ABSTRACT
When formal long-term care services are offered to a traditional, conservative, modernizing society that cares for its elderly within the family, clan, and village,1 it is appropriate to examine the extent to which the services are adopted and to specify the niche that they fi ll.2 There are 1.2 million Arab Israelis, constituting about 20 percent of the total Israeli population; 76 percent are Muslim, 15 percent Christian, and 9 percent Druze.3 Despite economic and social differences between Jewish and Arab Israelis,4,5 life expectancy of Arab Israelis is high, continues to increase,3 and is higher in Arab Israelis than in similar populations in neighboring countries. 6 Only 3.1 percent of Arab Israelis are aged 65 and older, compared with about 11 percent of Jewish Israelis, because of higher fertility and lower life expectancy,7 meaning that there are more potential sources of nonelderly social support among Arab Israelis than Jewish Israelis. Although 26 percent of Jewish Israelis and 44 percent of Arab Israelis aged 65 and older have diffi culty with, or are unable to perform some activities of daily living (ADLs),8,9 in 1999, 4.3 percent of the Jewish population (about 17 percent of the disabled Jewish elderly) and 0.7 percent of the Arab-Israeli population (2 percent of disabled Arab Israelis) aged 65 and older lived in an institutional setting.10 Provision of health care and long-term care to elderly Israelis is through universal health insurance (since 1995), which covers most acute and chronic health care and is responsible for regulating long-term care institutional care, with supervision and means-tested funding (analogous to Medicare), provided by the Ministry of Labor and Social Affairs or the Ministry of Health (depending on the eligibility of patients, based on their health and functional status).11,12 About 13 percent of Jewish and Arab elderly receive home care services under Community Long-
Term Care Insurance, an entitlement home care program begun in 1987 that provides hours of services to the elderly from home care service providers or allowances to families without service providers.13 Because Arab-Israeli elderly are more disabled than Jewish-Israeli elderly, this represents 29 percent of the Arab and 52 percent of the Jewish disabled elderly.14 The overall picture is of a population with high needs and disproportionately low utilization of services from the public sector.
