Introduction:

As part of the eligibility test for a long-term care benefit, a dependency test will be performed in the house of the applicant in order to assess the degree of the applicant's dependency on others
Applicants age 90 and above can undergo a functional assessment by a geriatric physician before they submit a claim, instead of a dependency test
In specific cases, benefit eligibility can be determined based on medical documents only without the applicant undergoing a functionality test
For more information see the National Insurance Website.


After a long-term care benefit claim has been submitted, and if the applicant meets the basic conditions of eligibility, someone authorized on behalf of the National Insurance Institute will visit the claimant's house in order to assess his/her daily functioning.

  • The ADL dependence test (ADL - Activities of Daily Living) is based on an evaluation form that includes a list of sections.
  • The test examines 5 daily activities: mobility, dressing, bathing, eating and personal care. Applicants are scored based on their ability to complete tasks: no assistance = 0 points; partial assistance = 1/2 point; Unable to complete task = 1 point.
  • In addition the assessor will assess the applicant's need for supervision (his level of understanding, orientation in surroundings, ability to identify relatives, and past events and incidents).
  • Those aged 90 and above, may undergo a functional evaluation by a geriatric physician, before they submit their claim instead of being tested at home by the assessor.
  • In certain cases it is possible to determine the eligibility for benefits based on medical documents alone. For example those whose medical condition is very serious, blind people living alone, those receiving dialysis or chemotherapy, or when a claim is filed for Temporary Long-Term Care Benefit. For more information, see Fast Track without for dependency test (ADL) for long term care benefits claim.
  • The entire process for the benefit shown in the following diagram. The steps that occur after the dependency test are listed in the Table below.
Submitting a Long-Term Care Benefit Claim
ADL Dependence Test
for the applicability of the
Conditions of Eligibility
Determining Dependence Level
by the claim clerk
Approval of a Temporary Benefit
or permanent benefit at level
A / B / C
or
Rejection of the claim
A local professional committee
facilitates the
provision of services
It is possible to Appeal a Long-Term Care Benefit Decision
If the condition has deteriorated of a benefit recipient at level A or B
it is possible to request reassessment

Target Audience and Prerequisites

Stages of the Process

  • After a claim is filed and the applicant is found to meet the basic criteria, a professional assessor (nurse or physiotherapist) will visit the claimant's home to determine the extent of his/her dependence on others and the level of supervision he/she requires.
  • The visit will take place approximately two weeks after the National Insurance Institute receives the claim form and in most cases will be coordinated in advance. On the short term track, one can change the date of the visit by contacting The National Insurance Institute's Counseling Center for the Elderly or by calling the national call center at *6050.
  • For those with cognitive decline, the functioning assessment will be performed in the presence of a family member or someone else who knows the claimant well and on a daily basis. For more information about accommodations made for those with dementia and alzheimer's see ADL Dependence Test for Alzheimer's Patients.
  • Claimants are asked to provide photo identification, the medications they currently take, assistive devices they use (such as a walking stick) and any other medical documentation they may have. Claimants are asked to provide details of their daily schedule: when and how they get up; how they sleep at night; how they get to the bathroom and manage going to the bathroom during the day and at night; whether or not they get help on a daily basis and if so, from who; how they manage when they cannot get help; how they manage shopping and preparing food; how they get dressed; what are their problems when functioning in different capacities and what causes them.
  • If necessary, claimants are asked to perform actions that reflect their functioning capacity (not any actions that may harm their well-being). They are asked to put garments on over what they are already wearing, and put on socks (this can be performed in private if requested). Those who are mobile are requested to go to the bathroom, wash their hands with soap, rinse and dry their face, go to the kitchen, heat up food and serve it at the table.
  • Those who have difficulty performing an action not generally examined according to the standard examination process will be requested to perform this action.
Example
An elderly man who gets up from his seat without assistance says that he requires assistance in order to sit on the toilet and get up from it. The assessor will request that the man sit on the toilet in order to examine the issue. The assessor may then realize that the toilet is too low and recommend that a special device be added to the toilet to make it higher, thus alleviating the problem.
  • At the end of the visit, the assessor will pass the test results to the National Insurance Institute.


Continuing the Process

Next Step Additional Information Instructions
A National Insurance Institute clerk will prepare a summary and determine if the claimant is eligible for a Long-Term Care Benefit Calculating eligibility for a Long-Term Care Benefit For those who qualify for the benefit, eligibility will be determined as temporary or permanent, and given a level - Level 1, 2, 3, 4, 5, or 6.
Notification of the test's outcome The decision will be sent in the mail within two weeks from the date of the ADL dependency test home visit
If a person is granted eligibility for a Long-Term Care Benefit, a nurse, social worker or health clinic will conduct a home visit to assess the services that should be provided according to which the committee will determine what services to provide. Professional Local Committee to Determine the Long-Term Care Benefit Services * One can Appeal the decision of the local professional committee.
  • The maximum duration of time it should take to handle a claim is approximately 60 days, from the first of the month after the submission of the claim (in most cases the service benefits are granted about a month after filing the claim.)
If you are not satisfied with the decision issued following the ADL test (in case of rejection or if you think the granted level of eligibility is too low), the decision can be appealed to an appeals committee. Appealing a decision relating to long-term care benefit claims A decision made by an appeals committee can be appealed at a Regional Labor Court.
If one wishes to appeal the decision regarding issues unrelated to the dependency (such as the income test), one may submit an appeal to the Regional Labor Court. Appealing a National Insurance Institute Long-Term Care Benefit Decision
  • The Claims Commissions can also be contacted to discuss the rejection of the claim.
  • Appeal applicants to the Regional Labor court, are eligible to receiveFree Legal Aid.
If the claimant's functional condition deteriorates, and they were initially eligible for the long-term benefit under Level 6, he/she can apply to increase their level of eligibility. Updating Long-Term Care Benefit Level Due to Worsening Condition

Court Rulings


Aid Organizations

Government Agencies

Government Agency Website Rights and Areas of Responsibility
*6050 hotlines - The National Insurance Institute Senior Citizens' Rights on the National Insurance Institute's website. Rights to various allowances given based on age and economic situation.
*9696 hotline - The National Insurance Institute's Call Center for Senior Citizen Counseling Services Senior Citizens' Rights on the National Insurance Institute's website. Free aid provided through counseling services for senior citizens and the call center for senior citizens and their families.
*8840 Ministry for Social Equality - Hotline for Public Inquiries Ministry for Social Equality website The *8840 hotline run by the Ministry for Social Equality gives the elderly a central address to direct all of their questions, provide information regarding rights, services and benefits entitled to the elderly. It also helps them actualize these rights.
Segula Unit - Hotline to help senior citizens in the hospital The Ministry for Social Equality A health hotline for senior citizens, to assist them and their families know their rights during the period of hospitalization.
The Ministry of Labor, Social Affairs and Social Services

Shil - Citizens Advice Service hotline - 118

Senior Citizens on the Ministry of Labor, Social Affairs and Social Services website Funding of Nursing Homes for independent and frail seniors. Various services are also provided within the community.
The Ministry of Health

*5400 "Kol HaBriut" Ministry of Health Hotline

Senior Health on the Ministry of Health website. Health Insurance and assistance for those suffering from age related health problems.
*5442 The Ministry of Housing and Construction Call Center The Ministry of Construction and Housing website Housing Assistance and Problem Solving for Senior Citizens


Government Agency Website Rights and Areas of Responsibility
*8840 Ministry for Social Equality - Hotline for Public Inquiries Ministry for Social Equality website The *8840 hotline run by the Ministry for Social Equality gives the elderly a central address to direct all of their questions, provide information regarding rights, services and benefits entitled to the elderly. It also helps them actualize these rights.
*6050 hotlines - The National Insurance Institute Senior Citizens' Rights on the National Insurance Institute's website. Rights to various allowances given based on age and economic situation.
*9696 hotline - The National Insurance Institute's Call Center for Senior Citizen Counseling Services Senior Citizens' Rights on the National Insurance Institute's website. Free aid provided through counseling services for senior citizens and the call center
The Ministry of Labor, Social Affairs and Social Services

Shil - Citizens Advice Service hotline - 118

Senior Citizens on the Ministry of Labor, Social Affairs and Social Services website Funding of Nursing Homes for independent and frail seniors. Various services are also provided within the community.
The Ministry of Health

*5400 "Kol HaBriut" Ministry of Health Hotline

Senior Health on the Ministry of Health website. Health Insurance and assistance for those suffering from age related health problems.
*5442 The Ministry of Housing and Construction Call Center The Ministry of Construction and Housing website Housing Assistance and Problem Solving for Senior Citizens
Equal Employment Opportunities Commission- 02-6662701 Equal Employment Opportunities Commission website] The commission responsible for enforcing equality in the workplace and for handling cases of prohibited discrimination.
The Population and Immigration Authority - *3450 Population and Immigration Authority website Treatment of foreign workers, responsible for giving permits for the employment of foreign workers, managing the financial deposits that employers of foreign workers are required to deposit, oversight of the entrance and exit of foreign workers into Israel, issuing a death certificate, and updating the Population authority.


Laws and Regulations

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