The world in which we live is aging at a dizzying pace and expressions like “70 is the new 50” or the creation of concepts such as the “Silver Tsunami”, a nickname for the aging baby-boomer generation, have become an inseparable part of the reality in our society.On the one hand, the spread of aging is a welcome phenomenon – a sort of solution to the great human effort to reach immortality. On the other hand, however, old age can be perceived as a period burdened by economic, social and health-related challenges and it is becoming more and more clear that throughout the world, and in Israel in particular – the focus of this article - we must begin to prepare systems and services for the provision of rapid and comprehensive solutions for the tsunami of aging that befalls us. This stems from an understanding that the services we have in place today are not sufficiently prepared to handle the range of challenges and issues that will arise as a side effect of this phenomenon.The dilemmas that come hand in hand with the aging of our population are innumerable, however five particular issues stand out: the first is who should be responsible for the elderly and their care – the government or the person’s family? The second: Should all of the elderly receive the same care or should the treatment assistance vary differentially – meaning each elderly person should receive care according to his or her economic, social and health status and receive only according to their needs? The third is, should we provide assistance to the elderly directly (e.g. specific medications) or should the elderly receive financial assistance equivalent to the value of their needs and should we hope that they purchase the relevant medications, for example, and not something else instead? The fourth dilemma is: should we provide assistance for specific projects or should we work on long-term solutions through legislation to provide care and assistance to the elderly? Fifth, which is also the main questions, is should the services provided be privatized or should the treatment be the responsibility of the state and its institutions?The question of privatization or nationalization is the main focus of this article, and while we do not pretend to offer a firm stance on the issue, the authors offer to shed some light on the basic concepts associated with our aging population and how we as a society might handle these issues from the perspective of comparison between privatization versus nationalization of services rendered. The main focus of this article will be around the issue of the residential arrangements for the elderly: Mainly - should the elderly move into what are typically called “old age homes” or should we allow for “Aging in Place” – an approach that favors allowing the elderly to remain in their own homes for the remainder of their lives. Which is the most favorable solution? This issue also falls under the dilemma of whether or not homes for the aging as one possible solution should be a state-provided service or if “aging in place” will result in the privatization of the services granted to the elderly.The focus of this article is the situation in Israel, a country in which a significant portion of the population is elderly and where, by 2035, 15% of the population will be considered senior citizens. We will present the dilemma through the lens of the situation in Israel. The article shall begin with an introduction offering an in-depth examination of the dilemma presented. We will continue by presenting basic concepts from the general literature in the field of gerontology available today. We will then examine the situation in Israel between the years 2017-2019 and conclude by examining the concepts of privatization and nationalization in regards to services for the elderly, while once again emphasizing that comprehensive solutions to these dilemmas are unlikely to be reached in the near future.
Service evaluation in old age psychiatry: using the general practitioner's view
