Tracing Stigma in Long-Term Care Insurance in Israel: Stakeholders' Views of Policy Implementation

Area of Science:

• Gerontology
• Public Health
• Sociology

Background:

• Few countries, including Israel, have legislated universal long-term care insurance (LTCI).
• Israel's community-based LTCI has improved care for frail older adults.
• Underutilization of LTCI by individuals with dementia and their families persists despite its universal nature.

Purpose of the Study:

• To investigate whether welfare stigma influences the uptake of LTCI by individuals with Alzheimer's disease (AD) and other dementias.
• To explore identity stigma related to AD and treatment stigma associated with LTCI bureaucracy.

Main Methods:

• Qualitative design utilizing personal in-depth interviews and focus groups.
• Triangulation of views from three stakeholder groups: persons with AD, relatives, and healthcare professionals.
• Comparative analysis of perceptions regarding LTCI and dementia care.

Main Results:

• Persons with AD reported stigmatized self-images, while relatives and professionals did not share these views.
• Welfare stigma was not evident in how relatives and professionals viewed individuals with dementia or LTCI.
• Treatment stigma was predominantly linked to the eligibility determination processes for LTCI.

Conclusions:

• Mandated, universal LTCI can still generate welfare stigma.
• Implementation processes, particularly eligibility determination, contribute significantly to treatment stigma.
• Addressing stigma is crucial for improving access to and utilization of long-term care services for individuals with dementia.