Much has been written about the reasons Israel is faring better than the United States in protecting its populace from the COVID-19 pandemic. A recent article by JNS Jerusalem Bureau Chief Alex Traiman, for instance, outlines the top 10 reasons for this, among them the fact that Israel closed its borders early and has a population and a military well versed in crisis management.

Such factors help to explain why Israel has a fatality rate of 31 per million (less than 300 in total as of this writing), while the United States has a fatality rate of 285 per million (a bit more than 100,000 in total as of this writing).

What both countries have in common, however, is their initial difficulty in addressing their most vulnerable populations: senior citizens in institutional settings.

Countries around the world have encountered the same difficulty, as senior citizens, most of whom have pre-existing conditions, are both particularly susceptible to contracting the highly contagious virus and to dying from it. Furthermore, senior citizens’ residences have a high concentration of similarly vulnerable people in a closed environment, which enables the spread of infection like fire in a forest.

It is thus not surprising that one third of all COVID-19 fatalities in the United States and Israel have hailed from such facilities. (In Sweden, the number is higher, with 50 percent of total deaths coming from such residences.)

The difference is that while only about two percent of Israelis over the age of 65 live in long-term-care facilities, some 6.5 percent of American senior citizens occupy such residences.

Israel is slightly more “old-school” than much of the West in this respect. Part of the culture in the greater Middle East—among Jews and Arabs alike—centers on the role of the extended family. Largely, then, seniors there tend to live either near their children and grandchildren or in their adult children’s homes. Israeli health services encourage the above model by providing subsidies for in-home care workers.

Though the in-home model doesn’t always work for a variety of reasons, it has been better where disease prevention is concerned, and minimized the trauma of elderly people leaving their familiar surroundings and moving to an unfamiliar group setting.

This is not to say that elderly Israelis living alone do not face other challenges, however. According to a 2018 Brookdale study, one-third of this population cited loneliness as a problem.  On the other hand, 86 percent surveyed expressed satisfaction with their situation.

The fact that life expectancy in Israel is high (age 79 for men and 82 for women)—with U.S. close behind—should not be a reason to dismiss the need to improve the quality of late life.  Strengthening in-home care options, in lieu of institutional care, will help increase both longevity and quality of life. It would also reduce the number of elderly in facilities who are especially susceptible to deadly illnesses, including the seasonal flu.

It is time for both countries to engage in introspection. If long-term eldercare facilities have been the largest single source of fatalities, perhaps in-home care should be encouraged as a more desirable option. The critical question at this juncture is: How are we taking care of our parents in their senior years?

Gary Schiff is a natural resource consultant for Israel and the US and a contributor to JNS.

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