(This article originally appeared in The Times of Israel.)

As our parents age, one of the most important decisions they will need to make is where they age. Should they stay in their existing home? Downsize to a smaller place? Move to a retirement community? Move to another neighborhood, town, or even country? There are many factors to consider – family, lifestyle, available resources and budget, and present and future care needs. It can make your head spin!

Want to increase the likelihood of a successful outcome? Take it one step at a time, involve all family members, and research all the various options in-depth. It’s not easy to know how or when to have “the talk” with aging parents, but the earlier the better.

Here is an overview of what’s available in Israel: 

Aging in Place

Aging in Place refers to aging in the home and community of one’s choice. Whether your parents want to stay in their home or move somewhere new , here are some things to consider:

  • Location. Do friends and family live close by? If the time comes when they can’t or don’t want to drive, what are their choices for alternative transportation? Are there stores, activities and restaurants nearby? Are there evenly-paved public walkways?  
  • Home Safety. Is the home “ready” for aging or is it easily adaptable? Are there stairs going into the home or multiple floors? Is there a bathroom on each floor? Are the hallways and doors wide enough for a walker or wheelchair? Accessible shower? Sufficient lighting? 
  • Care in the Home. If there becomes a need for full-time care, is there a space for a live-in caregiver?

Diyur Moogan

A kind of “aging in place”, diyur moogan is an independent living facility designed for “active seniors”, designed to enhance quality of life while providing a sense of security.  Diyur moogan offers an on-site framework for maintaining and developing social relationships and pursuing hobbies and interests, and provides easy access to services and support such as meals, cleaning, fitness, recreation and basic medical services.

Literally translated, diyur moogan means “sheltered living,” but to be accepted, one must be completely independent physically and cognitively. Most diyur moogan facilities do not offer assistance with daily functioning or more complex medical care. Should a parent need care down the road, you would probably need to either bring in private care – be it for a few hours a week or live-in –  or move him or her to a place where appropriate care is provided.

Some diyur moogan buildings also have “tomechet” (assisted) and “siyudi” (nursing care) departments for residents whose health has deteriorated and are experiencing difficulties in some daily functions. Here the resident receives all the care he/ she needs, without leaving the familiar surroundings.

There are many, many diyur moogan facilities in Israel to choose from, and they range vastly in amenities, cost and religious character. There are a number of residences in Jerusalem and the central region that cater specifically to English speakers. Diyur moogan is paid for privately and cost is based on the size of the apartment unit which can range from one to three rooms. Typically, it requires a large “buy-in” deposit that depreciates over time, plus a monthly fee that covers taxes, utilities, clearning, activities, transportation and basic medical supervision. A growing number of facilities now offer a monthly rental arrangement without buying in. 

In-Home Care

Whether living in a private home or a diyur moogan, you will want to factor in the cost of in-home care should the need arise. Israel boasts a developed and highly subsidized system of long-term care designed to enable aging in place (whether in the community or in a diyur moogan), over one-third of which is provided by live-in migrant caregivers. You can find valuable information about the costs of live-in care here: Confused About How to Budget for a Live-In Foreign Caregiver? Here are the Nuts and Bolts.

Residential Care

Nursing homes (beit avot) in Israel offer services for the elderly who need help in their daily functioning. Different homes, or different departments within the same home, address different types and levels of care needed.

  • Assisted Living (t’shushim): for individuals who need partial assistance for everyday tasks like showering, dressing, or eating. An assisted living facility offers on-site services  and activities. Assisted living facilities are regulated by social services (revacha) and generally funded by the individual, though in some cases partial funding from the revacha is available.
  • Nursing Care (siyudi): for individuals who need full assistance for everyday tasks like showering, dressing, or eating. Nursing homes are highly regulated through the Ministry of Health, which also provides a subsidy known as a “code” to eligible individuals.
  • Dementia/Alzheimer’s Care (t’shushay nefesh). for individuals with memory, judgment, and/or orientation deficits, who require daily assistance and constant supervision. The emphasis in these facilities is on the cognitive state of the person, so he or she may be completely independent functionally without any special physical problems. These institutions are also highly regulated through, and potentially subsidized by, the Ministry of Health.
  • Complex Nursing Care (siyudi murkav): for individuals who require both functional assistance and special medical attention in addition to assistance with daily tasks. Eligibility to be placed in a complex nursing care facility is determined by medical staff and a supervising nurse on behalf of the kupat cholim 
  • Rehabilitation (Shikum): for individuals with impaired functional ability caused by a medical condition or event who can potentially benefit from rehabilitation services. Admission is by referral from hospital medical staff to a dedicated rehabilitation facility or hospital rehab ward through the kupat cholim, and financed by the kupah.

These are not easy decisions. It is imperative that you have an open and honest discussion as a family for any option under consideration. Do your due diligence: read reviews and consult with a knowledgeable lawyer before signing a contract. Join our Facebook Group Sandwich Generation Israel where you can connect with people who have personal experience with many of the facilities in Israel. Consider working with a professional Care Manager to guide you through the different choices, explain government and private funding options and help your family come to a decision.