IN- DEPTH FEATURES
Retirement in Israel: Is It For You?

Part I

Our chronicles relate the stories of elderly, G-d-fearing Jews seeking to spend the remaining years of their lives in the physically primitive but spiritually enriching atmosphere of the Holy Land. After months of bumping in coaches and wagons on the dusty, rocky highways of Europe, and days spent seasick on the rolling, turbulent sea, these stoic pilgrims finally were able to take their first hesitant steps on the parched land of old Palestine.

An exhausting donkey-ride of a day or even two on a tortuous road into the Judean mountains brought them in view of the walls of Jerusalem. If they and their few possessions were lucky enough to escape the notice of marauding Bedouins and Arab chieftains, they finally experienced the thrill of walking into the Jaffa Gate and entering the walls of Jerusalem.

Once here, they joined the local Jewish community, which was a conglomeration of Jewish repatriates from the four corners of the earth. They spent and ended their days serving Hashem and mourning the Temple's destruction near its last remaining remnant. The small, damp, crowded apartments, and the frequent mad frenzies and demands of Arab governors, intruded in this idyll. But they were unfazed, serene in the knowledge that they were the lucky few fortunate enough to fulfill the dream that rested in the bosom of their Jewish brothers all over the world.

Those of today's religious retirees who move to Israel hardly have to undergo such severe initiation rites, yet most Jewish retirees are still reluctant to spend the evening of their lives in Israel. Many fear a seemingly insurmountable hurdle of worries and adaptation pains without realizing that these fears are less relevant today than ever before, while conversely the benefits are far greater.

This is true even today, when almost every day one hears disquieting reports of shooting and bomb attacks in Israel from the north to the south. Many retirees believe that instead of being the heartwarming land of our fathers, Israel is beginning to sound like a scene out of a South American guerrilla war movie. So how can they even consider moving to Israel for their retirement during these uncertain times?

Yet, all the retirees from abroad interviewed for this article were so positive about the move they had made that not one said they would consider moving back or regretted their decision in any way.

What makes Israel such an attractive retirement spot for religious retirees from abroad? With what do retirees occupy themselves? How do they manage financially? What kind of medical health-care do they get? Why did they decide to move to Israel, how did they prepare for their aliya, and what aspects of Israeli life do they find particularly problematic?

All this and more in the series of articles before us.

Israel's Growing Senior Population

Israel has one of the highest life-expectancy rates in the world. The number of elderly (65+) in Israel has grown at an unparalleled rate, increasing sevenfold since 1955 -- twice the rate of the general population. At the end of 1999, the elderly (65+) formed 11 percent of the Jewish population, totaling 608,000, of which 132,000 were 80+. And the number of the elderly is expected to rise continually, reaching 723,000 in 2010 and 1,026,000 in 2020, even outpacing the increase in the general population sector.

Shemtov Benjo, the director of the Department for the Elderly in the Jerusalem Municipality, says that according to Ministry of Absorption statistics, 2,100 elderly made aliya to Jerusalem from Europe and the U.S. in the past 5 years, of which 630 were religious.

Commensurate with the growth of this sector, Israel has seen accelerated development of services for the elderly. The Israeli government -- aided by such nonprofit organizations as the Joint Distribution Committee's Eshel (Association for the Planning and Development of Services for the Aged in Israel) and the Brookdale Institute of Gerontology and Human Development -- has developed a large array of services for the elderly, which cater to the different categories among them.

Israel is thus a haven for the elderly, and it has a fully- developed and comprehensive system of care and services catering to their needs.

Financial Benefits Israel Gives All Seniors

The State has passed two laws which have granted important benefits to the elderly. These two laws also apply conditionally to retirees from abroad who make aliya and move to Israel.

In 1995 the National Health Insurance Law went into effect, guaranteeing medical coverage by one of Israel's HMOs (kupot cholim) to all of Israel's residents. The importance of this law for the elderly is simply because they use health services more than any other segment of society, more than double the rate among the general population. Their rate of hospitalization is three times higher.

The second law especially relevant to the elderly is the Community Long-Term Care Insurance Law, which was passed in 1988. This law guarantees long-term care to the chronically ill or disabled in the framework of day care centers, supportive communities, old age homes, hospitals for the chronically ill and sheltered housing.

We will explain this in more depth later in the article, but the main point to remember here is that any senior who moves to Israel will be eligible to receive complete medical care, including living in nursing and senior citizens' homes. If he has his own funds he or she will have to pay for these services, but if not s/he will get them free.

Before these laws were passed, retirees from abroad over the age of 60 who moved to Israel were not eligible for medical services or a pension. A retiree who moved here had to have his own medical insurance from abroad -- which often would not continue to cover him if he left his native country -- or had to pay for private medical insurance in Israel which for retirement age individuals, was exorbitant. He had to have sufficient private funds to cover possible hospitalization costs or expensive operations and treatments. This alone inhibited many from coming.

Today, this is no longer true. The law today provides the same medical benefits to a retirement age oleh as it does to Israeli citizens who have lived here their entire lives. While some may have to pay for these medical benefits, the cost is far less than private insurance in the U.S.

Lower Cost Of Living

Less crucial than medical expenses but also of great concern to most retirees is the general cost of living in Israel, since most are living on limited pensions. Many view Israel as prohibitively expensive. However, new housing developments in recent years have provided low-cost alternatives for many retirees. As we shall see, whereas to live comfortably in Jerusalem requires $20-30,000 a year, those willing to settle in newer areas like Beitar Ilit and Kiryat Sefer can live comfortably on $10-15,000.

Once medical care and cost of living are no longer an obstacle, many retirees quickly come to the conclusion that there are many benefits to living in a religious town or neighborhood in Israel.

To write this article, we interviewed a dozen retirees from both the U.S. and Europe from widely divergent backgrounds. Their views represent a wide spectrum of experiences that a potential retiree can expect to experience himself if he or she (or they) decides to move to Israel.

Why Did They Come? Profiles Of Retirees From Abroad

The vast majority of religious retirees who move to Israel had visited Israel before. Most had come to visit children who were learning or living here, while to others, Israel had beckoned to them because it was the "Land of Our Fathers."

A significant number had intense memories of the Holocaust and the hatred of Jews which had surfaced then, and felt that the only place a Jew can really call home is Eretz Yisroel. Other retirees were less ideological and stated plainly that they didn't want to live among non-Jews anymore and loved the intense Jewish life and atmosphere in religious neighborhoods in Israel.

Saul and Chana Citron are both Holocaust refugees who spent time in displacement camps before moving on to the U.S. where they met, married and settled in the New York area. Both remember avidly studying Hebrew in the DP camp in preparation for moving to Israel but, as Saul explains it, "When I saw the Hashomer Hatza'ir officials visiting the displacement camps to recruit immigrants, I realized that Israel would be built around the wrong lines and decided to go to the U.S. instead."

During the decades after the war, the Citrons were occupied with making a living in the jewelry business and raising their three children. But Israel was sitting in storage in Saul's mind, just waiting for the moment when he retired and could fulfill his dream. His viewpoint was fueled by the stark realization of many Holocaust refugees that, "What else do the goyim have to do to us, for us to understand that we have to go to Israel?"

The Citrons' first visit to Israel was in 1972. Chana didn't know what to make of it when, on the second day of their trip, Saul was already dragging her around to see real estate agents. When Saul almost signed on a contract for an apartment, Chana burst out weeping, sensing that they were about to sign away their lives for a drastic change. Instead of touring the country during that visit, Saul toured with Chana from one real estate broker to the next. However, the short visit didn't result in finding the Israeli apartment that Saul had dreamed of.

Only when Saul visited Israel several years later by himself, did he finally sign on an apartment in Bayit Vegan.

Saul's dream moved into high gear. All of their extended family lived in the U.S., and all three of their children lived within several blocks of them -- but Saul was nonetheless determined to live in Israel. Before Saul retired the couple spent one month each year in Israel, and when their son decided to make aliya in 1987, that finally convinced the Citrons to move for good. Their friends in their chassidic shul in Boro Park gave them a warm farewell, convinced that they were crazy.

Rabbi and Mrs. M. S. from London had visited Israel five times before. Over the years, ten of their 16 children moved to Israel and they were living in Bnei Brak, Ashdod, Emanuel and Jerusalem. The S.'s knew they wanted to settle in Israel for their retirement, but they waited until Rabbi S. turned 65 and was eligible for a pension.

Mrs. S. says, "We would have come here even if we had no children. Just living among Jews and not having to deal with non-Jews in daily life is a tremendous advantage."

Max Carmen, from Detroit, prepared his Israeli home three decades ago, when his son was studying in the Mir Yeshiva and told him he wanted to settle in Israel for good. In 1972 he decided to buy an apartment in the new neighborhood of Arzei Habira which was just being built, assuming it would eventually be used either by him or his son. His son returned to the States, married, and then came back after his fourth child was born, but Max didn't retire and come until his own mother passed away (at age 101).

"We had enough of America," he says simply. "We have 7 children and loads of grandchildren living abroad, and only one son and his children here. But we would have come even if we had no children."

Rabbi Avrohom Gross was the rov of a shul in Washington Heights and the chaplain at Columbia Presbyterian Hospital in New York. He had visited Israel numerous times before making aliya at his retirement.

The Grosses too say they would have moved to Israel for retirement even without children here. (Although they do have married children living in Jerusalem, most of their children still live abroad.)

In their case, they had a solid family tradition of spending one's last years in Israel, since both sets of their parents came to Israel as soon as they reached retirement. The Grosses had always felt that living in Israel means achieving a more spiritual life, dwelling on holy land, living among one's own people and feeling closer to Hashem.

Since the Grosses knew they would settle in Israel, they bought an apartment seven years ago in Mattersdorf, but on a consecutive visit decided the advantages of living closer to town justified exchanging that for an apartment in Geula.

Rabbi and Mrs. K. had come to Jerusalem from northern England to care for a sick, elderly mother. The couple were anyway at retirement age when they decided to give up their jobs to help their elderly mother out. After she passed away, they decided to stay. "We hadn't thought of moving here," says Mrs. K. "But if Hashem brought us, we'll stay."

The R.'s had become religious after their son became religious during a visit to Israel. When their son married and settled in Israel for good and Mr. R. turned 62 and approached retirement age, he and his wife decided to settle in Israel to be near their son.

Two couples which the Yated interviewed moved to Israel despite not having support from family or previous acquaintances to ease their move to Israel.

The H.'s had always dreamed of moving to Israel. Says Mrs. H, "There were always reasons why we couldn't do it -- parnossa, parents, children, it was always something. Finally, all of our children were married and we only had one son left at home who had finished high school and was ready for beis midrash. We hoped that this son would come to study in Israel and settle down in Israel like us for good, but after a short time learning here he decided to go back, marry and live in the U.S. like his siblings.

"We decided to move to Israel because we felt our future was here. Once our children didn't need us, we still wanted to accomplish for ourselves. We felt that Jerusalem was an important step that would impact on our lives.

"We were both born before the State was founded. When I was young, Eretz Yisroel was a dream. I remember looking up the Wailing Wall in the encyclopedia, just to see the picture of Jews crying next to it. I told myself in awe, `It really exists.' I would stare at the picture and dream of it. Our parents and us dreamed of going to the Kosel and davening. When I grew up, I realized that the possibility of going there was real. We can touch the Kosel, live in Jerusalem and shteig here . . .

"After we moved here, we'd look at the Harei Efraim from our house and tell each other, `If only our parents could be here, to shep nachas from where they are in the Olom Ho'emes to see that we're here. They lived through the Holocaust and other discouraging times, and now here we are, their children, living in Eretz Hakodesh.' We were sad that our kids didn't want to come but we decided that we could either remain there and watch our children shteiging, or we could shteig ourselves."

The F.'s were not blessed with children, so this was never a component in their equation of where to live. Mrs. F. said she always dreamed of moving to Israel since her first trip in 1977. She remembers walking out of Yad Vashem and feeling a burst of energy to devote herself to "my country." Practically, the F.'s made aliya when Mr. F. reached retirement at 65 in 1992, and Mrs. F. was still in her 50s.

Everyone quotes: "Eretz Yisroel is acquired through suffering," but the experiences of most retirees tended to be fairly positive. From the spiritual point of view, the retirees were effusive in their description of the many opportunities that living in Eretz Yisroel has to offer. Most spoke with satisfaction concerning the standard of living and medical services. Still, everyone had a few items of life in Israel that regularly annoys them.

As Rivka Benari of the Association of Americans and Canadians in Israel (AACI) says, "People who make aliya and move into a religious environment are befriended and cared for. They don't feel alone. Every religious community has a tzedokoh, chesed, or welcome group and the religious world is known for its tremendous outreach. I find that they take care of their own, whether they need loans, clothing, or anything else. They also have an endless amount of activities."

Medical Care For Seniors In Israel

According to the National Health Law in effect since 1995, every Israeli, including an oleh, is eligible to receive medical care. That law in effect nationalized the health care system, putting the collection of all payments into the hands of the Bituach Leumi (the National Insurance Institute that handles the state pensions, like Social Security in the U.S.). Before that the Sick Funds (similar to HMOs in the U.S.) were independent and set their own conditions for joining, and it was difficult for an older person newly arrived to join. Now, collections are through the Bituach Leumi, payments to the HMOs are direct from the government, and people join separately, choosing whichever one they want.

There are four HMOs, which remain nominally independent: Clalit, Maccabi, Leumi and Meuchedet. There is a basic "basket" of government-mandated health services that all must offer, but there are differences between them. In a particular area there may also be variations, for example, an outstanding doctor.

Israel's elderly are members of the HMOs according to this distribution: 75 percent are members of Clalit, 13 percent are in Maccabi, 7 percent Leumi, and 5 percent in Meuchedet. Most elderly olim end up in Clalit because it is the only HMO that will take them. Before the Health Law it was impossible to get into any other HMO. Now it is only difficult. All the HMOs offer full medical services, lab tests, etc.

The retirees we spoke with expressed the full spectrum of responses concerning how they evaluated Israel's medicine. We heard everything from "Medical care is awful" to "Medical care is very good."

The impression Yated received after speaking with ten different retirees is that it is easy to enroll in a HMO, and the service one gets is acceptable and even good. However, the quality of medical care one receives depends to a large degree if the member had made it his business to find the best doctors, and secondly, how far away one lives from a clinic or from where a good doctor lives. Some retirees reported they had to travel far to obtain medical care, because each doctor has his own office in a different location, the lab is in the Kupah's center, etc. Although anyone who lives in Jerusalem is just an inexpensive and short taxi or bus ride away from any doctor's office, if one needs daily medical care it can add up.

One retiree emphasizes that Kupat Cholim is a very different system from that in the U.S. In many cases, the doctor doesn't know the patient well, doesn't have much time to check him, and doesn't automatically do a comprehensive checkup including such a basic as taking blood pressure. Many times, there are no nurses or receptionists to receive a person. She concludes, "We use the Kupat Cholim, but we've learned you have to be knowledgeable, know what you're doing, know how to talk with the doctor, and know how to choose doctors and specialists."

Mrs. G. agrees emphatically, "My father-in-law had better medical care here than my father received in the US. Today you have a choice of the best doctors. There are many top Anglo-Saxon doctors available in each Kupah. AACI advised my father-in-law to join Clalit, and anything he needed to have done, we were able to get done there. We did our homework on good doctors. We had friends who were doctors and helped us connect with the best. Most of his medical expenses were covered by the Kupah so that only on a rare occasion did he have to see someone privately."

Mrs. G. added that the medical care is accompanied by a care and concern that she thinks is found only rarely abroad. "My father was niftar in what was supposed to be the best nursing home in his town in the U.S. But I felt it was a disgrace how he was treated at the end. Here, everyone cares about a sick parent as if it was their own parent. My father- in-law was treated with tremendous care and concern by the hospital staff and the doctors alike. That's how it's like in Israel -- if you put a child on a bus, or if a child slips on the street, you know the people around him will look after him if anything happens."

Max stresses that medical care is low cost. Retirees in the U.S. who have Medicaid still need to supplement it with Blue Cross-Blue Shield, which costs thousands of dollars more. He says that other than paying a little more for the Kupot Cholim's upgraded health insurance plans (like Zahav and Adif) which give you better medical care for an additional low sum, one doesn't need private insurance. He says that he goes to U.S. doctors in Jerusalem who are very good.

An Oleh with a Terminal Illness

Mrs. Benari mentions an astonishing story with which she was personally involved. Although she has dealt with several cases of terminally ill people who decided to make aliya because they wanted to die in Israel, one particularly stands out in her mind.

A wealthy childless Holocaust survivor who was very sick, decided he wanted to end his life in Israel. He carried out the aliya process before he arrived, including joining Kupat Cholim Clalit. By the time he had arrived in Israel, he had to be taken straight to a hospice, which was paid for by Kupat Cholim Clalit funds. The man had willed his fortune to various charities in Israel but according to law, Clalit had to pay for his stay in the hospice. His burial was also free of charge.

A Bad Story

A hospital error can (and does) happen anywhere, but this story shows what can happen when one hasn't learned how to navigate the Kupat Cholim system properly. This happened to a couple who made aliya without children here and who had to figure out the system themselves.

The husband became ill the second year they were in Israel. He kept getting sicker and sicker, until finally the couple thought they found out what he had. He was prescribed medication by a Kupat Cholim doctor, but he continued to be ill. The Kupat Cholim doctor gave him another medication but this medication caused him to be even sicker.

The husband became seriously sick before a doctor finally discovered what was happening to him. It turned out that each medication was just treating side effects caused by the previous medication. The couple went back to the States and had a top-grade doctor treat the husband there. The husband was taken off all medications, and in the end, discovered he didn't need almost any of them.

Nursing, Convalescent, and Elderly Services

Although most Anglo-Saxon retirees usually associate with each other instead of blending in with the general Israeli populace, it's important to know that Israel offers a wide range of social, medical and nursing services for the general elderly population. They may find these services particularly helpful especially if they are living alone, are incapacitated and handicapped, or mentally frail.

The Services for the Elderly (Tel. (02) 6298002/3) offered by the Jerusalem municipality are many and varied. Mr. Shemtov Benjo, the department head, says that according to statistics which he possesses, about 2,100 retirees moved to Jerusalem in the past five years, 630 of whom are religious. (The other 1,470 came to fulfill the Zionist dream, escape antisemitism or economic problems, to join their children, or because they were abandoned by their families abroad and couldn't function independently.) Of these 2,100 senior olim, 441 needed the city's welfare services.

Mr. Benjo says that when assessing an ailing senior oleh's needs, the municipality always asks if there is someone local who can take responsibility for him. If the elderly oleh has no one, the State will still accept him. In several cases elderly olim came to Israel and were immediately placed in a seniors' home. "There is no such thing as an elderly person coming to Israel who is not cared for," Mr. Benjo says emphatically.

Here is a partial list of municipal services available for seniors in Jerusalem:

1) Community centers in Romema, Har Nof, Ramot and Bucharim neighborhoods run clubs where elderly people can meet, participate in enjoyable activities, socialize with each other, and sometimes receive a warm meal.

2) 25 Information, Referral and Placement Centers operate throughout the city, including in Bucharim, Beis Yisroel, Har Nof, and Meah Shearim. Their aim is to provide up-to- date information about old age residences, day centers for the physically disabled, respite care, services for the cognitively impaired and meals on wheels services.

3) Referral and placement of the elderly in old age residences, sheltered accommodations, respite and convalescent residences, and day care centers for the chronically ill and cognitively impaired.

4) Home care for the elderly who are tied down to their homes. Each senior has a card, and is checked regularly by volunteers. (Many chutznik volunteers help out in this program.)

5) Eight "supportive neighborhoods" including one located in Meah Shearim and Bucharim. This service, which is run by Misgav LeKashish, helps the elderly who are at least 75 percent handicapped. Those signed up for this program get a basket of benefits including an emergency device which remains in reach so they can press it whenever they need. The center immediately answers all calls. A housefather is appointed over each group to insure their needs are met. The advantage of this program is that it allows a handicapped senior to remain at home instead of moving him out to an old age home.

6) Elderly Protection -- to protect those who suffer from abuse or neglect.

7) Nachshon Convalescent Home -- for seniors who need a short vacation after an operation, or for families caring full-time for an elderly parent who need a place for him to stay if they need a short vacation. The Convalescent Home has place for 31 people and is kosher mehadrin. (Most food services provided by the Jerusalem municipality for the elderly are kosher lemehadrin, in keeping with the large percentage of religious living in the capital.)

8) Day centers for the severely handicapped -- running from 8 to 2, the day centers provide medical services daily to the severely handicapped. They are transported to centers to receive physical therapy, are served a meal, helped with grooming, given attention, and then are returned home. There are additionally five day centers that service 450 senile, Alzheimer's patients, etc. which also are open in the afternoon. The Levav clubs sponsored by the city specifically target Alzheimer's patients.

9) The Community Long-Term Care Insurance Law insures that people who are unable to take care of themselves and their home receive the daily services of a helper who cooks food for them, cleans their home, helps them with grooming, etc. The Jerusalem municipality has 6,000 people who receive this service, and the Services for the Elderly department checks up after them to make sure they do their work properly.

10) Public protected housing for the independent elderly who can live by themselves but need some help. Each housing unit is run by a housemother who helps the elderly in whatever they need. About 521 elderly make use of this service. These are similar to private retirement homes, but since they are public, they don't have the same range of services and standard of care. Each resident pays according to his financial state, with the poor paying only a symbolic amount (400-500 shekels a month instead of 5-6,000 shekels).

11) Occupational centers for the elderly ("Moadanei ta'asuka"), a new project of the Jerusalem municipality. There is one such large occupational center in Yad Sara's Headquarters on Herzl Avenue, and the city is preparing two more in the Diplomat Hotel including one for Russians, and another one in East Talpiot. These enable the elderly to work at a productive, fulfilling job at their pace and within the range of their skills.

Eshel (Tel. (02)6557551)

One group that is avidly working at developing community and institutional services, health promotion and prevention of illness for the elderly is Eshel, the Association for the Planning and Development of Services for the Aged in Israel, which is partially funded by the Joint Distribution Committee and the Brookdale Institute of Gerontology and Human Development. It is a secular organization that engages in activities like social work and medical support.

They publish much printed and electronic material concerning the elderly in Hebrew, English, and Russian, and also offer a range of their own services, such as bringing medications to those who can't get it themselves, ambulance services, etc. They have a website which features a large database of services all over Israel for the elderly (www.eshelinfo.org.il) which I found less unnavigable than promised. The English version is: www.jointnet.org.il/eshelnet/english/index_eng.html

Retir ement Homes

No matter what your financial condition, a senior who is in need of an old age home will be placed in one by Israeli law.

A public old age home I briefly spoke with on Yam Suf Road in Sanhedria Murchevet said that it has 200 beds and is always full. The Welfare and Health Services decide if a senior citizen needs to be transferred to it and they pay the cost. (If the resident has financial resources, he must pay for it according to his means.) That home services all kinds of Jews including Western and Eastern European, army veterans, Ethiopians, and more.

Most retirees from abroad would not be comfortable moving into such a home and there are in fact very few English speakers living there. However, Jerusalem does have a number of private retirement homes which do contain a large number of retirees from abroad.

Two which we superficially looked over are Beit Tuvei Ha'Ir (Tel. (02)5318491) in Geula (the Concord Hotel), and Neve Simcha (Tel. 5008111) in Mattersdorf, both of which have a large percentage of their residents from abroad. Two other centrally located ones are the Tamir Hotel (Tel. 5724444) on Ramot Road and Shomrei Hachomos (5890333) in Sanhedria Murchevet. A well-known one in Bnei Brak is Beit Abba Ve'ima (Tel. (03)5788088). These are all private retirement homes which offer a comfortable suite to live in and provide a range of social and medical services. Many of the residents are not in the least incapacitated but prefer to move to retirement homes because of the convenience -- their residences are maintained, food is provided, and services are at their fingertips. In most cases the residents are single women, although there are some couples who prefer this arrangement. Residents' children visit on Shabbos and the residents can socialize with the other residents instead of living alone and being lonely.

Ms. Evelyn Paluch, who is the social coordinator at Tuvei Ha'Ir, says that at the present, they have religious retirees from the U.S., England, Holland, South Africa, Israel, Switzerland and Austria. The retirement home has room for 145, and offers one to 2- 1/2 room suites, each with its own kitchen, bathroom and balcony. The program for seniors includes: gemora, parshas hashavua, Tehillim Club, Pirkei Ovos, gymnastics, swimming (in their own swimming pool), music lessons, and for the ladies: folk dancing, choir, and aerobics swimming. Newspapers and haircuts are provided for those who request them.

Seniors who don't live in the retirement home are welcome to hear the guest speakers and take part in activities every Shabbos. They have a Cultural Club which features first rate speakers every month including Chief Rabbi Lau, the Chief of Police, a musical program, and a "Moadon Chodesh Tov" (Hebrew).

Once a week they run in English a "Fitness and Learning Program" for women which includes aerobic exercises, a shiur, and coffee and cake. The program was recently expanded to 60 ladies in two groups. They also organize a trip once a month to places such as Gilo, Holyland Hotel, and the Kosel.

Mrs. Paluch describes the residents as ranging from 65 to 100. Most are ladies who are alone, but there are a few couples and lone men. The retirement home offers around the clock medical supervision by a nurse, and visits by a doctor four times a week. Every room has an emergency button. Rooms are cleaned twice a week. The retirement home also doubles as a convalescent home for people from abroad who need to rest after an operation, and who have children here.

Mrs. Paluch says, "If you're healthy, it's an active, fascinating life. We have a very interesting mix of people here." She says that the retirees who move in generally have children or grandchildren in Israel, or a middle-aged couple may be moving to Israel and they bring along an elderly parent who they feel will be comfortable there. She says that some of the lady residents love Jerusalem so much that they came despite the fact that their children are living abroad.

Neve Simcha is not only a retirement home, but also has a wing which provides complete nursing facilities to those who are totally dependent.

Rabbi Menachem Klein, the director of Neve Simcha says that, in his experience, people who are sick prefer retirement and convalescent homes, whereas healthy individuals prefer to move into their own apartment. He explains that today there are many services available to help the elderly manage at home, so fewer and fewer people are leaving their homes for institutions.

However, the loneliness and convenience of having all one's needs provided for is what often convinces a person to join a retirement home. A person's food is prepared for him daily. A laundry service comes right to his room to pick up his laundry. Repairs, medical care, and most everything else are all arranged by phoning the reception. The only disadvantage is that a person has to adapt himself to the retirement home's schedule, such as eating during the hours when food is served.

Mr. Klein says that "Residential Suites" which are essentially private condos are becoming popular in retirement homes. Neve Simcha built an entire new wing like this. Each suite has two rooms with a kitchen, and the resident can bring in his or her own furniture and live on the premises as if it were his own apartment. There is a joint (self- service) laundromat in the wing for the residents, and a supermarket nearby where people can shop for their own food. The residents of these suites also have the option to take advantage of the retirement home's other services including ordering food for Shabbos or weekdays, janitorial services, and more.

The reason why people prefer these residential suites is to maintain their independence and privacy. Neve Simcha also has "convalescent rooms" where people recovering from operations can stay.

For a retiree who is thinking of joining a retirement home in Israel, Mr. Klein recommends registering as an oleh abroad and arriving with membership in a Kupat Cholim already confirmed. Otherwise, if he needs medical service, it might cost a fortune. The retirement home needs to have detailed information about each resident's state of health in case an emergency arises and they have to deal with it.

He explains that the retirement home insists that every senior citizen who moves in must have a guarantor for him who lives in Israel to sign and, if necessary, approve treatments or operations he may need, and to commit himself to unexpected financial expenses if these arise.

"We had a case where one of our retirees suddenly needed full- time nursing care," explains Rabbi Klein. "We got in touch with the man's relative abroad and he told me that he refused to be responsible for it. In the meantime, we'd incurred more than $140,000 in uncovered medical expenses for him. If there is a guarantor in Israel, we can get hold of him much more easily."

He explains that Israel has a law (Chok Mezonos) which stipulates that if a father is sick, the children have to pay for his old age home, just like parents have to pay for their children's treatments. A child who doesn't want to pay for his father's needs can be forced to do so by law. But if the children are abroad, the nursing homes have no legal leverage.

Rabbi Klein says that before the government will authorize putting an elderly person in an old age or nursing home, they demand a contact person who will take responsibility for the invalid. If the elderly person doesn't have anyone who can be his or her guarantor, the government will not abandon him but it won't automatically pay for him either. They will check his financial state and may confiscate his Social Security check, his bank savings, and any other possessions he has to pay for the level of nursing care he needs. The State is very strict about each person paying for the services he gets if he has the means.

In Neve Simcha, 20-25 percent of the residents are from abroad.

Retirement Payment Schemes

All the private retirement homes have an interesting payment scheme which they offer retirees. Rabbi Klein explains that in Neve Simcha for example, retirees are asked to deposit with the institution $120,000 or $150,000, depending on the size of the room or suite. This sum remains his, but 2-3 percent of it is depreciated every year from it. The result is that he pays NIS 3-4,000 every month (about $7-900).

For this reasonable sum, he gets the full services of the retirement home -- utilities, cleaning, repairs, taxes, medical services, mikveh, social activities, and more. Food is separate. If the resident passes away or decides to move out, s/he or his heirs receive whatever remains of the deposit.

Alternatively, s/he can pay NIS 7,500-9,000 ($1750-2100) a month rent for the same services, depending on what standard of services he needs, including food. A full-time nursing suite costs NIS 11,000 ($2600). Convalescent rooms cost NIS 390 ($92) a day per person, and NIS 600 ($141) per couple. (Exact costs are subject to change and should be checked with the retirement home.)

The costs in the various homes vary, but they are basically similar all over. The amounts compare favorably with similar facilities in the U.S. and in some cases are way below what a similar level of services costs -- and these are in Yerushalayim.