COVID-19 has thrust the elderly into the top tier of our national concerns. Special headquarters have been established in order to protect their health and numerous government ministries are responsible for them. But at the end of the day, when a lonely elderly person sits at home, isolated from society, not daring to leave for fear of catching the virus – who takes care of them and their needs? A few different bodies share this responsibility, and they are insufficiently coordinated.
Gi Lavie is Head of Planning & Strategy at Clalit. Normally, his job includes comprehensive systemic assessments looking months and even years ahead. During the COVID-19 pandemic, he took it upon himself to look into the long-term health effects on patients who had not contracted COVID-19, but whose routine medical treatment was compromised due to the focus on the pandemic. One of the most hard hit populations in this period have been the elderly, who have largely abided by medical advice calling for them to stay at home. Hundreds of thousands of elderly people live in Israel, many of whom are confined to their homes even in the routine.
This is not a new problem. Public care for the elderly is divided between many institutions –HMOs, municipal social services, social organizations and more. Also at the government level, responsibility for the elderly is divided between numerous government ministries. COVID-19 has exposed the difficulty in providing holistic solutions for the elderly. Many volunteer organizations that were active during the peak of the first wave have gone back to their day-to-day activities, thus leaving the elderly back to receiving only partial solutions spread around a number of different bodies.
An elderly person’s health depends on much more than medical treatment and includes medical, social and welfare elements – as well as logistical solutions for many different needs. The lonely elderly person confined to their home does not have one go-to organization to provide specific solutions.
Clalit is Israel’s largest HMO, providing services to more than half of the country’s population. But when Gil and Clalit looked into the issue, they realized that in order to fulfill their responsibility to protect the health of elderly people, they had to join hands with the other players operating in the field. And this required a level of synergy which simply does not exist.
For example, the Clalit branch in the city of Acre is situated right in front of city hall. The two bodies provide services to the same individuals, yet despite their physical proximity, there is no streamlined information sharing and no shared “clientele” list, which means that they simply miss out on the opportunity to streamline processes and make them more efficient for patients.
Gil and his team decided to seize the opportunity brought about by COVID-19 to create a trifold solution focused on the elderly. Their goal was to streamline the activities of HMOs, municipalities and social organizations, and improve the solutions they provide for the benefit of their elderly clients and patients.
The municipality is a central partner, as it is the main local actor – it knows the local residents and organizations very well and understands all the unique characteristics at play. This is the reason the team decided to create a bottom-up process at the local level of municipalities and local actors rather than pass the responsibility on to government bodies at this point for top-down synergy.
In order to examine the model and develop it further, they decided to start a pilot program in two cities: Acre and Sderot. Gil’s partner in this process is Network member Dr. Assi Cicurel, a rural doctor and manager in Clalit’s Southern District Headquarters.
As part of the pilot program, municipality staff work together with the Clalit team to define target populations and build joint working procedures, in coordination with organizations and NGOs operating in the local area. The person responsible for synchronizing these bodies is the coordinator, a designated position recruited especially for this program. He maintains contact with all partners, including the patient. A digital synchronization tool is currently being defined to allow all parties to receive a comprehensive picture of the patient.
And how does it all look from the elderly person’s perspective? To them, it’s almost invisible. They can contact the same bodies they are used to, such as HMOs or social service organizations. These bodies will then enter the application to the shared system and operate in coordination with each other. The coordinator will make sure that the patient’s problems receive the necessary solutions and he or she will consolidate the solutions provided by the different bodies as much as possible.
As with any startup, this initiative also faces challenges. When talks with the Acre Municipality began, the city didn’t understand why this initiative was necessary and what interest Clalit had in promoting it. But when municipal employees understood how it would improve care for elderly people, doors started opening.
Identifying the correct success criteria is a challenge in itself. How does one measure success? Do higher patient satisfaction rates mean that the activity has achieved its goals? Maybe if the elderly person reports that they’re feeling less lonely or have no shortage of anything? Is it realistic to expect improvement of health indicators due to the activity?
Despite the difficulty in defining results, Gil said that Clalit views the initiative as a strategic, long-term step and as an opportunity to upgrade relations between HMOs and municipalities.
“Clalit’s size, power and capacities obligate us to be national leaders. If we can create a model for real partnership between HMOs and municipalities, thereby improving our patients’ health and quality of life, it will be a significant breakthrough.
I hope and believe that this is the first of many more partnerships between these groups, and that other organizations and government ministries will promote the extension of this model to other fields. Everyone, most of all our patients, stands to win.”