Background: In November 1980, Israel enacted the Long-Term Care Insurance Law, which became operational in April 1988. The law was designed to assist elderly individuals requiring help with daily activities, establishing key principles: universal insurance-based coverage for eligible individuals, family support rather than replacement, and in-kind service provision through home caregivers rather than cash benefits. This study examines the fundamental changes in these principles over 35 years of implementation.
Study Setup (Methods): We conducted a comprehensive policy analysis tracking the implementation of the law's foundational principles from 1988 to 2023. The study systematically documented legislative amendments, administrative reforms, and shifts in benefit delivery models, with particular focus on the 2018 reform and its implications for the original policy framework.
Results: The analysis revealed significant transformations, both gradual and dramatic. The 2018 reform fundamentally altered the in-kind versus cash benefit principle, allowing beneficiaries to receive substantial portions in cash and choose combined benefits. Support levels expanded from two initial tiers to six gradual levels based on dependency and disability. Maximum weekly support hours increased significantly post-2018. A notable policy shift enabled direct payment to family members for providing care, contradicting the original principle of supporting rather than replacing family caregiving.
Discussion: These changes reflect ongoing tensions in long-term care policy globally. While the shift toward cash benefits and beneficiary choice enhances autonomy and flexibility, it raises questions about quality control and the original intent to professionalize care. The expansion of support levels demonstrates responsiveness to diverse needs, yet paying family members blurs the line between formal and informal care. These transformations warrant critical examination of whether the law still serves its founding purposes or represents a fundamental policy redirection.

Authors:
Sigal Naim, Academic Center for Law and Science, Israel
Yitzhak Brick, University of Haifa, Israel

About the Presenter(s)
Sigal Naim is a senior lecturer at the faculty of Health at Academic Center for Law and Science, Israel and the departments of Human services, Yezreel Academic College, Israel.

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