On Dulberg, Internal and Geriatric Medicine Specialist, Medical Director of the “Vera House” nursing home at the Vera Solomons Center and Senior Physician in
the Geriatric Medicine Array at the Meir University Medical Center, Kfar Saba, Israel. Responsible for implementing the principles of palliative medicine in hospitals and has been recently working to integrate such principles within the adult population in the community and institutions.


In Israel, as in other western countries, life expectancy increases. As a result, the number of people suffering from chronic illnesses and conditions causing physical and emotional suffering growing up. Also, there is a steady rise in the number of people requiring assistance with basic Activities of Daily Living (ADL) and the number of people living in long term institutions and nursing home. Although nursing homes can be ideal facilities for supportive care, most of them do not operate upon the principles of palliative care and yet, most end-stage patients are referred to die in hospitals. In Israel, Palliative care is based on the laws of the State of Israel: Governmental Health care Insurance (1995) and the Dying Patient Law (2005). These laws enable a person with an incurable disease, for whom doctors have determined a life expectancy of less than six months, to request the avoidance of treatment that could extend their lives and suffering. Hospitals, health care providers and nursing homes committed to provide palliative care services. Despite such advanced laws, most patients are not actually provided the palliative treatment required.
Objective: Integrating principles of the palliative approach in a nursing home.
Secondary Objective: Reducing end-of-life referrals to emergency rooms and hospitals.
Methods: Integrating the palliative approach in nursing home, including: encouraging to fulfil Preliminary instructions and powers of attorney, training doctors, nurses and multidisciplinary team how to provide palliative care, Balancing symptoms and how to deal with end-of-life situations.
Results: Significant decline in emergency room and hospital referrals: 35% decline in hospital referrals within 4 years. Dramatic decline in hospital death rates and increase in the number of patients dying in the nursing home.
Conclusion: Despite the many challenges of providing palliative care in nursing homes, the process can be implemented in order to reduce suffering, increase patient, staff and family awareness, and significantly reduce unnecessary emergency room and hospital referrals.
Recent Publications:
  1. Recommendations for a National Plan for Palliative Care and End-of-Life Situations, Joint Israel, Eshel, Ministry of Health 2016.
  2. (Long Term Population Forecast in Israel 2009-2059: Technical Publication by the Central Bureau of Statistics, 2014)
  3. Bentur, N., Emanuel, L.L., Cherney, N., 2012.  “Progress in Palliative Care in Israel: Comparative Mapping and Next Steps”.  Isr J Health Pol Res 1(9):10.1186.

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