The photos in the brochures and on Web sites are all
different yet somehow similar: A group or a pair of
elegantly dressed older men and women sit or stand
against a backdrop of flowers or greenery, their
graying hair carefully coiffed, their faces
clear-eyed and smiling, their teeth white and
perfect. These are portrayals of the world of
retirement homes or, as many prefer to call
themselves, senior citizens' residences, in which --
at least according to the pictures -- happy seniors
live out their autumn years playing bridge or
billiards, strolling through gardens and sipping
coffee in the company of vivacious friends.
Although old-age homes have always existed in Israel
for those who cannot care for themselves, it is only
in recent years that the American idea of retiring
to a comfortable community of seniors has taken off
here. Over the past 20 years, retirement homes have
sprung up all over Israel, and each seems to be
trying to outdo the next in the level of luxury,
services and amenities offered.
"There are now more people over 65 in Israel than
there are under 25," said David Ditch, CEO of the Ad
120 chain. "The population is getting older, but
physically they're still young because medicine has
advanced so much. The standard of living has gone
up, and the elderly population has a lot of free
time and is looking for ways to fill it."
Official government figures bear this out. According
to Israel's Central Bureau of Statistics, there were
670,000 people age 65 or over in Israel in 2003,
comprising almost 10 percent of the population. This
proportion was more than double the 4.8 percent in
1955 and is expected to reach 12.7 percent, or 1.2
million people, by 2025. Life expectancy in Israel
has risen to 77.5 for men and 81.5 for women, more
than five years higher than it was in 1980.
But with increasingly long lives come other
challenges. Fully 25 percent of Israel's elderly
live alone, and while their health may be good,
loneliness and boredom can eat away at their days.
Retirement homes promise a range of social and
cultural activities in a supervised setting. But
before rushing out to book a place for grandma,
there are some factors to take into consideration.
"When someone comes to us and says they want to put
dad in a home, the first question we ask is, 'Why?'
and the first thing we do is meet the person to see
what they want," said David Danhai, who set up and
runs Yad Lakashish,
a free advisory service for the elderly. "If the
children say dad is lonely, we look at why he's
lonely. He may already live in an apartment but shut
himself off from his neighbors because that's his
personality. A closed-off person will be just as
closed off living in a home. Or he may be lonely
because he doesn't know where to go to find
activities and meet people his own age. We show such
people how to use the resources they already have in
their area, such as the local day center for the
elderly, golden-age club or public gardens. It is no
small matter for an elderly person to move out of
the home where he has lived for most of his life.
It's traumatic and drastic, and a step that
shouldn't be taken lightly."
There are two types of retirement housing in Israel,
and the differences between them are significant.
First are old-age homes (batei avot), which are
licensed and supervised by the Ministry of Social
Affairs. While many people think these are only for
the feeble and bed-ridden, in fact many of them are
designed for the independent senior who wants to be
taken care of.
Ministry conditions dictate that these homes must
provide three meals a day (and two snacks) in a
dining room, have a certain ratio of staff to
residents, clean residents' rooms daily, keep strict
hygiene in the home's laundry, among other
stipulations. An old-age home might have a greater
or lesser range of activities for residents, and
medical supervision is ever-present. Residents
generally live in one- or two-room apartments, which
may have an electric kettle but no cooking or
laundry facilities. All apartments have emergency
call buttons, and staff check in on residents if
they do not show up for a meal.
Residents pay an entry fee of NIS 130,000 to NIS
220,000 (approximately $31,160-$52,745), as well as
monthly maintenance fees of NIS 5,000 to NIS 7,500
(about $1,200-$1,800). This entry fee depreciates to
nothing within three to five years. The ministry's
Web site (www.molsa.gov.il)
lists some 190 licensed old-age homes across Israel.
The second type of retirement housing is sheltered
housing (diur mugan). This category is unlicensed
and unregulated, but that does not mean it falls
short. On the contrary, it is into this category
that luxurious retirement residences such as Ad 120
fall. And it is this category that has grown so
dramatically over the past two decades.
Sheltered housing buildings are essentially private
apartment buildings for seniors with some -- or a
lot of -- extras. Residents live in one-, two- or
three-room apartments which, unlike old-age homes,
have a kitchenette and cooking facilities and in
some cases space for a washing machine. Apartments
are cleaned weekly and have emergency call buttons,
but daily checkups on residents are not necessarily
made. Sheltered housing buildings usually have
swimming pools, gymnasiums, game rooms and libraries
and offer a wide variety of activities, including
arts and crafts, exercise classes, concerts and
lectures. In some homes, lunch in the dining room is
included; in others it is extra. Some add coffee and
cake in the afternoon.
Residents pay a deposit of NIS 530,000 to NIS 1.8
million (around $127,000-$431,000) for their
apartments, as well as a monthly maintenance fee
that can range from NIS 3,000 to NIS 5,000
(approximately $720-$1,200). The deposit depreciates
by 2 percent to 4 percent annually for 10 to 12
years, and what is left is given to the residents'
heirs. Each sheltered housing or old-age facility
has a separately run Ministry of Health licensed
nursing division for residents who need chronic
It is hard not to be impressed by Ad 120 in Hod
Hasharon -- especially by the seven-story
glass-roofed lobby with greenery hanging from the
balconies. Thoughtful design touches and careful
finishes are everywhere, from the paintings and
statues crafted by residents in all the public areas
to the carpeting in the corridors and the apartments
"The whole concept of private senior citizens'
residences came from the U.S. about 20 years ago,"
Ditch said. "Private entrepreneurs here started two
or three companies. In the beginning it was very
difficult because nobody knew what it was and what
the customers wanted, or even who the customers
were. We started 15 years ago and were one of the
first. We had to make a market for the product,
which took a few years. Today, it's thriving."
The Hod Hasharon complex, which opened six years
ago, was the company's second home. It is
constructing a third, even more luxurious, building
in Ramat Hahayal, north of Tel Aviv. Ditch said they
plan to build or to buy and renovate three more
buildings within the next five years.
Ditch added that Ad 120 chooses sites for their
proximity to shopping and entertainment centers
rather than building on cheaper land far from
activity centers; it is the only company with an
assisted living division for those who need help if
their health deteriorates but are not chronic
nursing patients, and it is the only home that has
an in-house doctor 24 hours a day.
"We have a very good name and we offer a very high
standard of service. Private companies like us
cannot afford not to give good service," he said.
In Herzliya, another sheltered housing building
stands out. Beth Protea was set up by former South
Africans in 1992 and is Israel's only
English-speaking retirement home. Most residents are
originally South Africans, but there are also some
British and Americans.
"Ours is a real family home, small and intimate,"
said director Lynn Lochoff, a former social worker
who has run Beth Protea for three years. "We pride
ourselves on being a home away from home. The idea
is that people can live out their advanced years in
dignity. You don't feel that you are in a facility
for the aged."
Walking around Beth Protea, one sees many residents
in the public areas. Some are chatting in the lobby;
others are in the library, taking advantage of
large-print English books. An art class is full.
Artwork and statues created by residents are
everywhere, and coffee and cake is served in the
afternoon. And here, lunch is included in the fees.
Lochoff points out that the staff checks on
residents if they do not come to the dining room for
Another feature is Beth Protea's outreach service,
Beth Protea Plus, which opened this year and
provides a free advisory service to the elderly on
"We were getting so many calls from South Africans,
Americans, even Israelis, about all sorts of issues
to do with the elderly that we decided to devote a
full-time social worker to help people with their
inquiries," Lochoff said.
In a quiet, green corner of Kfar Saba, Hamavri is an
old-age home that has been in operation for 33
years. It is similar to Beth Protea in the standard
of furnishings, but its status as a licensed old-age
home means its emphasis is somewhat different.
Director Riva Shtreifler has some harsh words to say
about the sheltered housing concept. "We take care
of every one of our residents," said Shtreifler, a
qualified nurse who has run Hamavri for 15 years.
"We check on residents if they don't come to the
dining room for a meal, and we pay attention to what
each one eats. We certainly don't force anyone to
eat, but we keep a careful watch on their intake. In
sheltered housing, nobody knows whether a resident
has eaten or not. Elderly people often can't be
bothered buying food or cooking, or they forget to
eat or don't feel well enough to eat. Our residents
put on an average of five to 15 kg in their first
year here because in their own homes they were
starving themselves," she said. "Also, our residents
who need regular medication are given it by a nurse.
They can't forget to take their medicine or take too
much of it by accident, as can happen at home or in
Shtreifler is also disparaging of sheltered
housing's emphasis on activities. Hamavri does offer
some activities, such as Yiddish and English
classes, music and crafts, but the range is clearly
less than in sheltered housing, and there is no
swimming pool. Many more people sit in the lobby,
some sipping tea or coffee, some reading newspapers
or doing crosswords, others simply lost in thought.
"Elderly people don't always want to be doing so
many things," Shtreifler said. "Sometimes they just
want to sit and think. They don't necessarily want
to be rushing around all the time feeling they must
Official figures back her up. According to the
Central Bureau of Statistics, some 91 percent of
elderly people took prescription medications and 25
percent were hospitalized in the year before the
survey. And 13 percent, or about 90,000 people,
needed assistance with daily activities such as
getting out of bed, dressing or washing.
Danhai, who has been running the
free advisory service for the past five years and
recently set up its Web site (www.yad-lakashish.co.il)
chooses his words carefully.
"I would say that sheltered housing suits the 'young
elderly.' That is, people who are under 75 or 80, in
good health, who are looking for things to do,
probably after losing their spouse. They want to
move away from their old home and all the memories,
and make a fresh start in a nice place," he said.
But in most sheltered housing, Danhai noted, no one
looks after the elderly until frail health lands
someone in a nursing unit. Many sheltered housing
facilities don't allow caregivers, or will only
allow them to stay in the resident's rooms.
"This is terrible, both for the [caregiver] and for
the elderly person. Old-age homes are more
care-oriented and have different divisions for
people who require different levels of care," he
Danhai points out that elderly people living at home
can take caregivers in at will, and financial help
for this is available from the government for those
who need it.
"My position is first and foremost to investigate
all the options an elderly person has at home," he
said. "Then, if staying at home is not an option,
then we can think about what is the best option.
People often think that if they pay more they will
get more. But that's not always the case."