Neglect, Ltd: Inside Israeli Hostels for People With Disabilities

A series of joint investigative reports by Shomrim and Kan, Israel’s public broadcaster, reveals the goings-on in hostels for people with disabilities in Israel. The physical and emotional violence, the hidden camera that captured images of neglect and maltreatment and the helplessness of the Welfare Ministry, which is supposed to oversee these hostels but does nothing

A series of joint investigative reports by Shomrim and Kan, Israel’s public broadcaster, reveals the goings-on in hostels for people with disabilities in Israel. The physical and emotional violence, the hidden camera that captured images of neglect and maltreatment and the helplessness of the Welfare Ministry, which is supposed to oversee these hostels but does nothing

A series of joint investigative reports by Shomrim and Kan, Israel’s public broadcaster, reveals the goings-on in hostels for people with disabilities in Israel. The physical and emotional violence, the hidden camera that captured images of neglect and maltreatment and the helplessness of the Welfare Ministry, which is supposed to oversee these hostels but does nothing

Roni Singer

Illustration: Shutterstock

July 27, 2022

Summary

Y

ael, a 28-year-old woman with Level 2 autism, has been a resident of four different shelters over the past five years. In all of them, she was subjected to violence, neglect, and mistreatment – until her family could no longer ignore the harm being done to her. After three police complaints and countless fruitless calls to the shelters and the Welfare Ministry, the family decided to put an end to the abuse, despite the heavy financial cost. They decided to rent an apartment and assume responsibility for looking after Yael. How expensive? The family quickly discovered that the generous sums of money that the state transferred to the shelters where Yael was a resident would not be available to them. Instead of the monthly sum that the government gave the shelters – which could be as high as 19,000 shekels [around $5,500], depending on the complexity of treatment – Yael was entitled to just 8,000 shekels a month [around $2,500]. The family had no choice but to pay for Yael’s monthly expenditure, which has created severe economic hardship.

“At the shelter, Yael was always dressed in rags and old clothes that had been donated,” says her sister, Roni Navon. “Our mother would buy her new clothes, but they would disappear within a couple of weeks. During the winter, when it was pouring down with rain, we were stunned when they kept sending her home in shoes made of cloth. My mother paid for her dental work, otherwise, no one would have treated her. The same thing happened when we took Yael to the gynecologist. Why is it like that? They get so much money for each resident, but they save wherever they can. As a family, we decided that we are no longer willing for Yael to suffer all this.”

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N.’s daughter has been a resident in a shelter in northern Israel since she left her previous shelter, where she was severely mistreated. N. finds it hard to choke back the tears. She feels guilty for having sent her daughter to a shelter but is unable to look after her at home. “It’s a dire situation,” she told Shomrim. “There’s not enough staff, and every time I visit, I see residents in full, wet diapers – including my daughter. Because she’s classified as “low functioning,” she is supposed to get more funding from the state, but the shelter spends the same on everyone. My daughter does not have a speech therapist, even though she should. Do you know why? They told me it was because my daughter does not talk, so what’s the point?”

Yael and N.’s daughter are not alone. Far from it. Over the past few months, Shomrim – in association with Kan public television’s “Zman Emet” investigation program – has been gathering testimony from many sources about the conduct of and the harsh daily reality in shelters and institutions for people with disabilities in Israel. These include shelters considered the best in the country, the kind that parents fight to get their children accepted into. It’s a cliché to talk about what goes in our backyards, but there is no better way to talk about what happens in the often-dilapidated buildings that are home to people with special needs.

Shomrim takes a deep dive into the problem in a series of articles. We expose the money trail that allows these institutions to rake in huge profits and to benefit from inadequate supervision. We shine a light on the endemic physical violence in these shelters and the equally harsh emotional violence we documented using hidden cameras—a chronicle of neglect and abandon.

Sisters Yael and Roni. Photo: Shomrim
"At the shelter, Yael was always dressed in rags and old clothes that had been donated," says her sister, Roni Navon. "My mother paid for her dental work, otherwise, no one would have treated her. The same thing happened when we took Yael to the gynecologist. Why is it like that? They get so much money for each resident, but they save wherever they can. As a family, we decided that we are no longer willing for Yael to suffer all this."

Where Does the Money Go?

Around 17,000 Israelis live in the 491 residential institutions for people with disabilities and special needs. This figure includes people with educational disabilities, intellectual disabilities, disabilities on the autistic spectrum – as well as special rehabilitation facilities. When it comes to intellectual disability and disabilities on the autistic spectrum, most of these people reside in shelters, some of which are small and others that house dozens of residents. Very few of them live in projects known as ‘community housing,’ which are mostly apartments for up to six people. The shelters are always full, and, according to estimates, there is a huge demand for solutions for people who need individual frameworks.

Around half of the shelters are operated by some 70 private companies, which run these welfare institutions for profit. A similar number of shelters are run by nongovernmental organizations, and just nine remain state-run. Not only do these shelters earn huge profits, but they are also only subjected to limited supervision – which, in many cases, is coordinated ahead of time – by the Welfare Ministry. When it comes to their financial conduct, these companies do not report to anyone: not the residents, not the parents and families, and – astonishingly – not even to the Welfare Ministry, which last year funded institutions and shelters for people with disabilities to the unfathomable tune of 2.1 billion shekels [more than $600 million]. In other words: even the Welfare Ministry has no idea where the money goes.

This is especially infuriating when one examines the Welfare Ministry’s budget: 50 percent of the department’s budget, which is around 9 billion shekels [around $2.6 billion], is transferred to the Disabilities Administration. Some 2.5 billion shekels [around $700 million] goes to funding residencies outside the family home – in other words, to the companies and NGOs that run welfare institutions. According to data relating to 2017 obtained by the Bizchut NGO from the Welfare Ministry, almost 90 percent of this budget was transferred to large shelters (some 1.3 billion shekels [around $400 million] to institutions and another 560 million shekels [around $165 million] to shelters), while community housing projects were given just 270 million shekels [around $80 million] in the same period.

Moran: "This situation will no longer be allowed to exist since there are already companies operating with the goal of establishing far-reaching budgetary oversight of their economic conduct – and then we’ll know more.”

Sigal Moran, Welfare Ministry Director General. Photo: Kan 11

In theory, there is a clear formula for calculating how much money each shelter receives for each resident. The government pays up to 19,000 shekels a month [around $5,500], depending on the complexity of the treatment needed. This money is supposed to cover not only all of the resident’s basic needs but also clothing, food (including any special dietary needs the residents might have), leisure and cultural activities, and anything else the residents need. “In practice,” says Na’ama Lerner, an attorney who has been actively campaigning for the rights of people with disabilities for many years, “it’s impossible to know exactly what the residents receive and do not receive. All I can tell you is that in every case I have seen until now, there is nothing but shortages.”

“Yes, unfortunately, it’s true that there’s no transparency,” is the frank admission of someone who, until recently, was a very highly placed official in the welfare service. “These suppliers [the operators of the shelters] who, as we all know, are for-profit companies, are not willing to be transparent. Do you have any idea how many times I tried to convince the Justice Ministry to obligate these suppliers to share information about their profits? I wanted these companies, for whom the government is the main client, to behave as if they were public companies and for them to publish data about how much many they have spent on what and what’s left over as profit. I was not successful.”

The director general of the Welfare Ministry, Sigal Moran, told Shomrim a similar story, admitting that the department has failed to conduct supervision and monitoring of the money that the state has given these companies. “But we’re here to change things,” she said. “This situation will no longer be allowed to exist since there are already companies operating with the goal of establishing far-reaching budgetary oversight of their economic conduct – and then we’ll know more.” Moran’s comments relate to a general process of tighter supervision that the Welfare Ministry hopes to implement.

A Routine of Neglect

Over the past few months, Shomrim has used a hidden camera and a private investigator to document the goings on at a shelter for boys with disabilities in northern Israel. The shelter and the timing were selected randomly to obtain an accurate picture of the daily routine in such places. Our camera did not record any incidents of violence or physical abuse. Instead, one sees a group of young boys and men with varying degrees of disability, wearing worn-out clothes, sitting in a small room with couches, large windows and a locked door.

They sit there for hours, get up to stretch their leg and then sit down again. The television is on a channel designed for toddlers and the residents groan, laugh, chatter, or simply stare at the wall. Some of them are drooling and they are all clearly bored. The instructors, glued to their smartphones, sit to the side. When the food arrives, each resident is given a portion; the dietician does not permit anyone to have extras, according to one instructor.

On all the days that Shomrim documented, an instructor only came once a day to take some youths out for “leisure hour,” when they would paint. The residents’ outdoor activity consisted of a walk in an enclosed yard within their residential unit. Every day that we documented was identical to all the others.

“There is something very misleading about these shelters,” says former Knesset member Stav Shaffir, who has first-hand experience with welfare institutions. Her sister, who was diagnosed with autism, resided in such shelters and she herself was involved in the issue in various ways as a member of parliament. During her tenure, she made several unannounced visits to several shelters.

“When you visit, the management will always show you a beautiful place, a villa, trees and activity with a clown. One time I went on a surprise visit and my parliamentary aide told me, ‘Stav, everything seems fine here. What is there to see?’ I replied: ‘Look around and tell me if you’d want to live here.’ It’s only then that you notice that there are no carpets, there are no handles on the doors, and the instructor tells you that they’re understaffed – so they don’t go out into the sunshine; they sit in a room. You realize that the only cultural activity they provide for adults is a clown. Why? These are grown-ups. Like us, they need to feel a sense of belonging and have activities. These institutions keep their residents at the age of 5 forever.”

Golan (not her real name), who worked as an instructor at a welfare institution in northern Israel with a good reputation, told Shomrim about the leisure activities there. “They call it an activity, but it really isn’t. Once a week, an instructor spreads cushions on the floor, puts on a video from YouTube – and they call it therapeutic activity. Once a week, a woman comes with two dogs and goes from floor to floor so the residents can pet them. That’s it. That’s all they do. I cried over being part of the lack of caring there. The cook was so disgusted by the food she prepared that she couldn’t even taste it, but the residents would have to eat it – and no one cared.”

Golan also says that “once someone had made a decision about one of the residents, the instructors would follow that decision without ever reassessing the situation or asking whether it was necessary.” In one harrowing example that she provides, an elderly resident suffered the humiliation of having his public hair shaved for many years, just because he once complained that it was irritating him. In another case, a dietician decided that another elderly resident needed 40 minutes of fast walking on a treadmill every day. “He would cry and shout that he doesn’t want to walk that fast, but no one listened and they would force him onto the treadmill. Once a decision is made, it’s set in stone and will never be changed. No one follows up to see the impact of the decision.”

A Routine of neglect, captured by Shomrim's hidden camera
Golan (not her real name), who worked as an instructor at a welfare institution: "I cried over being part of the lack of caring there. The cook was so disgusted by the food she prepared that she couldn’t even taste it, but the residents would have to eat it – and no one cared.”

Much More Than a Few Rotten Apples

Public and media interest in shelters for people with disabilities is stirred whenever an incident of violence is reported. In such cases, the institutions and the various bodies that are supposed to oversee them claim – either directly or indirectly – that it’s a case of a few rotten apples, who do not represent the care afforded by the shelter. It’s important to point out that there are institutions that do adhere to the directives and ensure that there is no violence, but Shomrim’s investigation reveals a picture that is far more complicated than a few rotten apples. Moreover, we reveal many cases of violence in many institutions. It happens because of the dangerous and flammable combination of residents with challenging behavior – who, in many cases, are unable to express themselves and explain what they are going through – and a team of caregivers who are constantly understaffed and, for the most part, earning minimum wage.

Shomrim asked the police for figures regarding assaults against people with disabilities and special needs but was told there is no such segmentation of the existing data. One possible indicator, however, can be found in a research paper published in 2017 by the Myers-JDC-Brookdale Institute, which was based on databases that only included minors. The research showed that children with intellectual disabilities or disabilities on the autistic spectrum were almost five times more likely than other children to be questioned by child investigators about incidents of abuse or neglect.

Over the past few months, Shomrim has collected many accounts of incidents of violence in welfare institutions. Time and time again, family members told of violence in even the most prestigious and sought-after institutions. The pattern repeats itself in every such account: family members find a bruise or wound during a visit to the shelter or during a resident’s time at home. They ask the institution for an explanation and are told that their loved one fell, that a door was accidentally closed on them, or that they got into a scrape with another resident. Most residents don’t talk about the incident – if they talk at all – and the family has no other explanation.

The last woman to contact Shomrim was in tears as she spoke about her son, Maor, who is in his 30s and lives in a shelter in central Israel. “He was all cut up. His face was covered in scratches. That’s after they called from the shelter and said he’d been scratched,” she says. “It wasn’t scratches, though; it was more like a slaughter. I asked the instructor to explain how it happened because Maor is nonverbal. At first, they said another resident attacked him, but their story didn’t make sense. I called the shelter director repeatedly over the past two days, but he refuses to answer.”

Assaults against people with disabilities, captured by security cameras
The pattern repeats itself in every such account: family members find a bruise or wound during a visit to the shelter or during a resident’s time at home. They ask the institution for an explanation and are told that their loved one fell, that a door was accidentally closed on them, or that they got into a scrape with another resident.

International Treaty and Legal Reform

Relatives of shelter residents have furnished Shomrim with dozens of accounts of physical violence that their loved ones experienced. Time and space prevent us from detailing all of the medical and video documentation forwarded to Shomrim, which includes broken bones, stitches, bruises, bitemarks, abrasions and other troubling evidence. The overall picture one gets from these accounts is unequivocal and deeply disturbing – and the situation is not being adequately addressed by those who have the authority to supervise these institutions, primarily the Welfare Ministry.

Many countries, including Israel, have alternatives to these institutions: independent living in a community framework, even for those with severe disabilities. “It’s a challenge, but it’s not impossible,” says Lerner. “The state is spending a lot of money on the current system and it’s time to take that money and do something a little different. For the sake of those who cannot speak and so that we can tell people with disabilities deserve a decent life.”

Welfare institutions are not inevitable. In fact, the State of Israel has signed an international convention promoting independent living for people with disabilities and community living while agreeing to close down all welfare institutions. When Isaac Herzog, now Israel’s president, served as welfare minister ten years ago, the first-ever committee to look into the issue was established. It determined that Israel should close all its welfare institutions within a decade while promoting community-based alternatives.

Lerner: “The state is spending a lot of money on the current system and it’s time to take that money and do something a little different. For the sake of those who cannot speak and so that we can tell people with disabilities deserve a decent life.”

Attorney Na’ama Lerner. Photo: Kan 11

Ten years have gone by and very little has changed. The State of Israel continues to promote the construction and growth of welfare institutions. In the last state budget, for example, 260 million shekels [around $77 million] were earmarked for the construction and expansion of existing shelters. The government also recently approved the transfer of additional 50 million shekels within five years for the establishment of a new shelter in the Negev.

The Bizchut NGO, which also works to promote community living for people with disabilities, recently sent a letter to the attorney general, arguing that “instead of closing shelters, as required by law and international law, and instead of developing a community-based alternative – the government plans on allocated resources for the expansion of residential and service-based institutions, which violates legislation, court rulings, commitments according to international conventions – and which infringes on the rights of people with disabilities to equality, to autonomy and to a life in the community.”

Over the past year, several families have joined forces in an effort to exert pressure for a policy change. Proposed legislation on the matter had been waiting on the shelf for five years before – rather unbelievably – the 24th Knesset managed to pass the Welfare Law for People with Disabilities just before it was dissolved.

While the new law is a step in the right direction, implementation will take a while. “We are working to reduce the number of frameworks because I think there’s a lot that can be done right now,” says Moran. “There is also a lot of work to be done regarding standards, quality and what the residents receive. I think that it will take around five years for us to complete the picture.”

Moran also sought to temper the spirit of this investigation. “You’re painting a very black picture and I cannot accept that everything is black. The people who work in these places do a job that isn’t easy and it’s not easy to recruit workers. It is true that the Welfare Ministry has not done enough, but we are here to change things.”

Meir Cohen, The Minister of Welfare and Social Services. Photo: Itzhak Harari, The Knesset
Responses

“We Take Any Harm to Residents Very Seriously and Have a Zero-Tolerance Policy”

Shomrim received the following response from the Ministry of Welfare and Social Affairs: “We take any harm to residents of shelters for people with disabilities very seriously and we have a zero-tolerance policy toward such incidents. Over the past year, the ministry has taken measures against operators who failed to meet the terms of their contracts and the requisite level of quality expected of them – including ending some contracts.

“At the same time, the ministry has taken a series of measures to tighten supervision of these shelters: we have tightened our oversight of working hours and changed the instructions to allow the use of cameras to prevent any harm to residents. These new instructions also allow inspectors to halt placements and impose additional economic sanctions against shelters that violate the terms of their contracts.

“At the same time, the ministry has started to conduct financial inspections of the residential frameworks to ensure that every such institution meets the terms of its contract. In addition, we have set up a hotline for the families of people with disabilities and we urge them to contact us to report any incidence of harm. A public committee headed by Shulamit Dotan, the former president of the Magistrate’s Court, is currently examining all of the residential frameworks for people with disabilities and is expected to submit its findings in the next few months.

“Following intense work over the past year, the Knesset approved the Welfare Law for People with Disabilities, which will kickstart a transition process from shelters to independent housing in the community, with a network of support services. Implementing this law will significantly promote the inclusion of people with disabilities in every aspect of life and put Israel on an equal footing with the most progressive countries in the world.”

The Justice Ministry submitted the following response: “Commercial companies, unlike a nonprofit organization, are not obligated to submit financial statements (with the exception of balance sheets in certain circumstances) and file basic reports to the Registrar of Companies. There is, therefore, no supervision or inspection of proper management, as there is for NGOs and public-service organizations that do are not-for-profit companies.

“A government department that wants to enter into a contract with a supplier and which requires information and continuous reports from the company, including financial statements, can include such demands in the contract (the funding is transferred from the state and is certainly entitled to include these demands and to ensure that the funds provided by the state are used correctly). Moreover, the ministry can insist that the supplier become an NGO or a public-service company as a condition of signing the contract.”

This is a summary of shomrim's story published in Hebrew.
To read the full story click here.