Long-term care benefit guide
Everything you wanted to know about a long-term care benefit
Going about obtaining a long-term care benefit from the National Insurance Institute for the care of a family member in the framework of the Long-Term Care Law involves completing various forms, a functional capacity test (ADL – Activities of Daily Living) of the care recipient, as well as other preconditions. Long-term care services are provided by companies specializing in long-term care and personal wellbeing services and that comply with the standards of the National Insurance Institute. Manpower Care specializes in long-term care and personal wellbeing services, and accompanies you throughout the process by means of first-rate caregivers, social workers and a competent and highly skilled team, available at all times. We will accompany, instruct and support you in the steps required to obtain the benefit, and our experts will even conduct a preliminary assessment of functional capacity, advising you whether applying for the long-term care benefit is recommended, and whether you meet the conditions for being granted the benefit. In addition, we will provide you with long-term care services in advance, as necessary, until the benefit is granted.
What is a long-term care benefit?
A long-term care benefit is a services benefit granted by law to men and women over pension age, living at home or in assisted living (but not in a long-term care institution) who need help in the activities of daily living: bathing, dressing, and housework, and/or supervision at home for their own safety.
The Long-Term Care Law enables seniors to continue living at home and in the community they familiar with in order to maintain their regular way of life and to ensure their quality of life to the greatest extent possible.
The Long-Term Care Law is funded by the National Insurance Institute. Long-term care services are provided by companies specializing in long-term care and personal wellbeing services and that meet the standards of the National Insurance Institute. Manpower Care complies with and exceeds all the standards, and has many years of specialist experience in long-term care and personal wellbeing services behind it.
Who is entitled to the long-term care benefit?
- Israeli residents over pension age.
- A person who chooses to continue living at home or in assisted living (those who live in homes for the aged, in a long-term care institution, or in a long-term care ward are not entitled to the benefit).
- A person who needs supervision or assistance with the activities of daily living, according to the functional capacity test (“dependency test”) of the National Insurance Institute.
- A person who does not receive another allowance from the National Insurance Institute, such as an attendance allowance or a disability pension (apart from a monthly allowance as a victim of Nazi persecution).
- A person who complies with the National Insurance Institute “Means Test”; that is, their income is below the ceiling set by the NII beyond which the benefit is not granted. A person whose income is higher than the defined income ceiling will receive only half of the benefit or none at all.
How do I submit a claim for the long-term care benefit?
- Application forms for the long-term care benefit are available at all branches of the National Insurance Institute, and on the NII website.
- The claim is divided into two parts:
- The attendant physician’s opinion on the condition and functional difficulties of the benefit claimant.
- Certificates in respect of the income of the benefit claimant.
- It is very important to specify the functional limitations of the senior, and his/her family status.
- In submitting an application for someone with Alzheimer, it is recommended that the diagnosis of a psychogeriatrician be attached.
- The forms must be submitted signed by the claimant or by someone on his/her behalf (a family member, social worker, or nurse, etc.).
- The application forms must be handed to the claims officer at the National Insurance Institute.
- Within a week of submission of the application, an assessor on behalf of the National Insurance Institute – nurse, physiotherapist or occupational therapist – pays a house visit to the senior in order to assess the senior’s functional capacity (“dependency test”).
What is the dependency test?
• The dependency test (or test of entitlement to the benefit) is designed to examine the claimant’s functional capacity, the extent to which the claimant is dependent on others, and the claimant’s need for assistance and supervision. Entitlement to, and the scale of, the benefit granted will be determined on the basis of the test’s results.
• The test is conducted by a competent person on behalf of the National Insurance Institute – nurse, physiotherapist or occupational therapist – and the test is personal, professional and objective.
• The test is done at the home of the benefit claimant.
• A family member may be present during the test.
• During the visit, the assessor examines the degree to which the senior needs the support and assistance of another person in several areas, including mobility in the home, eating, dressing, bathing and continence. The assessor also gains a general impression of the claimant’s mental and emotional faculties.
For whom is the dependency test not mandatory?
Persons aged 90 and over
• Persons aged 90 and over can choose to have a functional assessment conducted by a geriatrician employed at a public institution (hospital, Kupat Holim (HMO), etc.), instead of the assessment by the National Insurance Institute. The test can also be conducted during hospitalization, free of charge.
• A person who has had a dependency test conducted by the National Insurance Institute in the past must wait 66 months before being able to apply for another functional assessment by a geriatrician.
Claimants who have a certificate of blindness and are defined as “alone”
• A senior who is alone (according to the National Insurance Institute definition; that is, a senior who lives alone, with a spouse who is entitled to a long-term care benefit, or with a disabled child) and who has a certificate of blindness or a letter from a physician attesting to the fact that s/he is blind, automatically receives a long-term care benefit in an amount of 9.755 without a dependency assessment. However, the senior must submit a claim to receive the benefit.
• A blind person who does not meet the definition of being “alone” will be subjected to a dependency assessment and will be granted entitlement to a benefit that is based on the results.
How much is the benefit?
The scale of the benefit is based on the score received by the claimant on the dependency test of the National Insurance Institute. There are three main types of the long-term care benefit:
• 91% benefit: 9.75 hours a week in the case of a person found to be dependent on others for most of the activities of daily living or a person who needs supervision.
• 150% benefit: 16 hours a week in the case of a person found to be greatly dependent on others for most of the activities of daily living, most of the day.
• 168% benefit: 188 hours a week in the case of a person found to be totally dependent on others and in need of constant supervision.
Can the benefit be increased?
The benefit can be increased in two instances:
1. In the event of an appeal against a decision of the National insurance institute:
An appeal can be filed against a decision of the National Insurance Institute, and this should preferably be done a short time after the answer is received. If the appeal is delayed, the appeals committee may decide that there has been a deterioration in the senior’s condition, and instruct the claimant to apply for a repeat dependency test.
The application, together with the relevant documents, must be referred to one of the three appeals committees operating at the three main branches of the National Insurance Institute: Haifa, Ramla or Beer Sheva.
2. In the event of a deterioration in the senior’s condition:
If the senior’s condition has deteriorated, and the senior has only been granted a partial benefit, one can apply to increase the size of the benefit, up to the maximum benefit prescribed by law. The benefit will be increased only after the following two conditions are met:
a. A special form is completed, with the relevant documents attached confirming the deterioration in the senior’s condition.
b. Reassessment of the senior’s functioning (a repeat of the dependency test).
What is temporary entitlement to a benefit?
When there is a sudden impairment of function and an urgent need for long-term care services (for example: after an accident or surgery), Manpower Care offers an immediate long-term care service in advance, from today to tomorrow, until receipt of the necessary authorizations from the National Insurance Institute. The service is provided free of charge for a period of up to 60 days, comprising at least 6 hours of care a week.
Don’t go it alone! Manpower Care will accompany you all the way until the long-term care benefit is granted. Our experts will guide you in how to obtain the benefits, and even conduct a preliminary functional assessment, offering long-term care services in advance, as necessary.