Maccabi is the second largest HMO in Israel, covering about 2 million beneficiaries (25% of market share). It operates both as an insurer of its members, and as their care provider. It is a community based healthcare provider that provides most of the care in the community. Maccabi operates primary care General Practitioners, as well as secondary, and healthcare professionals, including nurses, social workers, physiotherapists, psychologists, speech therapists and occupational therapists. In addition to the community clinics, we have an extensive network of institutes and clinics providing specialized treatment in all major medical fields, as well as the largest network of private hospitals in Israel and a chain of pharmacies.
Maccabi fund also owns private, for-profit daughter companies: Maccabident- dental clinics, Maccabi enterprises- optometry and doctors clinics, Nevet- R&D company, Bait Balev- elderly homes and rehabilitation and Maccabi-Tivi- alternative care.
The geriatric services for our 150,000 members aged 65+ include multidisciplinary medical home care, comprehensive geriatric assessment and health promotion and prevention. Maccabi has developed strategies and services for treatment of the elderly population that are provided to the CI and dementia patients to ensure comprehensive multidisciplinary care.
Diagnosis Procedure in Maccabi
There are several pathways Maccabi is using for identifying and diagnosing patients with MCI and Dementia:
- Early screening in Maccabi
- Since the Maccabi information systems are fully computerized, the patients’ Electronic Health Record (EHR) are scanned for existence risk factors for MCI. The system identifies the population according to specific criteria and the patients are proactively invited for assessment.
- Early screening is also performed under the 75th birthday visit program, inviting every patient turning 75 for a visit with the General Practitioner (GP) for cognitive assessment, mental assessment of depression, functional assessment, stress testing, motor evaluation, nutritional assessment and assessment of caregiver burden.
- The Maccabi information systems include referrals to free and accessible to all, online websites offering self-diagnosis and self-exercise.
- Additional channels for early detection are self-report and family-report.
- Diagnosing MCI and Dementia in Maccabi
- Individual diagnosis is performed by an occupational therapist and/or geriatric service, nurses, home care units.
- Related depression may also be diagnosed by a social worker.
Care pathways for patients with MCI and Dementia in Maccabi
- Maccabi has an extensive set of professionals with expertise in treatment of the elderly. Every district employs a psychogeriatrician (MD). In addition, there exists a diversified geriatric array which includes multidisciplinary geriatric clinics, advisory geriatric clinics, portable geriatric clinics and virtual geriatric consultation services. Any healthcare professional may confer with the above units.
- Every district manages small therapy groups and workshops for MCI patients guided by occupational therapists and social workers, offering cognitive training that will equip the elder with proven strategies for fostering executive functions, enhance memory and conceptualization by means of changing the order of execution of given tasks, self-operating of several sensory channels while performing tasks, dividing tasks to mini-tasks to fit the attention span, avoiding automatic activities as much as possible and so on. A good example could be a task like prioritizing items in his grocery list based on his/her home inventory or scheduling his/her regular medications along the week in a shape of a colorful puzzle or crossword. These workshops also serve as a mean for reducing social isolation of the older, increasing their social interaction and involvement in the society by encouraging them seamlessly to participate in various activities (cognitive and physical tournaments, social activities like lecturers given by healthcare professional regarding health ageing, charity events etc.), thus contributing directly to their mental wellbeing.
- Dementia patients may suffer an assortment of psychological disturbances such as delusions, agitation, aggressiveness, severe disturbances in the sleep-wake cycle, impaired judgment, depression, anxiety and more. Alongside drug and medication treatment, Maccabi offers behavioral treatment in form of cognitive and environment intervention adapted for Dementia patients supplemented by providing individually suited interventions which cause pleasure such as music therapy or touch therapy. Sleep disturbances are one of the most common disturbances in dementia, and are also professionally assessed. Treatment of sleep disturbances must be multidisciplinary and initially includes non-drug intervention, such as exposure to light, physical exercise and activities directed at sleep hygiene.
- Maccabi operates an array of social workers who assist the family to have the knowledge about their rights and communicate with the provider.
- Homebound elderly (but not only) are treated by homecare multidisciplinary teams with all the relevant professionals in order to support the care at home and support the family.
Support for MCI and Dementia caregivers and family
A program intended for carers is comprised of:
- Specialized support groups which offers assistance and relief for family members caring for the patients.
- A proactive web center which initiates contact with the primary carer providing information on preventative medicine health promotion.