Challenges in geriatric and gerontological

education & training: The case of Israel

Sara CarmelBen-Gurion

University-Israel

Contents of presentationContents of presentation

Socio-demographical characteristics and Socio-demographical characteristics and trendstrends

Health profile & servicesHealth profile & services

Education and training of professionals:Education and training of professionals:– Undergraduate programs Undergraduate programs – Graduate programsGraduate programs

Achievements and challenges Achievements and challenges

Demographic changesDemographic changes

As of end of 2009As of end of 2009

Total population:Total population: 7.6 million7.6 millionIncrease since 1955:Increase since 1955: x 4.2 x 4.2

Elderly (65+)Elderly (65+):: 742,000 742,000 (9.8%)(9.8%)Increase since 1955:Increase since 1955: x 8.7 x 8.7

Percentage of population 65+

9.89.89.89.28.98.6

7.9

6.86.1

5

4

3

4

5

6

7

8

9

10

11

20011998199519901985198019751970196519601948

Source: Central Bureau of Statistics, Mashav-Planning for the Elderly, A National Database, JDC-Brookdale Institute & Eshel

Population groups according to religionPopulation groups according to religion

(2009)(2009)

JewsJews MoslemsMoslems ChristiansChristians DruzeDruze OthersOthers

PercenPercent of t of totaltotal

populationpopulation 75.5 17.075.5 17.0 2.0 2.0 1.7 3.7 1.7 3.7

Percent of 65+Percent of 65+

populationpopulation 88.8 5.888.8 5.8 1.9 1.9 0.8 2.6 0.8 2.6

• Source: The Elderly in Israel: Statistical Abstract, 2010; CBS, Mashav, A National Database, JDC-Brookdale Institute & Eshel

Percent of women in differentPercent of women in different

population groups (end 2009)population groups (end 2009)

From those aged:From those aged: 65+65+ 75+75+ 80+80+

AllAll 56.856.8 59.559.5 61.361.3

Jews and othersJews and others 57.057.0 59.759.7 61.461.4

Immigrants (FSU)Immigrants (FSU) 61.961.9 64.564.5 66.966.9

Arabs Arabs 53.953.9 57.057.0 57.657.6

Marital status (65+) 2008Marital status (65+) 2008 Jews & OthersJews & Others Arabs Arabs

Males: Males: MarriedMarried 77.0 77.0 87.6 87.6 WidowedWidowed 14.514.5 9.1 9.1 DivorcedDivorced 6.2 6.2 0.8 0.8 SingleSingle 2.32.3 2.6 2.6

Females: Females: MarriedMarried 40.440.4 39.2 39.2 WidowedWidowed 48.1 48.1 51.1 51.1 DivorcedDivorced 8.58.5 2.1 2.1 SingleSingle 3.0 3.0 7.5 7.5

Health profile & servicesHealth profile & services

Life expectancyLife expectancyAt BirthAt Birth At age 65 At age 65

  Total populationTotal population MenMen 79.779.7 MenMen 18.4 18.4

WomenWomen 83.5 83.5 WomenWomen 20.520.5  Jews and othersJews and others MenMen 80.3 80.3 MenMen 18.618.6 WomenWomen 83.983.9 WomenWomen 20.720.7  ArabsArabs MenMen 76.376.3 MenMen 16.016.0

WomenWomen 80.7 80.7 WomenWomen 17.8 17.8

Source: The Elderly in Israel: Statistical Abstract, 2010; CBS, Mashav, A National Database, JDC-Brookdale Institute & Eshel

Expectation of disability at birthExpectation of disability at birth

Males - 7.5 yearsMales - 7.5 yearsFemales - 10.2 yearsFemales - 10.2 years

Policy and Services in IsraelPolicy and Services in Israel

The dominant policy:The dominant policy:

To enable disabled and frail people to To enable disabled and frail people to continue living in their own homes and continue living in their own homes and communities as long as possiblecommunities as long as possible

Where do elderly Israelis liveWhere do elderly Israelis live??

96 % In the community96 % In the community

4 % In various institutions*4 % In various institutions*

______________**Assisted living, nursing homes, etcAssisted living, nursing homes, etc..

Social SecuritySocial Security

Basic pension benefit from Basic pension benefit from

Israel’s National Security Institute Israel’s National Security Institute provided to all (universal)provided to all (universal)

Supplementary financial support Supplementary financial support for low-income and needy for low-income and needy (discretionary)(discretionary)

Supplementary financial support Supplementary financial support for special needs (discretionary)for special needs (discretionary)

Services - public and privateServices - public and private

The National Health Care Law (1995)The National Health Care Law (1995)

Community Long-Term Care Insurance Community Long-Term Care Insurance Law (CLTCI - 1988)Law (CLTCI - 1988)

Adult day care centersAdult day care centers

Supportive communitiesSupportive communities

Meals on wheelsMeals on wheels

ServicesServices

Welfare servicesWelfare services Health screening programsHealth screening programs Voluntary services – visits, legal Voluntary services – visits, legal

services, home repairsservices, home repairs Rehabilitation wards and hospitalsRehabilitation wards and hospitals Long-term institutional careLong-term institutional care Long-term complex nursing/institutional careLong-term complex nursing/institutional care

National health insurance coverageNational health insurance coverage

Strong family supportStrong family support

National home care insurance for the National home care insurance for the disableddisabled

Network of adult day-care centersNetwork of adult day-care centers

Well developed health and social service Well developed health and social service infrastructure at the neighborhood levelinfrastructure at the neighborhood level

Low rates of institutionalizationLow rates of institutionalization

System strengthsSystem strengths

Landmarks in the development of Landmarks in the development of education and training of formal education and training of formal

caregiverscaregivers

Since 1948, public agencies (Malben, Mishan, JDC and Eshel) Since 1948, public agencies (Malben, Mishan, JDC and Eshel) established institutions for the aged, and trained personnel for established institutions for the aged, and trained personnel for working with elderly.working with elderly.1956 - The Israel Gerontological Society was established.1956 - The Israel Gerontological Society was established.1975 – the 10th Congress of the International Association of 1975 – the 10th Congress of the International Association of Gerontology took place in Israel.Gerontology took place in Israel.

1982 - Geriatrics was recognized as a specialization discipline 1982 - Geriatrics was recognized as a specialization discipline by the Scientific Council of the Israel Medical Association.by the Scientific Council of the Israel Medical Association.1991 – The first post-graduate program for physicians that 1991 – The first post-graduate program for physicians that provided certified training in geriatrics was opened.provided certified training in geriatrics was opened.1999 – Two MA programs in Gerontology were established.1999 – Two MA programs in Gerontology were established.

Undergraduate programsUndergraduate programs

Geriatrics is taught in all four medical Geriatrics is taught in all four medical schools in Israelschools in Israel

Academic programs in geriatrics and Academic programs in geriatrics and gerontology are integrated in schools of gerontology are integrated in schools of nursing, social work, and physical therapynursing, social work, and physical therapy

Formal and informal courses are given for Formal and informal courses are given for directors of nursing homes, nursing aides, directors of nursing homes, nursing aides, day-care center personnel and volunteersday-care center personnel and volunteers..

Graduate programsGraduate programs

Specialization in geriatric medicineSpecialization in geriatric medicine

Post-graduate programs for physicians that Post-graduate programs for physicians that provide certificate training in geriatricsprovide certificate training in geriatrics

Academic programs in schools of advanced Academic programs in schools of advanced nursing and social worknursing and social work

Master’s degree program in gerontologyMaster’s degree program in gerontology

GeriatricsGeriatrics

Specialization in geriatric medicine is offeredSpecialization in geriatric medicine is offeredin two tracks: in two tracks:

(1)(1) Two years of residency in geriatric medicine Two years of residency in geriatric medicine for specialists in internal or family medicinefor specialists in internal or family medicine

(2) Two years of residency in internal medicine (2) Two years of residency in internal medicine followed by two years of residency in followed by two years of residency in geriatric medicine and 6 months of researchgeriatric medicine and 6 months of research

Residency in geriatricsResidency in geriatricsStructure:Structure:

• During residency in geriatric medicine, During residency in geriatric medicine, physicians participate in all clinical and physicians participate in all clinical and academic activities in one of the 20 certified academic activities in one of the 20 certified geriatric departments, and rotate through geriatric departments, and rotate through long-term care, rehabilitation, psycho-long-term care, rehabilitation, psycho-geriatric and outpatient clinicsgeriatric and outpatient clinics

• Two board examinations in each Two board examinations in each subspecialty – internal/family medicine and subspecialty – internal/family medicine and geriatricsgeriatrics. .

Residency in geriatricsResidency in geriatrics

Demands from graduates:Demands from graduates:

Knowledge in physiology of aging, clinical Knowledge in physiology of aging, clinical aspects of aging, end-of-life care, and the link aspects of aging, end-of-life care, and the link between morbidity and functionbetween morbidity and function

Ability to provide consultations regarding Ability to provide consultations regarding elderly patients and their problems as well as elderly patients and their problems as well as advice in using community servicesadvice in using community services

Ability to coordinate multidisciplinary Ability to coordinate multidisciplinary personnel teamspersonnel teams

Program AchievementsProgram Achievements

Has increased the cadre of well-trained Has increased the cadre of well-trained

professionals in the field (~ 170 graduates)professionals in the field (~ 170 graduates)

Has increased awareness of the need for Has increased awareness of the need for

geriatric specialists among professionalsgeriatric specialists among professionals

Has improved quality of care both directly and Has improved quality of care both directly and

indirectly by training personnel and becoming indirectly by training personnel and becoming

involved in education and researchinvolved in education and research

■■ Has enhanced prestige of the profession.Has enhanced prestige of the profession.

The MA Program in GerontologyThe MA Program in Gerontology

The MA program in GerontologyThe MA program in Gerontology

Faculty of Health SciencesFaculty of Health SciencesBen-Gurion University of the NegevBen-Gurion University of the Negev

Beer-Sheva, IsraelBeer-Sheva, Israel

Objectives of the programObjectives of the program

To upgrade the level of professional To upgrade the level of professional caregivers in social and health services, and prepare caregivers in social and health services, and prepare a new cadre of highly qualified professionalsa new cadre of highly qualified professionals

To promote research in gerontology in IsraelTo promote research in gerontology in Israel

To advance multidisciplinary and interdisciplinary To advance multidisciplinary and interdisciplinary orientations in research and practiceorientations in research and practice

To create a more harmonious integration between To create a more harmonious integration between research and practice in the southern region and the research and practice in the southern region and the rest of the country.rest of the country.

Structure of the MA program in Gerontology

Administrative/

Managerial Track

specific courses

Field Work

Clinical Track -

Case management

specific courses

Research Track

specific courses

48 course credits*

* I hour per semester equals 1 course credit

Basic Courses

48 course credits 36 course credits

Thesis- optional

Field Work Thesis- optional

Thesis

Elective Courses

StudentsStudents

The target population for the program The target population for the program includes graduates of :includes graduates of :

Medical professions (physicians, nurses, physical Medical professions (physicians, nurses, physical therapists, nutritionists, etc.) therapists, nutritionists, etc.)

Social sciences (behavioral sciences)Social sciences (behavioral sciences)

Management & administration Management & administration

Admission criteria: A BA degree from a recognized Admission criteria: A BA degree from a recognized university, with a final grade of at least 80 (out of 100)university, with a final grade of at least 80 (out of 100)

Achievements of the programAchievements of the program

Successful entry into the professional labor marketSuccessful entry into the professional labor market

Improving quality of care - directly, by collaboration with Improving quality of care - directly, by collaboration with

community services, and indirectly, by preparing a highly community services, and indirectly, by preparing a highly

qualified cadre of professionals dedicated to quality of qualified cadre of professionals dedicated to quality of

carecare

Creating a professional community, thereby enhancing Creating a professional community, thereby enhancing

research in agingresearch in aging

Developing contacts with the international communityDeveloping contacts with the international community

System weaknesses - caregiversSystem weaknesses - caregivers

Informal caregivers:Informal caregivers:

Current and foreseen shortage of paid home Current and foreseen shortage of paid home caregiverscaregivers

Current and foreseen increasing burden on family Current and foreseen increasing burden on family caregivers caregivers

Lack of training and support services for Lack of training and support services for informalinformal caregivers (family and paid home caregivers).caregivers (family and paid home caregivers).

System weaknesses - caregiversSystem weaknesses - caregivers

Formal caregivers: Formal caregivers:

Current and anticipated shortage in Current and anticipated shortage in professionals from all disciplinesprofessionals from all disciplines

Insufficient education and training Insufficient education and training in the in the communitycommunity for specialists in geriatrics for specialists in geriatrics

Insufficient education and training in Insufficient education and training in geriatrics, especially for professionals in geriatrics, especially for professionals in primary care and in medical centers who primary care and in medical centers who treat elderly personstreat elderly persons

Conclusions and recommendationsConclusions and recommendations

Increase efforts to attract students to choose careers in geriatrics and gerontology by:

fighting ageism, increasing benefits, and promoting awareness to societal needs

Increase geriatric knowledge and training of all clinical specialists who treat the elderly

Initiate obligatory education and training for paid care workers

Create support and training programs for family caregivers

Conclusions and recommendations/2Conclusions and recommendations/2

Address future needs by increasing knowledge and training of medical personnel in the community rather than in general and geriatric hospitals

Establish interdisciplinary committees of experts to evaluate, revise, and recommend changes and innovations in the various programs

Institutionalize models for continuous collaboration among professionals involved in caring, research, and education

Establish international forums of experts in the related professions for continuous evaluation of current educational programs in the various countries, based on which to formulate suggestions for innovations and updates in core studies.

Thank YouThank You

System weaknessesSystem weaknesses Long-term care is not covered by the Long-term care is not covered by the

Health Law, causing duplication and Health Law, causing duplication and fragmentation of long-term care services fragmentation of long-term care services and continuity of careand continuity of care

Minimal preventive programs for the Minimal preventive programs for the healthy and independenthealthy and independent

Lack of programs for specific population Lack of programs for specific population groups of elderly and their caregiversgroups of elderly and their caregivers

Insufficient education and training in Insufficient education and training in geriatrics to formal and informal geriatrics to formal and informal caregiverscaregivers

Diversity and disability of elderly Diversity and disability of elderly (65+) in ADL - 2009(65+) in ADL - 2009(% ) (% )

Ethnic origin: Ethnic origin: Jews and othersJews and others 21.821.8ArabsArabs 45.445.4

Gender:Gender:MenMen 17.217.2WomenWomen 28.628.6

Source: The Elderly in Israel: Statistical Abstract, 2010; CBS, Source: The Elderly in Israel: Statistical Abstract, 2010; CBS, Mashav, A National Database, JDC-Brookdale Institute & EshelMashav, A National Database, JDC-Brookdale Institute & Eshel

Community Long-Term Care Insurance Community Long-Term Care Insurance Law (CLTCI) -1988Law (CLTCI) -1988

The law intends to complement, rather The law intends to complement, rather than replace, the existing system of than replace, the existing system of service provision, including family care, service provision, including family care, and formal medical and social servicesand formal medical and social services

Principles for entitlement:Principles for entitlement:Universal -Universal - A basic level of care is provided to A basic level of care is provided to

all all according to needs (up to 15 hours per week).according to needs (up to 15 hours per week).

Discretionary –Discretionary – Supplementary care is Supplementary care is provided provided

according to needsaccording to needs..

CLTCI (cont.)CLTCI (cont.)Eligibility:Eligibility:Men from age 65 and women from age 60, Men from age 65 and women from age 60,

living in the community and limited in ADLliving in the community and limited in ADL

Services include:Services include:Domestic helpDomestic helpPersonal carePersonal careCommunity day-care centers for frail Community day-care centers for frail elderselders