People in Need of Long-Term Care (Siud): Rights and Services

Step-by-Step Instructions

1. 1

   In brief

   Long-term care (siud) describes a state where a person is dependent on another for daily activities — dressing, eating, bathing, mobility within the home, and continence — or requires supervision to prevent danger. It can arise suddenly from a stroke or accident, gradually from dementia, or as a complication of illness.

2. 2

   Hospitalisation and discharge planning

   Older adults are often admitted to hospital before being formally designated as needing long-term care. Actions to take during the hospital stay to secure continuity of care:

   • Contact the liaison nurse (achot mekasheret) of your health fund based at the hospital, and arrange rehabilitation in advance of discharge.
   • Those needing close long-term care after discharge may qualify for a temporary permit to employ a foreign caregiver (up to 3 months) — even if they don't yet meet the usual eligibility criteria.
   • You can file a claim for Gimla Siud already during hospitalisation — ask the medical team for an interim hospitalisation summary. Attach a specialist's opinion (oncologist for cancer, nephrologist for dialysis, geriatrician who can weigh all the patient's conditions) to strengthen the claim. See our detailed section on the Gimla Siud application.
   • If immediate help is needed before Bituach Leumi's decision, "pre-siud" services from private caregiving companies (contracted with Bituach Leumi) provide at least 6 weekly hours at no cost to the patient for up to a month while the claim is pending. Ask the hospital's social worker for the list of participating companies.

   Special situations at discharge:

   • Stroke or hip fracture: consider inpatient rehabilitation. Ask the hospital social worker about temporary Gimla Siud.
   • Holocaust survivors: may qualify for 50 sponsored care hours over 2 months after hospitalisation.
   • Bereaved families in Ministry of Defence care: check for Ministry of Defence caregiving support — see the MoD Elderly, Orphans and Widows portal.
3. 3

   Long-term care benefit (Gimla Siud) — the main financial support

   Gimla Siud is the National Insurance long-term care benefit for Israeli residents at retirement age who live at home (or in independent-living apartments in sheltered housing), need daily help, and meet the income test.

   Delivery — as services (via contracted caregiving companies), partly in cash, or fully in cash when a live-in caregiver is employed at least 12 hours/day, 6 days/week.

   Six eligibility levels — 2026 rates:

   Level	Weekly service hours (full benefit)	Monthly cash-equivalent (foreign caregiver, full benefit)
   Level 1	9 hours OR ₪1,661 in cash	—
   Level 2	10 hours	₪2,410
   Level 3	14 hours (+3 hrs for Israeli caregiver)	₪3,374
   Level 4	18 hours (+3 hrs for Israeli caregiver)	₪4,338
   Level 5	22 hours (+4 hrs for Israeli caregiver)	₪5,302
   Level 6	26 hours (+4 hrs for Israeli caregiver)	₪6,266

   Reduced benefit (50% of the above) applies when income exceeds the standard-benefit threshold but stays under the disqualifying ceiling.

   Income thresholds (applying April–December 2026):

   • Singles: full benefit up to ₪13,769/month gross; reduced benefit ₪13,769–₪20,654; no benefit above ₪20,654.
   • Couples: full benefit up to ₪20,654/month gross; reduced benefit ₪20,654–₪30,980; no benefit above ₪30,980.
   • Additions apply per dependent child.

   Temporary benefit — 60-day short-term coverage for temporary functional limitations expected to improve.

   Cannot combine Gimla Siud with: Special Services Allowance (Sha"rm), Special benefit for high-degree work-injury disabled, State personal-care allowance, or duplicate MoD benefits. You must choose one.

4. 4

   Application process and the ADL dependency test

   The claim process:

   1. Submit the Gimla Siud claim to Bituach Leumi (a family member, guardian, social worker, or nurse can file on the patient's behalf).
   2. If basic criteria are met, an assessor (nurse or physiotherapist) will conduct an in-home ADL Dependency Test (Mivchan Tlut ADL) — usually about 2 weeks after the claim is filed, by appointment.
   3. A claims officer calculates the total dependency score.
   4. You receive a decision — approval at one of the 6 levels (temporary or permanent), or denial.
   5. The service mix is set based on your level and preferences.

   The ADL Test in-person visit:

   • The patient will be asked to show ID, current medications, mobility aids (e.g. walking stick), and any medical documents.
   • The assessor may request the patient perform simple tasks reflecting daily functioning (dressing, walking to the bathroom, preparing food) — never anything unsafe.
   • The patient may insist a family member or trusted person be present, and may request the appointment be coordinated with that person.
   • Living alone — if you live alone, make sure the assessor knows this even if a relative is present during the visit. An assessment conducted somewhere other than the patient's own home may lead to a wrong conclusion.

   Automatic eligibility — some conditions grant Gimla Siud without an ADL test:

   • Diagnosed cancer patient (by an oncologist)
   • Dialysis patient (by a nephrologist)
   • Alzheimer's patient (by a geriatrician)
   • Blind person living alone (with a blindness certificate)

   Appeals:

   • Dependency-level decisions → appeal to the Appeals Committee (Va'adat Ararim)
   • Other decisions (e.g. income calculation) → appeal to the Regional Labor Court (Beit HaDin LaAvoda)

   Deterioration after approval — if the patient's condition worsens (except at level 6), the family can request a re-assessment.

5. 5

   Special Services Allowance (Sha"rm) — for adults under retirement age

   Kitzbat Sherutim Meyuchadim (Sha"rm) is a separate National Insurance benefit for adults aged 18 up to retirement age who need substantial help from another person in daily activities. It's paid in addition to the general disability allowance.

   2026 rates by dependency level:

   • 50% rate: ₪1,943/month
   • 112% rate: ₪4,501/month
   • 188% rate: ₪7,181/month
   • 235% rate: ₪9,126/month

   Key rules:

   • Sha"rm is paid in cash only (unlike Gimla Siud, which is primarily services).
   • Recipients qualify for additional benefits: electricity-bill discount, foreign-caregiver employment permit, and more.
   • Cannot combine with Gimla Siud — recipients at retirement age must choose one.
   • Cannot combine with the Special benefit for high-degree work-injury disabled, or State personal-care allowance.
   • Mobility allowance and Sha"rm are usually mutually exclusive — with exceptions for wheelchair-bound patients and 100% mobility disability.

   Applying after retirement age — those who reached retirement age can still file for Sha"rm up to 6 months post-retirement, but eligibility is retroactive to pre-retirement period only.

6. 6

   Support for Holocaust survivors and MoD-assisted families

   Holocaust survivors (receiving payment from the Ministry of Finance or Claims Conference) are entitled to substantial additional support alongside Gimla Siud or Sha"rm:

   • 9 extra monthly care hours (worth ~₪2,169) for those living at home (not in institutions or supported-living).
   • 50 caregiving hours over 2 months after hospitalisation or health crisis.
   • Full exemption (100%) from co-payments on prescription medications in the health basket.
   • Extensive additional benefits — see the Authority for the Rights of Holocaust Survivors.

   Bereaved and MoD-assisted families:

   • Bereaved parents (living at home or in sheltered housing) — care hours funded by the MoD if not eligible for Gimla Siud. See MoD portal.
   • Widows/widowers of fallen soldiers with medical needs — MoD-funded caregiver.
   • Hostile-action victims (disability recognised): supplement for special needs; family members may qualify for compensation supplements.

   Private long-term care insurance:

   Many older adults have policies purchased via their health fund, employer, or privately. When siud sets in, check all three sources plus the Ministry of Finance's insurance registry ('Har HaBituach'). Most policies pay a monthly benefit for a limited period (typically 3 years) — factor this into long-term financial planning. See Private long-term care insurance overview.

7. 7

   Medical rehabilitation (Shikum)

   Medical rehabilitation is a right under the National Health Insurance Law, delivered by your kupat cholim. The goal: restore as much daily-life function as possible after a stroke, hip fracture, or similar event.

   Inpatient rehabilitation (Shikum b'Ishpuz):

   • Intensive rehabilitation for up to 3 months in the current hospital or a specialised rehabilitation hospital.
   • Longer stays possible with kupah committee approval.
   • Criteria: ongoing medical supervision needed; motor/cognitive/emotional/speech impairments requiring specialised knowledge; not deliverable in the community.

   Community rehabilitation (Shikum b'Kehilah):

   • 12 physiotherapy treatments per year covered under the health basket, plus an additional 12 treatments at co-pay in contracted clinics.
   • Multi-disciplinary day-hospital-style programmes.
   • Focused single-discipline programmes (e.g. physiotherapy or occupational therapy only).
   • Community day centres (mercazei yom) after formal rehab is exhausted.

   Home rehabilitation:

   When conditions at home allow, treatment can be delivered there:

   • Home visit by the treating physician at least every 2 weeks
   • Home visit by a nurse at least weekly
   • At least 5 treatment sessions per week across at least 3 days, from one or more members of the rehab team
   • Phone-available on-call during clinic hours

   Tip: Arrange rehabilitation before discharge — contact the kupah's liaison nurse at the hospital.

8. 8

   Mobility devices and home modifications

   Mobility and rehabilitation equipment (wheelchairs, anti-pressure mattresses, hospital beds, patient lifts) is co-funded by the health fund and Ministry of Health. See Assistance with funding mobility devices.

   • The family doctor or specialist + clinic nurse fill in a functional-medical form.
   • Referral goes to a physiotherapist or occupational therapist, who recommends the device.
   • Equipment is supplied via the kupah.
   • Check equipment suits the patient AND the caregiver, and fits the physical setup at home.
   • Amutat Yad Sarah lends equipment at low or no cost as an alternative source.

   Home modifications — the Ministry of Construction and Housing subsidises accessibility renovations for mobility-impaired people. Covered work includes:

   • Widening doorways or adding new openings for wheelchair access
   • Bathroom and toilet adaptations
   • Building pathways, ramps, and handrails
   • Kitchen adaptations
   • Electric shutters or automatic doors
   • Wheelchair-lift installation

   Grant amounts (2026):

   • Up to ₪65,000 for interior/exterior modifications
   • Up to ₪130,000 for wheelchair lift installation

   Support is delivered as grant + loan in 4 tiers (90%/60%/30%/0% grant, remainder as loan) based on family income and household size. Public-housing tenants receive 100% grant regardless of income.

9. 9

   Medical treatment at home

   Once a patient returns home, many medical services can be delivered there — avoiding travel to the clinic.

   Home visits typically available:

   • Blood draws and lab tests
   • Physiotherapy
   • Physician home visit — check kupah policy plus private insurance
   • Increasingly complex tests are now possible at home

   Health fund community nursing services (free):

   Injections, vital-sign monitoring, wound care, proactive chronic-disease follow-up, patient education.

   Home palliative care (tipul beiti tomech) — for patients with progressive terminal conditions, delivered by an interdisciplinary team through the kupah.

   Home hospitalisation (Ishpuz Bayit) — for patients requiring hospital-level care who can be safely treated at home. Includes doctor visits, nursing, IV medications.

   Supportive-community programme (Kehilah Tomechet):

   Some municipalities partner with community organisations to offer home-doctor calls at any hour for a symbolic co-payment. Ask your local welfare department.

10. 10

    Long-term care institutions

    When home care is no longer viable, institutional placement for long-term care and mentally-frail elderly — funded via "code" (hospitalisation on a code basis) — becomes an option.

    • Institutional placement covers complex long-term care patients, patients with severe cognitive decline, work-accident victims, and hostile-action victims.
    • Funding is on a graduated income-based scale — the family contributes according to means, with the state covering the rest.
    • Note: Living in a nursing home (beit avot) does not by itself disqualify Gimla Siud, provided the resident is in an independent-living or "frail" (not full-siud) wing. Full-siud wings, cognitive-decline wings, and geriatric hospitals disqualify Gimla Siud.
    • During hospitalisation in a general hospital: Gimla Siud recipients continue to receive personal-care services in the hospital for the first 30 days.
    • After discharge from hospital or institution: Gimla Siud is reinstated once the patient returns home.
11. 11

    Rights of family caregivers (Care Givers)

    Family members providing care to a dependent adult have their own legal rights, including:

    • Paid absence from work to care for a sick parent — sick leave can be used for immediate family care under Israeli labour law.
    • Access to information and consultation via Yad Mechavenet — Bituach Leumi's free consultation and guidance service for medical committees. Phone: *2496.
    • Discounts and subsidies on caregiving-related expenses.
    • Enduring power of attorney (yipuy koach mitmashech) — a legal instrument to plan care and financial decisions before the family member loses capacity. Consult a licensed attorney.
    • Support groups and community services through the local welfare office and organisations listed below.
12. 12

    Helping organisations

    Government hotlines:

    Organisation	Phone
    Ministry of Health — Older Age	*5400
    Senior Citizens call centre (Ministry of Social Equality)	*8840
    Bituach Leumi (National Insurance Institute)	*6050
    Yad Mechavenet — Bituach Leumi consultation service	*2496
    Segula Unit — hospital rights-claiming service	—
    Sh'il (Citizens' Advice Service)	118
    Central Government Response Centre	1299