Home health care is a vital component of the human right to dignity, life, and health. The State's obligation to equality requires that a person who becomes dependent on home health care should not have their access to the appropriate support determined by their economic status, and that this right should not be guaranteed only to the wealthy. However, Israel's response to ensuring adequate home health care, especially when it comes to community-based care, is incomplete, accessible to very few, and discriminatory.
Public home health aide care in Israel is provided in two main ways. The first is through the home health aide allowance provided by the National Insurance Institute for people living at home, and the second is via the funding for home health care provided by the Ministry of Health. Institutional care is relatively accessible but is intended only for seniors who cannot continue living at home. Most seniors do not require institutional care, but instead need assistance with specific activities. The problem is that the home health aide allowance for seniors who can continue living at home provides only partial coverage and is insufficient to cover the high costs associated with home health aide care.
To enable more people to remain at home, the State allowed HMOs to sell home health aide insurance to their members that is operated through private insurance companies. The State even encouraged HMOs to insure their members with home health aide insurance in order to save on institutional nursing care costs. Regulations and regulatory oversight were provided by the Capital Market, Insurance, and Savings Authority.
However, the health funds' home health aide insurance model has now come under significant scrutiny. Due to increased life expectancy, longer periods of dependency on home health aides, and more people effectively utilizing their rights to health aids coupled with poor management, there are fears that the insurers are on the brink of financial collapse.
In response to these concerns, the regulator worsened the insurance benefits. In early 2024, amendments came into effect that significantly reduced the monthly amount received by insured individuals, excluded children aged 3-5 from insurance (younger children had already been excluded earlier), and modified index linkage. As a result of these changes, the amount given to individuals with insurance for home health aides was reduced by approximately 1,200 ₪ per month for each insured person. Important to note is that as a result of the significant increase in the minimum wage, the cost of at-home caregiving has risen substantially, while the general cost of living is also skyrocketing. Together, these factors have made home nursing care accessible only to those with means.
The Association for Civil Rights in Israel and the Clinic for the Rights of Holocaust Survivors and the Elderly at Tel Aviv University are working to promote accessible home health aide care that the State is responsible for running and funding. Over the past few years, we have approached the Capital Market, Insurance, and Savings Authority, the Knesset Health Committee, and other entities to advance major changes in the field.
ACRI and the Clinic believe that the amendment process was fundamentally flawed. Among other issues, it was conducted hastily without sufficient public participation, and overstepped its authority. The reform disproportionately harms insured individuals, goes against the legislative intent, and is arbitrary and discriminatory. At no stage were alternatives explored in which the State would take responsibility and rescue the group home health aide insurance market from collapse.
“The State, as the regulator of this market, must first be ready to put its hand in its pocket and save the market from collapse; and second must regulate comprehensive home health aide insurance for every citizen through broad legislation," wrote ACRI and the Clinic in their appeal to the Knesset Health Committee. "This is mandated by the State's obligation to protect human rights, primarily human dignity, life, health, and equality.”
Almost a year after the amendments took effect, the Capital Market, Insurance, and Savings Authority, HMOs, and insurance companies have continued to reduce benefits to save insurers from collapse. Without any solutions, the situation will continue to deteriorate, and those who find themselves depending on home health aides will discover that the home health aide allowance covers only part of the costs, and that the home health aide insurance that they have paid into their entire lives is insufficient.
In the absence of a response, resource-poor seniors will enter nursing homes too quickly and without justification, or their family members will need to leave their jobs to care for their spouses or parents, severely impacting household economics and risking the family’s descent into poverty and debt.
ACRI and the Clinic's Appeal to the Health Committee, October 30, 2024 (Heb)
ACRI and the Clinic's Response to the Draft Amendment, November 21, 2024 (Heb)