Dementia care in Japan - independence and choice

Pioneering dementia care in Japan has found a way to not only deliver care that has respect at its heart, but to pay for it too in an equitable way.

Japanese craft made by people with dementia

I saw some truly unforgettable sights in my recent trip to Japan; the sun setting at the Kiyomizu-dera temple, masses of people crossing the world's busiest crossing at Tokyo (a la Lost in Translation), a traditional kabuki performance. However amazing, the one thing stands out above the rest was viewing a group of people living with dementia giving it their all in a group karaoke session. Even if pitch and tone may not have been perfect, it was the joy and togetherness in the room that struck me as remarkable.

Karaoke was just one of the pursuits on offer at Yumeno Mizuumi Muna, one of the care settings I visited on the outskirts of Tokyo, as part of an information-swapping trip to Japan, our partners in a global approach to tackling dementia through our respective governments.

Respect for individuality and freedom

Around 80 people attend the day sessions at the centre. Independence and choice are absolutely key here. There is no 'one size fits all' approach to activities. People, most living with dementia, and others with disabilities, put their own agenda together for the day, selecting activities upon arrival, which have a bar code attached so everyone knows who is doing what at any given point.

 Vivienne in Japan

From woodwork to baking to watching samurai movies, everyone does their own thing. Staff are present, but not obtrusive. This is very much about a fiercely guarded respect for individuality and freedom, regardless of a person's dementia.

Also subtle are the ways in which staff keep a track on people's cognitive capacity, and any progression in a person's dementia. People help with tasks such as matching chopsticks ready for the next day, and any difficulty is subtly noted.

Residential care in Japan

As well as day care services, the centre also offers some short and longer term residential care. Each room is, again, individual and made to feel like home. This care - which I am told is pioneering and seen as the way forward in Japan - is paid for through long term care insurance. The system is part funded by by compulsory premiums for all those over the age of 40, and part-funded by national and local taxation.

'Co-payments' of around 10 per cent, are paid by everyone receiving care. Given the ticking time bomb that is the cost of social care here, and the drain on family resources that can kick in at the same time as diagnosis, it seems the Japanese have found a way to not only deliver care that has respect at its heart, but to pay for it too in an equitable way. The poorest people receive the care they need, and those with greater funds pay higher co-payments.

'Creating happiness' for people with dementia

The happiness at the centre was palpable, and that wasn't a one off. With my host, Hiroko Sugawara, of the National Caravan-Mate Coordinating Committee, Japan's version of Dementia Friends, and interpreter Midori, we then headed off to the Noto Community Care Centre, whose approach is to 'create happiness' and enable people to live well. Here there is also a mix of day and residential care. Residents live in groups of nine. One woman took me to see her room, proudly pointing out the elements that showed her individuality.

 Japan dementia

As I watched people chatting or embroidering together, there was a real sense of contentment. This, I was advised, is how the success of the care provided is assessed.

Dementia Friends in Japan

The next day, the learning continued, as we shared information on Dementia Friends, as well as the Caravan Mates movement it was inspired by. I presented a Dementia Friends session to 500 people at a conference and awards ceremony, which, was well received. We then had a great question and answer session on approaches, and the cultural differences which underpin these.

There is much less interactivity in the Japanese model, and more of an emphasis on learning about dementia. Whatever the differences, we agreed that any movement that has inspired millions of people here and in Japan to learn more about dementia, and to act, is remarkable to see, and that there is a lot we can learn from each other.

Greater understanding is one thing, action is quite another. I was privileged to watch the awards ceremony, which rewarded dedication to building dementia friendly communities. People had travelled from across Japan to share their innovations, which ranged from engaging university students in finding people with dementia who had become lost to dementia cafes and a fire station working hand in hand with the police in a groundbreaking partnership. They were people of all ages and backgrounds; people with a shared purpose to create communities in which people affected by dementia could fully participate, built upon a principle of respect for everyone. That is an inspiring sight.

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My name is Clare Jones, I am a British Senior Occupational Therapist and Positive Approach to Care Certified Trainer who has been working with people living with dementia, at all stages of their journey, for over 25 years.

The reason I am writing to you is because I have applied for the Winston Churchill Memorial Travelling Fellowship Grant which would enable me to spend a total of 8 weeks learning about the services and support that are provided to people living with dementia and their care givers in other parts of the world.

I am particularly interested in the developments that are taking place in Japan in relation to

a) meaningful activities -eg: the Yumeno Mizuumi Muna day care service set up by an Occupational Therapist

b) support for carers , service providers and local businesses, aiming to develop knowledge, skills and competency in communicating and helping someone with dementia to live as well as possible, whether they are at home, out and about in their local community, or within a care home setting. I would love to meet with someone from the National Caravan mate service and the Ninchisho Supporter Programme or the Lemon Company.

I would love to get in touch with the lady who posted about her trip to Japan (14/2/2017) to ask more about her experiences.

Looking forward to your response, kind regards Clare

Hi Claire, thanks so much for your lovely comment. If you could email our international team at [email protected] they'll be able to help you out more with this!

Hello, I have a client with dementia she is an 88 year old Japanese woman who resides at home with our care. I work one on one with her and am seeking information about unique and stimulating ideas to try with her that align with her Japanese heritage and culture that would give her a sense of enjoyment, meaning and purpose. Can you assist me with any ideas or suggestions. I would be extremely grateful! Thank you, Rose Strieter, Senior Home Care/Alzheimer's Solutions

Thank you for getting in touch, Rose.

Initially, we’d suggest creating a 'life history'. This would help to learn more about the person, their background and their interests. Often this can be done with help from family and friends, as well as the individual, depending on their ability to communicate and answer questions, as well as their willingness to do this. There are various formats this could be recorded in.

Take care not to make assumptions – appropriate activities can be found once more is known about how long someone has been in the UK, what lifestyle they are used to, and what their values and beliefs, likes and dislikes are.

Reminiscence activities based on this person’s life history can also bring comfort and pleasure.

Meaningful activities can then be introduced around themes that are likely to trigger communication or memories. So perhaps cultural activities to mark traditions, festivals and appropriate photographs, music, maybe physical objects such as clothing, musical instruments, sensory activities can be introduced.

Look out for references to travel shows about Japan (or videos on YouTube) that may feature specific places, traditions or music that this person might respond well to.

There are activity books and online resources that suggest how to create memory boxes, introduce arts and crafts or food preparation.

There may be local places to visit or other visual activities such as films which might stimulate or entertain. This is also dependent on the person’s language and physical capabilities.

There is an Alzheimer’s Association in Japan that may be able to provide further ideas for resources. (Please note that not everything is easily accessible in English). Here are the details:

Alzheimer's Association Japan
c/o Kyoto Social Welfare Hall
Horikawa-Marutamachi, Kamigyo-Ku
Kyoto
Japan 602-8143
Tel: +81 75 811 8195
Fax: +81 75 811 8188
Email: [email protected]
Web: www.alzheimer.or.jp

Organisations in the UK, such as the Japan Foundation and the Japanese Society, may have events/publications that provide ideas:
The Japan Society
13/14 Cornwall Terrace
London NW1 4QP

The following report provides background reading about dementia care in Japan:
'Reminiscence and arts for older people in Japan and how Japan cares for its growing number of people with Dementia' - Pam Schweitzer, 2017
Read it here: https://www.wcmt.org.uk/sites/default/files/report-documents/Schweitzer…

We hope this is useful.

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