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Choosing a Nursing Care Home

27 December 2023

The decision to admit a loved one to a nursing facility is not simple. It may involve substantial emotional difficulties, as well as careful consideration of an entirely new issue to find the most suitable facility for a family member.

Not every nursing facility is appropriate for every functional condition. Initially, you should carefully evaluate your family member’s physical condition and according to the results you can start searching for an appropriate institution. For example, an independently functioning older adult can go to an assisted living residence, whereas a person with mild physical deterioration will go to a nursing home with a ward for people with mild physical deterioration. Determining the functional capacity level of an elderly person is conducted by a committee for classifying chronically ill patients.

Below, we have compiled a table where you can easily understand which institution and ward suit your family member, according to their functional capacity level. In addition, it is specified who covers the admission charges for each institution.

When a family member’s physical condition no longer allows for home caregiving, it may be necessary to consider transferring your loved one to a nursing care institution (a nursing facility or a nursing home). This is not an easy decision, and in addition to the emotional difficulties, some practical questions come up about choosing and funding the right institution and deciding between available options.

How to choose an appropriate hospitalization institution

When choosing a long-term hospitalization institution, the patient's medical and functional capacity level (status), as well as their treatment requirements, are taken into consideration. These requirements may include either rehabilitation, mild physical deterioration, physical impairment, cognitive impairment, complex long-term nursing care, or long-term ventilation.

The patient’s status is determined by a committee that is responsible for classifying chronically ill patients. This committee is overseen by a medical geriatric expert who is affiliated with the regional health bureau.

Funding long-term hospitalization in a nursing facility

There are several options available to fund long-term hospitalization in a nursing facility:

  1. Private funding: d long-term hospitalization can be funded privately and/or through nursing insurance, if you have such a policy coverage
  2. Long-term hospitalization funding assistance through a public authority (government ministries or HMOs), depending on the applicant’s medical and functional condition

If a family member is in a nursing facility, you may be eligible for an income tax credit. Log in to the Income Tax website for further information.

In the table below, you can see which institution and ward are suitable for your family member according to their level of functional capacity. In addition, it is specified who covers the admission charges for each institution:

How to fund long-term hospitalization in a nursing facility

Functional Capacity Level Definition Suitable Hospitalization Facility/Ward Funding Body

Independent

Without a significant decline in the ability to perform basic daily living activities  (ADLs)

Assisted living residence

 

Community dwelling cluster

 

No need for nursing care/or supervision

 

Private

 

 

 

 

Funding from the Ministry of Housing or the Ministry of Immigrant Absorption for homeless and disadvantaged elderly people

Mild physical deterioration

Mild to moderate decline in daily living activities

 

Partial assistance is necessary for basic activities

Nursing facility, ward for mild physical deterioration

Private

 

Or

 

Partial funding from the Ministry of Welfare and Social Services and copayment (of the patient or family members) through the welfare bureau in the local authority

Physical Impairment

Severe and long-term decline in mobility, daily activities, and medical condition. Substantial and long-term mobility decline.

 

Requirement for long-term care and medical follow-up

Nursing care ward

Private

 

Or

 

Partial funding from the Ministry of Health and copayment of the patient or family members

(Through the regional health bureau)

Cognitive Impairment

Substantial cognitive performance decline (extensive difficulties in memory, orientation, and judgment)

 

Ongoing supervision is needed

Cognitive impairment ward

Private

 

Or

 

Partial funding from the Ministry of Health and copayment of the patient or family members

(Through the regional health bureau)

Complex Long-Term Nursing Care

Combination of severe and long-term decline in daily activities, and unstable medical condition

 

For example, deep pressure wound, severe respiratory problems, long-term intravenous treatment, terminal disease

 

Long-term medical care and monitoring is needed

 

Ward for complex long-term nursing care

HMOs funding, with copayment of the patient or family members

Hospitalized Medical Rehabilitation

Temporary functional decline due to illness or physical injury:

  • Stroke and neurological injuries
  • Fractures, orthopedic problems, amputations, and joint replacement,
    treading prohibition.
  • Arthritis with dysfunction
  • Function decline due to severe and long-term illness (pneumonia, complex surgery)

 

Hospitalization requirement

 

Wards of rehabilitative geriatrics in geriatric hospitals

 

 

Rehabilitative wards in rehabilitative hospitals

HMOs funding, without copayment

Long-Term Ventilation

Requirement for long-term ventilation

Long-term ventilation

HMOs funding, without copayment

It is important to make sure the admission institution holds a proper license from a governmental ministry (the Ministry of Health or Welfare) and is entitled to care for people in the medical condition of your family member.

Type of hospitalization ward or care

Type of license

Rehabilitation

A license from the Ministry of Health for rehabilitation or rehabilitative geriatrics

Nursing ward

A license from the Ministry of Health for rehabilitative geriatrics

Cognitive impairment ward

A license from the Ministry of Health for cognitive impairment care

Physical impairment ward

A license from the Ministry of Health for physical impairment care

Complex long-term nursing care ward or long-term ventilation ward

A license from the Ministry of Health for complex long-term nursing care

Hospitalization in an institution without a license is dangerous!

Hospitalization in an institution without a license is dangerous!

Hospitalization of your loved one in an institution without a license exposes them to dangers:

  • Inappropriate treatment: an unlicensed institution may compromise the quality of treatment due to a lack of supervision and implementation of standards and regulations
  • The institution may be closed: hospitalization in an unlicensed institution exposes its residents to enforcement procedures, including the possibility of the institution being closed or the residents being transferred to another licensed institution.

 

Alternatives for long-term hospitalization

The decision of whether to keep a family member at home or hospitalize them is a collaborative effort involving the caregivers, their relatives, and the medical team. This decision takes into consideration various complex factors, such as the patient's medical condition, and the potential risks involved. One of the key factors in determining the need for hospitalization is whether the patient's condition poses a threat to their life, and if they require close monitoring or acute or invasive treatment. Additionally, the patient's hemodynamic and respiratory stability are also important considerations in making this decision.

Moreover, it is important to consider the insuring HMO’s options: patient follow-up treatment unit or house-bound patient treatment unit. Can the patient receive necessary services in their area of residence and can the HMO provide the patient with comprehensive and quality care outside the medical institution. The patient's social support system should also be considered: does the patient have family support? Additionally, and equally important, the presence of a primary caregiver (family member, nursing law caregiver, or a foreign caregiver) to maintain their living conditions and home environment safety. It is important to point out that a nursing caregiver is not a medical professional. Their role is to respond to the patient’s nursing requirements in terms of function: assistance in mobility, washing, dressing, walking, and preparation and serving of food. The nursing caregiver is not responsible for the medical treatment; therefore, they are not an alternative for nursing hospitalization.

If you prefer your family members to stay at home, you should be aware that HMOs offer various community services. This service can assist them to avoid institutional hospitalization. You should refer to your HMO to inquire about its suggestions. Every HMO defines its services by other names (home care units, home treatment units, home-bound care units, etc.). The required information can be found on the HMO websites.

HMO Inquiries

Frequently asked questions and answers about nursing care hospitalization

Applications should be forwarded to the health bureau in your area of residence (according to the address on the patient’s ID slip). The documents can be brought directly to the bureau during office hours or sent by fax, e-mail, or mail, according to the details on the bureau’s website.

Payment Commitment

Towards the end of the process, when the level of copayment for each family member is determined, it is important to sign a payment commitment in one of the following methods:

  • In the health bureau where the process has been conducted
  • In another health bureau, in coordination with the health bureau where the process has been conducted
  • In the presence of a private solicitor and with confirmation of their signature. A payment commitment form can be received from the relevant health bureau coordinator and the signed documents should be submitted to the bureau

  • The time estimation for handling the application is specified in the service charter
  • The processing of the application depends on how quickly the required documents are sent on the applicant’s behalf
  • These documents are also used to determine the patient’s classification and the level of copayment for family members

The application may be rejected for several reasons:

If, after checking the documents or after a direct medical examination of the patient, the classification committee in the health bureau, headed by the district geriatrician, decides that the patient does not answer the requirements for hospitalization of a physically impaired or a cognitively impaired person. In this case, a notice of rejection of the application will be given.

It is extremely important to fill out and submit all the required documents, as well as sign the commitment forms. Otherwise, it will not be possible to complete the application processing, especially in the following cases:

  • The patient has met the requirements for hospitalization, nevertheless, the necessary documents for determining the patient's and family's copayment have not been provided
  • The required commitment forms have not been properly signed

Is it possible to challenge the decision of the classification committee through an appeal process?

It is possible to file an appeal, which will be reconsidered in the following cases:

  • A family appeal: an application will be submitted for a renewed discussion of the patient’s classification, with updated or additional medical documents
  • A change in the condition of the applicant who has already been defined as physically impaired or cognitively impaired. In case of improvement or deterioration in the patient’s condition, a re-examination of the patient’s classification will be needed, and if required, the patient will be transferred to an appropriate facility
  • If the health bureau team receives new information regarding the patient's condition, they may initiate a new discussion about his classification
    • If at least three months have passed since the classification date and the applicant has not yet been hospitalized, the classification decision should be updated, according to up-to-date documents and examination, as applicable
    • If the appeal has been rejected by the Regional Classification Committee, the classification can be appealed by contacting the head of geriatrics division in the Ministry of Health via written correspondence, along with the relevant documents to the address:

Head of Geriatrics Division, Ministry of Health, 39 Jeremiah St., POB 1176, Jerusalem 9101002, or via Kol Habriut *5400

Yes. If a patient or their family disagrees with the level of copayment assigned, they may send an appeal in writing through a social worker.

How do you appeal?

You can submit an appeal in writing through a social worker in the health bureau in the patient’s area of residence. The appeal should include a letter of request with solid reasoning, and any relevant supporting documents. The social worker will send the application and their recommendation in writing to the appropriate appeal committee (regional or national).

Patients and family members are typically required to sign commitment forms and standing orders prior to hospitalization.
However, in rare cases, a patient may be referred for hospitalization before signing these documents. The decision to do so is made at the discretion of the regional or district doctor, or the regional geriatrics doctor.

It is important to point out:

  • The family will be required to pay for the copayment from the start of the hospitalization and and there is a possibility of retroactive collection
  • If the outstanding balance is not paid, actions to collect the debt will be pursued

Yes. Nursing benefits are limited to individuals who live at home or in assisted living facilities, meaning they are not applicable to those living in institutions.

The patient and the family’s copayment will be reduced if the patient has been admitted to a hospital or when a patient who stays in a nursing facility funded by the Ministry of Health, goes out on a holiday.

The Ministry of Health delivers partial payment to the geriatric facility as part of the agreement “Reserving a Bed”: a sum received by the facility and determined by the Ministry of Health to reserve a bed while the patient is admitted to a hospital. As part of this agreement, the facility will reserve the patient’s place for at least 30 consecutive days.

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