirement home (not in an institution).

* Income Test – eligibility for the benefit and its exact  rate are  determined through an Income Test.  A person whose income is above the upper limit set by Bituach Leumi will receive only half the benefit, or none at all.  In calculating the benefit, the spouse’s income is also taken into account (the long-term care benefit is not  intended only for people in the low income range).

* The elderly person is not receiving the Sherutim Meyuchadim (special services) stipend from Bituach Leumi, or the Ezra L’azulat  (helping others) stipend from the Ministry of Defense.

*The elderly person is found to be  greatly dependent on others in  performing daily living activities.

In cases where the individual’s functioning is temporarily impaired,  the benefit will be provided for a limited period of time. Eligibility is determined by a “dependence  evaluation”, conducted by an assessor from  Bituach Leumi (usually a nurse or a physiotherapist)  in a home visit.

Congratulations! You are 90!

Individuals who are 90 years old or over may choose to  undergo  a functionality evaluation conducted by a geriatric specialist* instead of the dependence evaluation.  The geriatirc physician is required to fill in Appendix C in the  Long-Term Care Benefit claim form, and attach a document containing  medical information from the  patient’s pesonal doctor.

* The law specifies that this evaluation may only be conducted by a geriatrician employed  by: a ‘public medical institution’ owned by the government, one of the Kupot Holim or a local authority, or a corporation which is a public institution.

Note: An individual who has already undergone a dependence evaluation by a nurse from Bituach Leumi, may submit a geriatrician’s functional evaluation only six months later.

Long term care benefit for Blind People

An elderly individual defined by Bituach Leumi as ‘solitary’ (for example: lives alone, with a spouse eligible for the Long Term Care Benefit, with a disabled child), who has a Blind Person’s Certificate or a letter from a physician attesting to his/her blindeness, autamatically receives 9.75 points for the Long Term Care Benefit, without a dependency evaluation (a claim for the Long Term Care Benefit must be filed). A person who is not defined as solitary and has a Blind Person’s Certificate will be examined, and will then receive the Benefit based on the awarded points.

Short term care from  Bituach Leumi

People who need immediate short-term care (9.75 hours a week for up to 60 days) can request “short term care” from Bituach Leumi.  This often occurs after a period of regular hospitalization (not rehabilitation), or hospitalization as a result of breaking an arm or leg or pneumonia with high fever.  The applicant  must submit the regular request form for  Bituach Leumi’s long-term care benefit.   A professional medical evaluation must be attached to the request form, and the claims clerk at Bituach Leumi will decide, according to the medical recommendation, whether the benefit will be given on a short-term basis.  This form can be submitted through the hospital social worker . Eligibility for the  short term care benefit will be immediately effective upon returning home.

Benefit continued for 14 days during hospitalization

In the past, when an elderly person  receiving the long-term care benefit  was hospitalized, the benefit would be suspended until his  release.  However, a 1995 amendment to the Bituach Leumi Act specifies that  an elderly person hospitalized in  a  hospital (excluding long-term care, rehabilitative and mental institutions)  is entitled to the benefit during the first 14 days of his hospitalization.  If he  remains in hospital for more than 14 days, the benefit  is suspended  after this period of time,  and renewed  upon his release.

Degrees of Bituach Leumi’s Long-Term Care Benefit

The benefit is determined according to a score attained in Bituach Leumi’s dependence evaluation:

91%:  9.75 weekly hours for a person found to be dependent on others for most  daily living activities, or needs supervision.

150%:  16 weekly hours for a person found to be dependent to a very large extent on the help of others  for most  daily living activities, most hours of the day.

168%: 18 weekly hours for a person who is completely dependent on others, to the maximum degree, and need aconstant supervision.

 Addition of weekly hours for those eligible for the long-term care benefit who employ an Israeli caregiver

The National Insurance Institute has been providing extra care-giving hours to persons in the higher levels of dependence, eligible for the long-term care benefit , who employ an Israeli caregiver , and do not employ any foreign workers, according to the following criteria:

* A person dependent to a very large extent on the help of others  for most  daily living activities, most hours of the day, who currently receives 16  weekly care-giving hours will receive 3 extra care-giving hours a week.

* A person dependent to a very large extent on the help of others  for most  daily living activities, most hours of the day, who currently receives 8  weekly care-giving hours (because of his income) – will receive 1.5 extra care-giving hours a week.

* A person who is completely dependent on others for all daily living activities around the clock, or needs constant supervision, and currently receives 18  hours – will receive 4 additional care-giving hours a week.

* A person who is completely dependent on others for all daily living activities around the clock, or needs constant supervision, and currently receives 9 hours (because of his income) – will receive 2 additional care-giving hours a week.

Bituach Leumi has forwarded this information regarding additional hours  to agencies that provide nursing services, and there is no need to officially request these  extra hours.

Receiving the long term benefit in cash

aperson who is entitled to a long- term care benefit who employ a full- time caregiver (foreign or Israeli)  for at least 12 hours a day for 6 days a week, under certain circumstances , can choose to receive their benefit in cash, and employ the caregiver privately. they can also choose to continue employing the caregiver with the manpower company.

In order to receive the long-term benefit in cash, the applicant must meet certain conditions: the caretaker must be over 18 years of age, and cannot be a relative of the recipient; the caretaker must be employed  and paid wages, based on a written contract; the employer must have a permit to employ a foreign worker; and the worker must have a legal permit to stay in Israel.

A person who choose to receive the long term benefit in cash, can also recieve the other long term services such as- a presonal alarm unit, absorbent products, laundry services and visits to a day care center.

Cost of the chosen services will be deducted from the cash benefit payment received by the family.

How to claim the long-term care benefit from Bituach Leumi

To receive the long-term care benefit from Bituach Leumi, you must fill out a claim for long-term care benefit form, and submit it to the claims clerk at the Bituach Leumi branch near your home.  If you find it difficult to fill out the form you can get help from the claims clerk, the Counseling Service for the Elderly at the Bituach Leumi branch or  a  nursing care agency.  The form must include a written medical opinion from the applicant’s physician. Proof of income documents must be attached.

It is a good idea to request, on the form, that the nurse’s home visit  should be arranged with a member of the family.

The assessor visit to the home of the elderly person

It is very important that you or another family member who is aware of your elderly relative’s condition be present during the visit of the Bituach Leumi assessor.

When the assessor arrives,  ask to see her Bituach Leumi worker’s identification.

It is essential to understand that Bituach Leumi’s  long-term care benefit is given on the basis of the person’s  level of functioning in daily living activities,  rather than his  overall health. It is therefore important to stress the difficulties experienced daily by your elderly relative.

The law defines eligibility for Bituach Leumi’s long-term care benefit based on the person’s independence at home only, and not outside. Thus  mobility  limitations outside the home are irrelevant.  The dependence evaluation examines the person’s ability to dress, bathe, eat, use the bathroom and walk inside the home,  as well as his need for supervision at home for his own safety (due to  deteriorating memory or other psycho-geriatric conditions that endanger him or his environment).

Update – October 2014: A special committee of Bituach Leumi recommended that major changes be introduced into the dependency assessment of elderly individuals applying for a long-term care benefit. Based on these recommendations, the approach has been altered: the general identical evaluation process will be replaced by an individualized assessment for every applicant. In some cases, the person will not be required to demonstrate his abilities, and an interview will suffice.  For instance, when a person confined to his bed or to a wheelchair reports that he/she is totally dependent on the assistance of others, and presents medical documents attesting to this condition, and the assessor arriving from Bituach Leumi receives the same impression, there will be no need for a physical test of functional capabilities.

According to the new approach, a demonstration will only be required when the degree of dependency cannot be construed from indirect observation of other activities. For instance: persons holding and presenting their medications will not be asked to demonstrate how they wash their hands with soap.

Deterioration

If the maximum long-term care benefit has not been granted by  Bituach Leumi, and the elderly person’s condition deteriorates, you can contact Bituach Leumi and request a re-evaluation due to deterioration.  This application must  include the appropriate documents, confirming the deterioration in the person’s daily functioning.

Procedures for appeal when an application has been denied

  1. Appeal –  The appellant  may appeal in writing , enclosing  relevant documents, directly to one of three appeal committees operating in three  main Bituach Leumi branches:

* The Haifa branch – for people residing in northern Israel

* The Ramla branch – for people residing in the central region

* The Beersheba branch – for people residing in the south of Israel

In this way one may appeal Bituach Leumi decisions regarding  initial applications for long-term care benefits, as well as applications for increasing the allotted  number of weekly home-care hours due to a deterioration in the elderly person’s condition.  The appeal should be made as soon as possible after receiving the negative response from Bituach Leumi. (This is to prevent situations in which the committee decides that the  applicant’s condition has worsened  and requires him to submit a new application).

Please note: the three branches mentioned above receive appeals  from many different  places in their regions, and therefore the processing of appeals  takes a long time.  The  Bituach Leumi does not place a time limit on the  processing of appeals.

  1. Repeated application – If an elderly person’s request for the long-term care benefit was turned down, and later his condition deteriorated, he may apply to Bituach Leumi for reavaluation. Medical documents attesting to this deterioration should be attached to the request. Social workers or nurses from the person’s Kupat Holim can be very helpful,  and should be consulted.
  2. Filing a complaint – complaints about the committee’s decision with regard to an elderly person’s entitement to the long-term care benefit may be  submitted  to the claims clerk in the local branch of Bituach Leumi, closest to his place of residence.

What services does  the long-term care benefit include?

The following is a list of services available to recipients of the long-term care benefit l- as long as they can be provided in their home communities:

* The assistance of a home caregiver in daily living activities (dressing, bathing, eating, bathroom assistance, walking inside the home), managing the home, and needed supervision.  The quota of hours can be exchanged for payment to a foreign worker who is legally employed to care for the person.

* One working hour of the caregiver = one weekly home care hour.

* Care in a Daycare Center for the Elderly: The person can visit a daycare center for up to 5 days a week. Optionally,  the hours allowed by the benefit can be split between home care and days spent in the daycare center.

Services provided at the daycare center: bathing, supervision, recreational activities, hot meals and social interaction, as well as transportation to and from the daycare center.

* A day spent at the daycare center is equivalent to the following number of home care hours:

For a person entitled to 9.75 hours weekly: 2 home care hours = one day at the center.

For a person entitled to 16 or18 hours weekly: 2.75 home care hours = one day at the center.

There is also a small fee per day for meals, transportation etc.

* A supply of absorbency products such as adult diapers, absorbent pads, sheets, etc.  These products are provided to the elderly person according to his needs,  and delivered to his home once a month.  The value of the products is determined individually  for  every person, vis-à-vis home care hours. Products may be ordered directly from companies listed by the Bituach Leumi. For further details press here.

* Laundry service: Laundry is taken from the person’s home and returned clean.  Up to 5 kg is considered one laundry unit. To check the value of laundry services in care hours, please consult the social worker at the social services department in your local authority. Usually one laundry unit is equal to 1.25 weekly hours.

* Usually one laundry unit = about 1.25 home care hours.

* Emergency alarm button: The alarm button makes it possible for the elderly person to contact an emergency call center simply by pressing the button, 24 hours a day.

 The call center can order the following for the subscriber: doctor, ambulance, fire department, home repairman, etc.  Payment for these services is decided directly with the professional.  The fee for an ambulance is the same as set by the health funds.

* The emergency alarm button- To check the value of an emergency alarm button in care hours, please consult the social worker at the social services department in your local authority. Usually the button is equal to 0.25 weekly hours.

The social worker in your local authority’s Social Services office determines, together with the elderly person and his relatives, which services they would like to use.  In other words, the care program of your elderly relative is a joint decision.  The social worker also establishes the contact between the elderly person and his family and the service providers.

Assistance before long-term care benefit is granted

This service makes it possible to have a caregiver at home right away, until  assistance from  Bituach Leumi is approved.  The service is provided for a limited period of time, based on professional considerations. It is free of charge, at the expense of the home care agency.  The agency can also assist you in applying to the Bituach Leumi.

The information presented in the english website is partial. For full info please visit our hebrew website

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