Israel has not built a coordinated national response to its aging population, despite more than a decade of government decisions identifying the issue as a strategic socioeconomic challenge, State Comptroller Matanyahu Englman warned in a special report on Sunday.
The report examines whether Israel is prepared for a growing number of older citizens who will need pensions, healthcare, long-term care, welfare services, and support navigating retirement. It found gaps across all of those areas, while the number of Israelis aged 65 and over is expected to rise from about 1.3 million today to two million by 2050.
“Aging of the population is one of the central challenges facing the State of Israel,” Englman said. “Providing an appropriate response to the elderly population is a moral and value-based obligation.”
He said the audit showed “a large gap between governmental recognition of the importance of the challenge and action.”
The report found that responsibility for older Israelis is divided among the Health Ministry, Welfare Ministry, Social Equality Ministry, health funds, and National Insurance Institute (NII), but no single body has the authority, budget, or responsibility to ensure that they work together.
The comptroller found that Israel has no funded multi-year national plan on aging, no empowered coordinating body, and few measurable targets.
Israel needs better plan to deal with elderly people, comptroller says
Although the government identified aging as a major long-term challenge in 2015, none of the four central policy goals reviewed by the comptroller was fully implemented. Those included keeping NII financially stable, adapting retirement policy to longer life expectancy, increasing employment among older Israelis, and expanding geriatric medical care.
About 70% of government bodies dealing with aging said cooperation between relevant institutions was only moderate or worse, while 90% said information-sharing was inadequate.
Englman recommended that the Prime Minister’s Office, Health Ministry, Welfare Ministry, Social Equality Ministry, and NII create a funded multi-year plan. He said it should appoint a coordinating authority, set measurable targets, define each body’s responsibilities, improve information-sharing, and create a unified budget.
The report’s sharpest warning concerns the long-term care system. NII provides benefits to older Israelis who need help with daily tasks such as bathing, dressing, eating, moving around the home, or personal hygiene. The aid can be given through home-care hours, services, or direct cash payments.
Annual NII spending on long-term care rose from NIS 7 billion before the 2018 reform to NIS 21b. in 2025. The number of recipients rose from about 180,000 to 392,000, while the share of retirement-age Israelis receiving the benefit increased from about 16% to 30%.
Englman said the reform damaged NII’s long-term financial stability. “This brought forward the year the fund will be depleted by more than six years, to 2035,” he said.
This does not mean that NII would stop operating in 2035, rather, the report explains that NII’s reserve fund is projected to run out that year - meaning it would require additional state financing to meet all of its legal obligations.
Yet despite that forecast, the socioeconomic cabinet did not discuss NII’s long-term financial stability in recent years, the report said.
The comptroller recommended that any major expansion of benefits be accompanied by an actuarial analysis - an assessment of whether the system can afford those commitments over time.
He also criticized the way NII decides who qualifies for long-term care benefits and how much assistance they receive.
How does NII handle eligibility?
Eligibility is based on dependency assessments, which measure the extent of help an elderly person needs in daily life. The report said Israel is the only OECD country that systematically conducts these assessments without face-to-face meetings, with only about 1% of them conducted in person at the person’s home.
Applications assessed through medical documents were approved at a rate 16 percentage points higher than those assessed through in-person visits, the report found.
In a comparison with one health fund, National Insurance assigned care levels an average of 1.7 levels higher. The comptroller estimated that this could create NIS 9.5b. in additional annual costs.
He recommended limiting document-based assessments to repeat applications or clearly severe cases, instead of using them routinely.
The report also found weak oversight of cash benefits and family members employed as caregivers. As more recipients receive money directly rather than services, Englman said NII does not conduct annual home monitoring for all of them and has not set a clear supervision procedure for family caregivers.
“The report further shows that following the reform, more elderly people receive cash benefits, but NII does not conduct annual monitoring in the homes of all recipients of the cash benefit,” Englman said. He recommended regular home visits and stronger supervision of care companies and family caregivers.
The report also warned that geriatric healthcare capacity has not kept pace with demand. The number of geriatric hospital beds per 1,000 Israelis aged 75 and over fell by 16% between 2020 and 2023, while the number of geriatricians barely changed.
The Health Ministry has adopted healthy aging programs but has not converted them into a funded, long-term plan with measurable targets, the report found. Englman recommended expanding preventive care and setting staffing and hospital-capacity goals.
On retirement and welfare, the comptroller found that Israel has no formal policy to prepare citizens for retirement, even though retirement can affect income, health, housing, social ties, and independence.
About 77% of respondents aged 60 to 75 said they had not participated in retirement preparation.
“Today, Israel has no organized government policy for preparing citizens for retirement,” Englman said. “The rate of older citizens employed after retirement age is low and will not allow the government’s targets to be achieved.”
Employment among Israelis aged 67 to 74 stood at 22.3% for women and 35.4% for men in 2025, and the comptroller said current trends suggest Israel will miss its 2030 targets.