OVERVIEW OF DEMENTIA CARE IN JAPAN

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OVERVIEW OF DEMENTIA CARE IN JAPAN
Shivani Nandi, Ph.D.
Acknowledgements 1. Dr. Magda Tsolaki for
opportunity to speak at the National Alzheimer
Conference of Greece, 2007 2. Dr. Miyake Yoshio
for information on activities of Alzheimer
Association Japan (AAJ)
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Demographic change of elderly people with
dementia by year
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Summarizing 2.5 decades of change
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Summarizing 2.5 decades of change
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Activities of AAJ

• Meeting of family caregivers
• Helpline
• Monthly Newsletter
• Conducting surveys

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Activities of AAJ (contd)

• Annual conference
• Awareness campaign
• including World Alzheimer
• Day
• Requests to government
• International activities
• Publication of survey reports etc

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What is the Long Term Care Insurance (LTCI)?

• LTCI for frail elderly is a social care system
• introduced by the Japanese Ministry of Health
  Labour and Welfare in April 2000
• incorporates Alzheimers Disease and other
  dementia in the group of special age-related
  illnesses that allows the insured person to
  claim benefits
• benefits not in cash but in form of
  institutional or community-based services
• 10 percent co-payment
• Alzheimers disease is beginning to receive
  legitimacy as a disease.

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Public Long Term Care Insurance System (LTCI)

• ? Established in April 2000.
• ? Insurer the municipalities
• ? Insured people aged 40 and above
• ? Eligible
• - Persons aged 65 or older in need of care or
  support
• - Persons aged 40 to 64 participating in medical
  insurance, in need of care or support due to
  age-related diseases such as presenile dementia
  or cerebrovascular disorders, etc

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Problems with the LTCI

• Unreliable software to evaluate minimum data set
• used for the 1st stage computer evaluation
• - tends to under-evaluate dementia
• The LTCI is difficult to understand and the
  eligibility
• requirements are unclear
• In the first year since its introduction, demand
  for the
• services was lower that anticipated
• Service is inconsistent and potential users
  hesitate to openly
• use services

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Problems with the LTCI (Contd)

• Recent information shows many eligible elderly do
  not even apply
• Find the application process overwhelming
• Unable to afford the co-pay
• Would rather continue to provide care themselves
  rather than troubling others (resulted in some
  tragic incidents of mercy killing and suicide in
  the past year)

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LTCI monthly benefit for home care
Higher benefits set for institutional care
Matsuda, S. Jour of Integrated Care, Vol 1 2001
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Changes at a social level
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Changes at a social level
1. Establishment of Group Homes (Recognized by
the LTCI) Emphasis on a new philosophy in care
for people with dementia General consensus to
move away from Traditional Long Term Care
Institutions (TLCs) to community level care,
informal, personalized care . Dissatisfaction
with existing long-term care facilities
2. Establishment of three Dementia Research and
Training Centers Diffusion of knowledge and
training
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Group homes are clusters or small dwellings of
6-8 residents sharing common premises in a
neighborhood
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Group homes or Takurosho are located within the
community like a house next door with
residents who have very special needs...
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Lack of a Rigid Routine

• Distinguishing features of Group
• Homes from LTC facilities
• small-size
• personalized care
• home-like setting
• encourage participation of residents
• NO RIGID ROUTINE

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Emphasize and protect dignity of the individual

• Nature of care
• Supervisory but not
• custodial,
• encouraging but not enforcing.
• emphasis on ones personhood
• Plenty of communication with the PWD
• Recently, attempt to introduce validation
  method of care
• ("validate" or accept the values, beliefs and
  "Reality" of the dementia person
• even if it has no basis in your reality )

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Family members encouraged to participate in
special events. This gathering celebrates the
third anniversary of the establishment of the
Group Home Aobadai in Yokohama with family
members. In some group homes, neighbours and
school children visit freely and interact with
the residents.

• Residents encouraged to occupy them-
• selves in housegiving tasks.
• increases sense of worth and
• stimulates latent capacities

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The resident to the right occupies herself with a
doll which to her now is the baby she lost in
her youth. The staff know the histories of each
resident and provide the emotional support to
live in the past
21

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About problem behaviour
When elderly with dementia wander around the
house, someone provides companionship.
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Group homes as a different and ideal care model
for people with dementia
Findings show less need for medication for
residents, less incontinence and less
disorientation
1. Malmberg, B. Steven, H. Z. "Group homes for
people with dementia a Swedish example", The
Gerontologist, vol. 33, no 5, pp 682-686, October
1993 Johansson, Lennarth. (1990). "Group
Dwellings for the Demented Patients - A New Care
Alternative." Ageing International, no.1635-37
2. Judd, S Marshall, M. Phippen, P. Design
for dementia Published by Journal of Dementia
care, London, 1998 Middleboe, T. "Prospective
study of clinical and social outcome of stay in
small group homes for people with mental
illness", British Journal of Psychiatry,
Vol.171, No. 9, 1997.
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Effect of group home environment on staff members
Results show increased knowledge and new
emotional and social attitudes, resulting in
higher competence and professional conduct
towards patients as well as increased
motivation, job satisfaction and quality of work
for GL (group living) staff but not for TI
(traditional insitution) staff.
Lena Annerstedt, Betty Bauer Alferdson, Staff
attitudes and job satisfaction in the care of
demented elderly people group living compared
with long-term careinstitutions IN On
Group-Living Care for the Demented Elderly, Lena
Annerstedt. Lund, 1995
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Group Home Fureai no Ie
toilet
Bed Room
Entrance
toilet
Bed Room
Dining room
Bed Room
Living Room
Bed Room
Bed Room
Total residents 7 Rooms Single 8, 6, 6,
Tatami Twin 10, 12 Tatami
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Room and service charges
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Some findings

• Deterioration in the levels of LTC need in
  non-profit group homes is significantly smaller
  than in for-profit group homes
• Findings show that profit providers supply a
  better quality of service than for-profit group
  homes
• One report says that 45 of surveyed group homes
  are
• willing to provide terminal care in future

Morozumi, R. Ownership and quality of care
provided A case study of Japanese Group homes
for the elderly with dementia http//keiken8.kier.
kyoto-u.ac.jp/arigagroup/HEC/2005/HEC2005_morozum
i.pdf
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Reforms to LTCI

• Instituting support services focused on
  prevention to improve physical exercise,
  nutrition etc for elderly expected to require LTC
• Charging partial cost of accommodation and meal
  service for facility users who had been covered
  by LTCI benefits
• Creating a flexible, community-based,
  small-scale in-home and facility-based care
  system.
• MHLW expects above reforms to help reduce the
  total cost of Long-term Care Insurance from 19
  trillion Yen to 16 trillion Yen

International Longevity Institute Archives
http//www.ilcjapan.org/english.html