Abstract: OBJECTIVES: Israel's National Health Law of 1994 established the rights of citizens to receive quality health services. The Law set several mechanisms for treating clients' complaints. This study examined complaint patterns and reasons, complaint channels, and knowledge regarding complaints among citizens insured by Israeli health services, with the goal of contributing to the usage of complaints as a tool for improving medical services to citizens. METHOD: The study was conducted using a telephone survey, with national probability sample of N = 1500 respondents aged 21+. FINDINGS: About 75% of respondents did not have a cause to complain over the last 12 months, 25% reported a cause to complain, but only 9.5% (143 of 1500) actually complained. Approximately half of the causes for complaint concerned structural problems such as payments, waiting lists or eligibility. Causes regarding processes and interactions, or medical treatment and its outcomes, each accounted for a quarter of causes. Most complainers, about 75%, submitted their grievances informally at the local level. Only a minority (17%) appealed to official bodies established by Israel's National Health Law at the Ministry of Health or at the HMOs. Clients' awareness regarding rights to complain was found to be low. CONCLUSIONS: There is a need to improve clients' knowledge and change complaint patterns, develop means for analyzing existing knowledge about client complaints already available to front-line employees. Furthermore, there is a need to plan organizational mechanisms for capturing and using future complaints submitted on a local level or informally, which are the bulk of the complaints.

Abstract: OBJECTIVE: To examine the prevalence of informal complaints on health services among clients of Health Maintenance Organizations, and explore demographic correlates. Such complaints are a potentially important source of information regarding quality of healthcare. METHOD: Primary data were collected by a phone survey from a nationwide random sample of 1500 persons aged 21+ in Israel. RESULTS: About 25% of the respondents reported a cause to complain, but only 9.5% actually complained. About 75% of the complainants submitted their grievances informally at the local level. Only a minority (17%) appealed to official bodies established by law. Minority groups and recent immigrants had significantly lower rates of reasons to complain and actual complaints. CONCLUSIONS: Suggestions are made for outreach efforts to socially vulnerable groups and for developing organizational mechanisms for capturing and using future complaints submitted informally to front-line employees, which are the bulk of the complaints. Further research is needed regarding factors affecting customers complaining and non-complaining behavior, including factors that specifically affect the behavior of minority groups.

Abstract: The duty of a guardian is to protect a patient who is unable to care for himself or herself. Guardianship has been considered an abrogation of autonomy while conversely it often prevents irreversible harm to the patient. We examined the decision-making process for appointing a guardian in 60 cases from one mental health center in Israel, by examining the patients' medical records and court appeals. The results of our study suggest that guardians are usually appointed only in extreme cases, though alternative solutions are rarely sought, and that clear criteria for physicians when recommending guardianship are lacking.

Abstract: Films often portray the complexities of real-life aging issues, showing how they are apparently handled outside of and around the law or legal issues. Furthermore, films considering the aged and the social issues associated with aging also reveal how the law actually functions as a framework around and within which people develop customs, habits, and behaviors related to the issue of old age. Exposing these hidden socio-legal boundaries allows us to better understand both the films concerned and the place of law within our aging society. In an attempt to better understand these issues, this article deconstructs five relatively modern and well-known films. All feature aged protagonists, and all tell their stories against a background of legal issues that are only alluded to, and remain hidden "behind the scenes." Two main questions are addressed by this analysis: First, to what extent does the reality of old age as described in the films considered here reflect familiar social phenomena identified by empirical studies? And, second, to what extent does the legal infrastructure embedded in the narrative of these films reflect the legal regulations that govern the aged in today's society. The conclusions that arose from the analysis of the cinematic and the legal reality expressed in the films demonstrate that the current level of discourse on major issues in social gerontology ignores the importance and relevance of law. Therefore, it behooves us to "bring the Law to the gerontological stage," where the current situation as it actually exists can be analyzed and perhaps even changed.

Abstract: The aging of the world has led the field of law to the realization that it must respond and change in order to deal with this phenomenon. One way in which law has responded to societal aging was by adopting preventive measures in the field of elder law. The Israeli legal system is only in its initial stages of establishing and implementing preventive tools for old age. Thus, the purpose of this exploratory study was twofold: First, it looked into the knowledge about, understanding of, and actual usage of preventive legal tools in old age in Israel. Second, it compared the Israeli findings to those of a similar American study. The findings of this exploratory study indicate that overall in Israel, the actual usage of preventive legal tools in old age is low both in absolute terms and compared to the American rates. Another important finding is the significant gap between the knowledge about preventive legal tools and their actual use by older adults. The findings suggest that Israel and other countries that are in their initial stages of developing preventive laws for older persons should consider broader socio-legal issues than the mere enactment of preventive legislation.

Abstract: The choice of the old and terminally ill to die at home has been the subject of various types of research. However, one of the aspects of this subject, which has been investigated very little, is its legal context. The absence of such legal research is contrasted by the vast amount of academic writing on the legal aspects of the right to die with dignity and euthanasia. The object of this article is to analyze and break down the "right to die at home" into its different legal components. This legal analysis will be based on Professor Isaiah Berlin's definition of two different concepts of liberty: negative and positive freedoms. The main conclusion from the legal analysis presented in this article is that it is important to understand that at the legal level the right to die at home is dependent on many different elements. These elements may be classed in two basic categories: negative and positive freedoms and rights. Even though the former is a necessary condition of the latter, without the latter the first remains purely theoretical for many old people.

Abstract: Historically, the frail elderly, as well as other vulnerable populations who are unable to care for themselves, have been subject to legal proceedings known as guardianships. Despite changes and reforms, adult guardianship law has survived as a fundamental legal institution aimed at protecting the frail elderly as well as other incompetent adults. However, very little is known on the reality of adult guardianship under Israeli law, and the experience of the adult population under guardianship was never empirically studied in Israel. The empirical void regarding the workings of the Israeli law in this area served as the impetus for this study. The study investigated the issue of adult and elder guardianship in Israel as revealed in Family Law Courts' rulings, while focusing in particular on the profile of the wards, the reasons and motives, the legal procedure, and the outcome of the guardianship process. The study was a quantitative analysis, based on a random sample that included 523 court cases requesting legal guardianship for adults due to impaired legal competence. Rulings on these cases were provided in Family Courts from Haifa, Nazareth, and the Krayot areas in the period of the years 2000-2002. A clear but somber picture emerges from the findings of this study: Every year thousands of elderly individuals are subjected to the plenary legal authority of guardians appointed by law. This severe legal outcome takes place without providing these elderly the right to express their positions, without the provision of legal representation, and without their being seen or heard by the courts. These findings lead to the conclusion that there is urgent need in Israel to carry out extensive reform in the realm of civil legislation on the issue of guardianship for adults and the elderly.

Abstract: This paper describes current problems in Israel in the fields of geriatric medicine and elder law. The background to the problems is discussed, with a commentary on the deficiencies in everyday practice. The author presents proposals for change both in the legislative system and in application of acceptable standards of medical care and practical use of improved legal provision.