COVID-19 is confining some of most vulnerable seniors indoors — at what cost?
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COVID-19 is confining some of most vulnerable seniors indoors — at what cost?

CEO of JDC-Eshel, experts in the elderly population, sets out measures to protect susceptible population during and after the pandemic

Sue Surkes is The Times of Israel's environment reporter.

Illustrative image of an elderly person with a cane. (oneinchpunch/ iStock by Getty Images)
Illustrative image of an elderly person with a cane. (oneinchpunch/ iStock by Getty Images)

Vulnerable, elderly people are most at risk of dying from coronavirus. As of Wednesday, of the 26 people to die in Israel from COVID-19, the disease caused by the coronavirus, most were aged over 70.

Following the virus-related closure of day facilities, which provide a range of activities, and the cessation of family visits to protect elderly parents and grandparents, many seniors are either stuck inside their apartments or in nursing homes and other institutions across the country.

Their physical needs must be met, be it food or exercise — muscles atrophy much faster at advanced ages, making rehabilitation much harder for those who have no incentive to get out of bed or out of a chair.

No less important is mental stimulation and emotional support. There have been reports of some elderly saying that not knowing how long the pandemic will last, they’d rather die of coronavirus than loneliness.

Eshel, a branch of the Joint Distribution Committee, is Israel’s social research and development incubator and has been charged with developing responses to the complex challenges faced by Israeli society with the aging of its population.

Yossi Heymann, CEO of JDC-Eshel. (Keren Ben-Zion Ganfi)

The Times of Israel spoke to Yossi Heymann, the CEO of Eshel — The Association for Planning and Developing Services for Older Adults in Israel — about measures to protect the elderly during this time.

Times of Israel: How do you define elderly and how big is the elderly population in Israel?

Yossi Heymann: According to the official definition, anybody in Israel aged 65 or above is elderly. That was the retirement age until 2004. The same base age is used for international comparisons.

There are around 1.1 million people in Israel aged 65 and over and most of them live in the community. The vast majority — around 80 percent — are independent and active, although not necessarily without any economic or physical problems.

Of the remaining 20%, around 200,000 people qualify for nursing allowances. They still live at home even though their level of functioning is declining. Some will have a carer at home.

Finally, there are around 25,000 people, or 2.3%, who are in geriatric centers and nursing homes.

Who’s most at risk?

It is the 200,000 who are most at risk during the coronavirus period. The challenge is to strike the right balance between isolating them for their own protection and continuing to care for them.

On a physical level, they need food, many need help with showering and dressing, with going to the toilet.

No less important for their health is the relief of loneliness, and help to prevent a decline of social, cognitive and physical skills. The fact is that lots of elderly are sitting in a chair, not going outside. This creates a decline that doesn’t kill like coronavirus, but those who don’t get infected could be functioning on a far lower level when all of this is over.

An elderly man reads the newspaper at home. (Cameravit/iStock/Getty Images)

For those without a carer, it can be very, very hard. The families of those living at home can’t visit [because of the risk of transmitting the virus].

What challenges are the institutions for the elderly facing?

Elderly people there are continuing to get the services from social workers, nurses, and so on. But it’s harder for the teams to get there [because of virus-related restrictions on movement]. Many of these service providers are on minimum wage. They’re under huge pressure, worried about infecting the elderly people. Some institutions are forcing them to live in.

A nursing home for the elderly in Jerusalem, April 15, 2008. (Anna Kaplan/ Flash90)

How are you, at Eshel, adapting to the current situation?

We have to think about coping with the current situation, as well as the day after.

One of the things we’re trying to do is to jump years ahead on something we’ve been intending to do anyway — distance rehabilitation.

If you need physical therapy, you might go to a rehabilitation center, although there aren’t many in Israel, or a physiotherapist might come to your house.

An elderly woman watches TV. (Bojan89/iStock/Getty Images)

We’re rushing to develop physical and cognitive therapy that can be done via a TV, which most elderly people have.

The plan is to have both one-on-one and group therapy. Whatever we can develop now will also help us when this period is over.

Another thing is to keep active retirees going. We have a number of occupational centers which we’re adapting to be able to teach skills to people online such as how to do CVs and interviews.

Why are you preparing elderly people who have retired for work?

The world of work is changing and will change a lot after this crisis. The luxury that countries can pension people off at 65 is one that they won’t be able to allow themselves in the future. In the past, people who worked from the ages of 18 to 65 spent 97% of their adult lives working and the taxes they paid covered their pensions. Today, people live much longer — until around 82 on average — and they can increasingly live with chronic illnesses. Governments can’t afford this anymore. Somebody has to prepare for this and we are already doing it, preparing able elderly people for work.

Is the messaging clear for the elderly and their families on how they should behave during this period?

We’re actually helping the army’s Home Command to produce public service video clips that are suitable for the elderly. (A week ago, the government tasked the Israel Defense Forces with assisting the country’s elderly population by ensuring access to food and medication, as well as basic human interaction during the coronavirus crisis).

Officers and soldiers in the IDF’s Home Front Command in an operations room at the Dan Panorama Hotel in Tel Aviv, March 17, 2020 (Israel Defense Forces)

We’ve also launched a special web page (in Hebrew) called ‘Ageing during Coronavirus,’ which has a lot of information for professionals, carers and volunteers, and we’ve co-produced eight video clips to help families and carers on various subjects — how to explain what coronavirus is and to calm fears, how to teach an elderly person to use WhatsApp in order to communicate with family, what physical exercises to encourage, and so forth.

Some of the materials are also available in English, Arabic, Russian and Amharic.

An elderly man seen playing a card game on an i-Pad, July 24, 2013. (Chen Leopold/Flash90)

We’re also speeding up our work on creating a virtual campus to help people with issues, such as health and finance, online. The more socioeconomically disadvantaged elderly people are, the less they’ll be able to manage themselves, and that affects their health.

A few days ago, we held our first webinar on financial literacy in which 80 people from our employment centers took part.

This must be a time of great stress for those who work with the elderly. Are you helping them too?

We have three centers in Israel where we usually train 2,000 professionals in care for the elderly each year. We have 60 different courses. That’s all stopped because of coronavirus. So we’re ramping up webinars for professionals that we’ve only done partially up to now.

The social welfare ministry is organizing hot meals for tens of thousands of elderly people across the country. What’s your involvement?

Thanks to a donation from the Schusterman Foundation, we’ve been able to offer a list of 27 items that the 140 poorest councils can give to their elderly residents. The grants we’re able to provide range from NIS 6,000 ($1,680) for the smallest local authority to NIS 102,000 ($28,600) for the city of Jerusalem.

Jerusalem’s City Hall. (Abir Sultan/Flash90)

The items range from medicines, diapers, laundry services and transport to hospitals or clinics for appointments, to payment of electricity bills, a subscription to a newspaper, light repairs, and supply of kits to help relieve loneliness, encourage physical activity, deal with dementia or give a small gift to a foreign carer.

You talked before about preparing for ‘the day after’ coronavirus. Can you elaborate?

We’re thinking about the day after in terms of the world of work and of rising life expectancy.

And, together with a startup, we’re working on developing the ability to identify the state of an elderly person from afar.

Today, the welfare services or the family will tell you about an elderly person. A lot of it is subjective.

A carer helps an elderly woman to put on her slippers.(doble-d/iStock/Getty Images)

We’re trying to develop profiling with the help of deep data and Artificial Intelligence, and without buttons, belts or bracelets [used for measuring aspects of a person’s health].

All companies, such as the telephone and electric companies, legally collect information on all of us. How many times we spoke on the phone, with which numbers — they are forbidden from listening into the calls — when we called, how long we spoke for, and so on.

Through this and many other parameters, we can analyze the physical and mental state of a person. How long did it take for the person to get to the phone after it started to ring? If it took 10 seconds three years ago and today it takes 30 seconds, that tells you all sorts of things. Maybe three years ago, the person spoke on the phone 10 days a month and now that’s gone down to two. Perhaps an average conversation was once four minutes, and now it’s much less. If the person is phoning at 2 a.m. or 4 a.m. that might tell us something. Also, we know where people are going. We can know if the elderly person is going out or not.

An elderly man speaks on the phone. (fizkes/iStock/Getty Images)

We would only need the person’s agreement to our use of the data and his or her identity number and phone number. If we think someone’s depressed we can then connect with agencies or families or young people and ask them to get in touch. We can act if somebody seems to be having physical problems. Even if we’re wrong, the price of a mistake is just a phone call. At the very least, somebody has phoned the person and said hello, how are you?

This is a complex thing to develop. We’re trying to speed it up. We’re currently doing a pilot with 1,000 people and are raising funds to extend it to 3,000. People want to be connected. Maybe it can be introduced countrywide in another two years.

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