Assisted-living for older people in Israel: market control or government regulation?

Abstract

In recent decades there has been a rapid expansion of assisted-living facilities for older people in many different countries. Much of this growth has occurred with only limited or no government regulation, but many problems have arisen, typically around the quality of care, which have led to demands that governments act to protect vulnerable residents. This paper examines whether formal legal regulation is the optimal policy to protect the needs and rights of frail residents, while respecting the legitimate interests of others, such as operators and owners. It presents the case for and against direct legal regulation (as in institutions), and suggests that no overall a priori assessment is possible. The analysis is based on the case of Israel, where proposed regulations for assisted-living have been introduced but not implemented. After a brief history of assisted-living in Israel – its recent dramatic growth and why this occurred – the paper concludes that formal direct regulation is not the best route to follow, but that the better course would be to develop totally new ‘combined’ regulatory legislation. This would define the rights of residents and encourage self-regulation alongside minimal and measured mechanisms of deterrence. Such an approach could promote the continued development of the assisted-living industry in Israel and elsewhere, while guaranteeing that the rights, needs and dignity of older residents are protected.

Perceptions of old age and aging in the continuing care retirement community

“…Nevertheless, the CCRC is intended for older adults who are functionally independent upon entering the CCRC. As such, although the CCRC shares some features with total institutions (Goffman, 1961), such as the fact that all residents live and operate in a single place that is separated from the general community, it still strives to maintain and support its residents’ autonomy (Doron and Lightman, 2003). As such, the CCRC offers housing and services such as home maintenance and security, health care, meals, and other amenities.…”

Perceptions of Older Residents and Their Adult Children Regarding Continuing Care Retirement Community Staff

“…Interviewees reported feelings of satisfaction and confidence with the presence of the CCRC staff. This demonstrates that the CCRC staff has an important role in residents’ lives by meeting their evolving needs and maintaining their activity engagement (Doron & Lightman, 2003; Oswald & Rowles, 2006). Furthermore, older adults and their adult children reported being less concerned about the physical and functional decline of the older adults, knowing that health care services are easily accessible in the CCRC.…”

Moving to a Continuing Care Retirement Community or Staying in the Community? A Comparison Between American and Israeli Older Adults

“…This living arrangement is usually available to older adults who are independent in their activities of daily living (ADL), at least upon entering the CCRC (Denham, 2018). This longterm care setting is designed to allow older adults to experience maximum independence, while meeting increasing needs for assistance and support (Doron & Lightman, 2003) that commonly arise from deterioration of physical and cognitive functioning (Smith, Walter, Miao, Boscardin, & Covinsky, 2013). As such, many CCRCs have assisted living units and nursing care units available for older adults with physical and cognitive impairments.…”