Following 34 coronavirus-related deaths in homes for the elderly, a public outcry and a High Court petition to which the state must respond by Monday, the Health Ministry has appointed Ronni Gamzu, currently director general of Tel Aviv Sourasky Medical Center aka Ichilov Hospital in Tel Aviv, to coordinate between government departments and formulate a national plan of action.
Ron Ozeri, chairman of the Association of Nursing Homes and Sheltered Housing in Israel, has been warning the government since early March about shortages of protective clothing and equipment for staff and a general lack of preparedness for the pandemic in institutions tasked with caring for a high-risk population.
A source within the association told The Times of Israel on Sunday that with the outbreak of COVID-19, the Health Ministry directed protective equipment and sterilization materials mainly to hospitals and pharmacies while nursing homes for the elderly were told to protect themselves only if someone became sick. That, said the source, made no sense in light of the fact that the virus can take 14 days to appear. “You can’t feed someone or shower them while maintaining a social distance of two meters (6.5 feet),” the source said.
A directive mandating that all nursing home staff should wear protective gear all the time was issued just a week ago, the source went on. “That was declarative. Now the question is whether that equipment is delivered.”
Frustrated by what it says was the Health Ministry’s lack of response to its appeals, the association, together with 23 individual nursing homes, petitioned the High Court last Tuesday.
Among their demands are immediate tests for all residents and staff in the 27 out of 350 institutions for the elderly where coronavirus has broken out, followed by tests within ten days for all those in the remaining institutions that are apparently unaffected.
The petition also demands around NIS 80 ($22.4) million to compensate institutions that have had to buy protective equipment on the black market at inflated prices, organize private transportation where public transportation has been canceled, pay overtime for 12-hour shifts and prepare backup teams to step in where carers and others have had to go into isolation.
The court ordered the state to respond by Monday and an urgent discussion of the issue to be held before three judges on Thursday morning.
Several hours after the petition was filed, the Health Ministry issued a notice saying it was willing to carry out tests in nursing homes already hit by the coronavirus.
According to the Association of Nursing Homes and Sheltered Housing source, however, thorough testing has only been carried out in five of the 27 affected institutions to date, with partial, sample testing undertaken in another eight. “It’s all a month late,” The Times of Israel was told.
“They’re preparing in advance for a committee of inquiry,” the source went on. “Then they’ll find excuses… failure of other ministries, lack of cooperation..”
The 350 facilities for the elderly in Israel comprise sheltered housing (assisted living) complexes for the independent elderly, many of which also have a nursing care department for those whose health deteriorates with time, and nursing homes for people with complex medical conditions needing full-time supervision and care. Some 70% of those in the latter either cannot afford to pay for private carers at home or have medical complications which require round the clock help. They are referred and paid for by the Health Ministry.
Of the 103 coronavirus-related deaths at this writing, about a third — 34 — have been of elderly people in nursing care.
Among the worst-hit by the coronavirus so far has been the nursing care department within the Mishan Beersheba sheltered housing complex, where 13 out of 35 residents have died and three are in the hospital in serious condition.
Relatives of residents at Mishan in Beersheba say they are planning to file a lawsuit against the facility’s managers and the Health Ministry for alleged medical malpractice, while police are reportedly investigating whether there was neglect.
Of deaths elsewhere, nine were from the Yokra institution in Yavne’el, in Israel’s north, four were from the nursing section of the Nofim sheltered housing complex in Jerusalem, and three were from the Bulgarian home for the elderly in central Rishon Lezion.
A staff member from the Yokra institution in Yavne’el reportedly caught the coronavirus and took it home to the Arab town of Daburiyya, where 26 locals are now infected.
COVID-19 has also broken out at a Mishan facility in the central city of Holon and at the Freemasons Nursing Home in the northern coastal town of Nahariya.
Pleading for help
Over recent weeks, nursing home directors have appeared on television begging for assistance.
Jocelyn Sayag, co-founder of the HaBonim HaHofshiim home in Nahariya, told the Walla Hebrew-language news site eight days ago not only that protective equipment was in short supply but that most of her 30 staff members had either been sent into isolation or were too afraid to come to work for fear of infecting the residents, leaving just her, her ex-husband, her four children and one nurse to care for everyone.
In the ultra-Orthodox neighborhood of Bnei Brak, an epicenter of the epidemic, the coronavirus was discovered at the Ganei Margoa home after which the entire medical and care staff of 18 had to go into isolation, leaving the director, Moshe Cohen, alone.
Omri Cohen, director of the Mishan network of nine homes, warned that without the proper steps, the coronavirus would spin out of control. A month into the outbreak, he claimed that his organization had not received any official guidance from the Health Ministry.
The source at the Association of Nursing Homes and Sheltered Housing in Israel told The Times of Israel on Sunday that the sector was short of 6,000 staff during regular times. Israelis were not interested in the physically and mentally exhausting work of lifting, showering and feeding elderly people, and the government had not acceded to requests in the past to allow foreign workers to come instead.
The Health Ministry was talking about drafting students of medicine and nursing care who need to do practical training, the source said.
“The ministry has asked us to map needs, as if it doesn’t know what the needs are. You would expect ministry officials to go into the field and provide what’s needed,” the source said.
“We’re hanging great hope on Ronnie Gamzu. Up to now there’s been no address, nobody to turn to. Sheltered housing comes under the Welfare Ministry, nursing homes are under the Health Ministry. The Health Ministry sends us to the Home Front Command (tasked by the Prime Minister’s Office, along with the Defense Ministry, a week ago to assist with operational aspects of nursing homes) and the Home Front sends us to the Defense Ministry.
“To date, the guidelines haven’t been well organized. They change every few days, their practicability isn’t properly checked (such as one requirement that a worker only works in one place, which was subsequently canceled) and there’s no synchronization between the rules from the health and social welfare ministries.”
On Saturday, the director general of the Health Ministry, Moshe Bar Siman-Tov, insisted on Channel 13 TV that the ministry was prioritizing nursing homes, that the Magen David Adom emergency services had started testing two days before, and that compared to countries such as France, where 4,000 people had died of COVID-19 in nursing homes, nursing home deaths in Israel were among the lowest in the world while testing rates were among the highest.
A not-for-profit organization called Veshamarta is meanwhile stepping into the vacuum, helping to raise funds to buy and distribute protective equipment to homes for the elderly, train staff how to use it, recruit volunteers to bolster staff in areas that do not require special training, and generally help to support staff and residents.
Headed by social entrepreneur and businessman Ronny Douek, the organization brings together businesses, social organizations and volunteers who coordinate with the relevant government offices to ensure that the institutions get what they need.
As part of the project, a representative of the Aharai organization, which helps developing young leadership and social involvement among youth and young adults, has been allocated to each of the country’s institutions for the elderly to report back on the problems and needs.
The coronavirus is affecting nursing homes differently
At the private Zigfried Mozes Old Age Home in Jerusalem’s upscale Baka neighborhood, which combines assisted living with a nursing department, director Amnon Sirota told The Times of Israel that money was not a problem and that from early on, the facility was able to acquire enough protective equipment and sanitizing gel.
He also said he had received sufficient written guidelines (Hebrew) from both the Health Ministry and the Welfare Ministry, tightening up procedures even more strictly himself.
“We immediately divided the staff into two, one group under me and the other under my deputy so that if, God forbid, somebody became infected, we would not have to shut down the whole team,” he said.
“From the start, we’ve been very careful with personal and general hygiene. All workers wash their hands and get masks and gloves at the entrance to the facility. There, they also have their temperatures measured and sign a form saying that they haven’t knowingly been exposed to the virus.”
Employees and resident volunteers were going around regularly with diluted bleach to clean frequently touched surfaces such as banisters, door handles and elevator buttons, Sirota added, while bottles of hand sanitizer were distributed throughout the building.