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Keywords:

  • community care;
  • dementia;
  • long-term care;
  • medical care

Abstract

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. FUTURE BASIC POLICY FOR PERSONS WITH DEMENTIA
  5. CONCRETE CONTENTS OF MEASURES FOR PEOPLE WITH DEMENTIA
  6. BUDGET IN 2009
  7. THE 2009 REVISION OF THE FEE SCHEDULE OF THE LONG-TERM CARE INSURANCE SERVICES
  8. CONCLUSION
  9. ACKNOWLEDGEMENTS

In May 2008, the Japanese government launched the ‘Emergency Project for Improvement of Medical Care and Quality of Life for People with Dementia’ under the idea that it is necessary to build a society, without delay, where people can live life safely without anxiety even after being affected by dementia, where they can be supported by appropriate and integrated services of medical care, long-term care and community care. We would like to introduce our future dementia policy standing on the outcome of this project, which was published as a report on 10 July 2008. The measures for people with dementia in Japan have gradually achieved good results. For example, public understanding and awareness of dementia has increased through renaming the term for dementia in Japanese from ‘Chiho’ to ‘Ninchi-sho’ in 2004, and the comprehensive care system was founded focusing on the importance of providing community based long-term care while maintaining the person's familiar human relationships and residential circumstances. However, case reports show that there are yet some cases that fail to deliver appropriate treatment or long-term care service as a result of a lack of timely definite diagnosis in an early stage or a lack of coordination between medical care and long-term care. Therefore, the future dementia policy should be designed by envisaging the flow of the measures that would support the life of the person and his/her family, and improve their quality of life; starting with measures that link early notice of the patient, his/her family or neighbor to early diagnosis, and then measures to develop well-designed comprehensive care planning that provides appropriate medical and long-term care services through good coordination, while promoting research and development of diagnosis/treatment technology. In addition, in regard to early-onset dementia, comprehensive self-support measures including employment assistance should be promoted.


INTRODUCTION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. FUTURE BASIC POLICY FOR PERSONS WITH DEMENTIA
  5. CONCRETE CONTENTS OF MEASURES FOR PEOPLE WITH DEMENTIA
  6. BUDGET IN 2009
  7. THE 2009 REVISION OF THE FEE SCHEDULE OF THE LONG-TERM CARE INSURANCE SERVICES
  8. CONCLUSION
  9. ACKNOWLEDGEMENTS

In 2004, ‘Chiho’, which had been used as a word meaning dementia in Japanese, was changed to ‘Ninchi-sho’, leading to the ‘10-year Plan to Understand Dementia and Build Community Networks’. Public understanding of dementia has advanced steadily over the past several years and support for people with dementia and their families has also advanced through building a community care system and base arrangements for long-term care services, including the introduction of a community based service, such as group homes for people with dementia.

Following these changes, the Minister of Health, Labour and Welfare launched the ‘Emergency Project for Improvement of Medical Care and Quality of Life for People with Dementia’ to promote a cross-sector review within the ministry on research and development, medical care, long-term care, and support for people with dementia and their families. The underlying idea of this project was that it is necessary to build a society without delay, where people can live life safely without anxiety even after being affected by dementia, where they can be supported by promoting measures for dementia more effectively and providing appropriate and integrated services of medical care, long-term care and community care. The achievement of the project has been summarized in a report published on 10 July 2008.

The present study introduces Japan's future dementia policy based on this report and will also overview the budget, and the revision of the fee schedule of the long-term care insurance services in 2009.

FUTURE BASIC POLICY FOR PERSONS WITH DEMENTIA

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. FUTURE BASIC POLICY FOR PERSONS WITH DEMENTIA
  5. CONCRETE CONTENTS OF MEASURES FOR PEOPLE WITH DEMENTIA
  6. BUDGET IN 2009
  7. THE 2009 REVISION OF THE FEE SCHEDULE OF THE LONG-TERM CARE INSURANCE SERVICES
  8. CONCLUSION
  9. ACKNOWLEDGEMENTS

The previous measures for people with dementia in Japan have focused on the provision of long-term care services. Providing community based long-term care focusing on the importance of maintaining the person's familiar human relationships and residential circumstances has contributed to the spread of dementia care and has gradually achieved good results. In contrast, there are still some cases with poor outcomes in delivering appropriate treatment or long-term care service as a result of a lack of timely definite diagnosis in the early stage of the illness or a lack of coordination between medical care and long-term care.

Therefore, the future dementia policy should be designed by envisaging the flow of measures that would support the life of the person and his/her family, and improve their quality of life starting with measures that link early notice of the patient, his/her family or neighbor to early diagnosis, and then measures to develop well-designed comprehensive care planning that provides appropriate medical and long-term care services through good coordination, while promoting research and development of diagnosis/treatment technology. In addition, in regard to early-onset dementia, comprehensive self-support measures including employment assistance should be promoted.

Active and comprehensive measures for people with dementia should include the following essential aspects, which are to: (i) understand the situation; (ii) promote research and development; (iii) provide support from the medical side; (iv) provide support from the the long-term care side; and (v) take measures for early-onset dementia (Table 1). The details of these aspects are explained in the next section.

Table 1.  ‘Emergency Project for Improvement of Medical Care and Quality of Life for People with Dementia (2008)
Investigation of the actual situation of people with dementia1 Prevalence study based on medical diagnostic criteria 2 Investigation of the actual situation of the medical and long-term care services provided
Acceleration of the research and development1 Prevention 2 Improvement of the diagnostic technique 3 Development of the regimen 4 Management after onset i.e. provision of adequate long-term care
Promotion of early diagnosis and provision of appropriate medical care1 Development and dissemination of the clinical practice guideline of dementia 2 Reinforcement of the medical system for dementia, in which Medical Centers for Dementia play important roles
Dissemination of adequate care and support for people with dementia and their families1 Standardization and advancement of dementia care 2 Cooperation with medical care, including early detection of dementia 3 Spread of knowledge about dementia and supportive measures in medical care, long-term care and community care 4 Arrangement of the system where everyone can consult with ease
Measures for people with early-onset dementia1 Specialized consultation call center 2 Tailored support system after diagnosis 3 Employment support networks 4 Research and dissemination of care services for people with early-onset dementia 5 Public information enlightenment about early-onset dementia

CONCRETE CONTENTS OF MEASURES FOR PEOPLE WITH DEMENTIA

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. FUTURE BASIC POLICY FOR PERSONS WITH DEMENTIA
  5. CONCRETE CONTENTS OF MEASURES FOR PEOPLE WITH DEMENTIA
  6. BUDGET IN 2009
  7. THE 2009 REVISION OF THE FEE SCHEDULE OF THE LONG-TERM CARE INSURANCE SERVICES
  8. CONCLUSION
  9. ACKNOWLEDGEMENTS

Investigation of the actual situation of people with dementia

The survey carried out in 1991 provides the estimated number of the elderly with dementia in Japan. However, unfortunately, no nationwide survey on the prevalence of dementia has been carried out after that and we do not have any updated data.

In order to understand the actual situation of people with dementia, it is necessary to immediately implement a prevalence study based on medical diagnostic criteria, and also investigate the actual situation of the medical and long-term care services provided and the living conditions of the elderly with dementia as soon as possible.

Acceleration of research and development

In order to make comprehensive measures for people with dementia based on early and appropriate diagnosis more effective, acceleration of research and development, according to the stage of dementia, is necessary. Concretely, it should be promoted from four viewpoints: (i) Prevention; (ii) Improvement of the diagnostic technique; (iii) Development of the regimen; and (iv) Management after onset, i.e. provision of adequate long-term care. In particular, the improvement of diagnostic technique and the development of the regimen should be placed as the most important issues, and accelerated by gathering resources and in cooperation with other ministries.

Prevention

Preventive methods against dementia have not been established yet. Presently, a community-based study, which elucidates the risk factors and preventive factors of dementia and the effect of preventive intervention, is underway and should be promoted continuously.

Improvement of diagnostic technique

To make an earlier diagnosis of Alzheimer's disease, more accurate and less invasive research and development, such as the study of amyloid imaging and biomarkers in blood and urine, are in progress now and should be accelerated furthermore.

Development of the regimen

There is an expectation for the remedy to reduce amyloid β accumulation to stop the aggravation of Alzheimer's disease as a causal treatment, and some remedies are already under clinical trial, mainly in the USA.

In Japan, studies to develop causal treatment early are being carried out and are planned to be accelerated in cooperation with the Ministry of Education, Culture, Sports, Science and Technology, which is responsible for promoting basic research, under an efficient research system with a concentration of resources.

Management after onset; adequate long-term care

Based on previous studies, appropriate long-term care and environment are known to prevent or improve behavioral and psychological symptoms of dementia (BPSD), and appropriate support for core symptoms, such as memory disturbance and disorientation, is known to maintain the activity of daily living.

Presently, a program of standardization and advancement of dementia care, which analyzes ‘what care is effective for what type of diseases under what kind of situation’, is being carried out and should be promoted continuously.

Subjects in studies should shift from fragmented care based on personal experiences towards comprehensive and continuous care from the early stage of dementia throughout life based on scientific evidence. For example, study of the rehabilitation effect on cognitive function, and the person-centered study and study of support in line with this approach should be promoted.

Promotion of early diagnosis and provision of appropriate medical care

The present challenges are listed below.

  • 1
    Ensure to keep the care process from early definitive diagnosis, planning of the treatment and care strategy to the provision of adequate medical and long-term care, through the detection of people suspected to have dementia by local primary care physicians, followed by referral to the dementia specialists.
  • 2
    Provide appropriate medical treatment during the acute phase of BPSD.
  • 3
    Adapt community healthcare services and specialized medical services to be able to correspond to serious physical complications of dementia such as cancer, cardiovascular disease and femoral neck fracture.

For these purposes, we should promote the training of dementia specialists, upgrading of dementia specialized medical institutions, and reinforcing its function to cooperate with long-term care facilities. In addition, we should facilitate support for healthcare provisions including care for underlying health conditions, such as lifestyle-related diseases, with close cooperation between primary care physicians and dementia care specialists, as well as long-term care service utilization supported by primary care physicians.

Development and dissemination of the clinical practice guideline of dementia

To standardize and spread medical care skills for dementia, development and dissemination of the clinical practice guideline of dementia established by dementia-related academic societies should be supported.

Reinforcement of the medical system for dementia, in which Medical Centers for Dementia play important roles

Medical Centers for Dementia, which are to be arranged to provide specialized medical care in cooperation with long-term care, would function as the core institutions of community dementia medical care. The Medical Center for Dementia would employ a staff member to facilitate coordination with long-term care provided in the community, including that provided by the comprehensive local care center. In addition, training would be provided to the staff to enhance its function as a specialized center.

Dissemination of adequate care and support for people with dementia and their families

Dissemination of adequate care

Like the care model for physical disability, a care model for dementia has been developed and improved with a basic idea to support the dignity of the elderly. The skills are improving. For example, it is now possible to prevent or improve BPSD by providing adequate care according to the change in symptoms of each person. In contrast, there are cases where the BPSD gets worse because of the gaps in the quality of care among facilities, or insufficient coordination between long-term care and medical care services interfering with the flow from early diagnosis to adequate long-term care.

The measures that should be promoted now are described.

Standardization and advancement of dementia care.  Specific cases of dementia care should be accumulated, analyzed and evaluated to promote the standardization and advancement of dementia care.

Cooperation with medical care, such as early detection of dementia.  The comprehensive local care center would be equipped to facilitate coordination between dementia care and medical care in the community, and provide specialized support regarding dementia care or protection of rights by establishing cooperation systems with dementia support doctors and employing a staff member (Dementia Coordinator) to manage coordination with the Medical Centers for Dementia (Fig. 1).

image

Figure 1. Coordination between medical care and long-term care. BPSD, behavioral and psychological symptoms of dementia.

Download figure to PowerPoint

This Dementia Coordinator, by receiving advice from the dementia support doctor, would: (i) gather information on elderly who have been diagnosed dementia definitely; (ii) provide the information to the comprehensive local care center of the person's residence; (iii) introduce medical specialists or professionals on protection of rights to the person; and (iv) provide counseling and advice on dementia care.

To enhance the capacity of the community to correspond to dementia care, training would be provided to (i) staff of the comprehensive local care centers, care managers, staff of long-term care service providers, doctors and visiting nurses through workshops using case studies for mutual learning; and (ii) governmental institutions, residents' associations and volunteer groups to facilitate their cooperative work in the community.

Support for people with dementia and their families

To make it possible for people with dementia and their family caregivers to continue living in their familiar environments, it is important to develop measures to support the lives of people with dementia from the community as the whole. The advisory system where people with dementia and their family caregivers can consult with ease is not sufficient.

  • 1
    Spread of knowledge about dementia and supportive measures in medical care, long-term care and community care
    • (a)
      Promotion of the 10-year Plan to Understand Dementia and Build Community Networks

The measures listed below, which have been developed by local municipalities and concerned bodies, should continue to be promoted to facilitate the spread of knowledge about dementia and build the platform to support the person with dementia and his/her family.

  • (a) 
    Measure to Build Community Networks for Persons with Dementia
  • (b) 
    100-Member Committee to Create Safe and Comfortable Communities for People with Dementia
  • (c) 
    Nationwide Caravan to Train One Million Dementia Supporters
  • (d) 
    Campaign to Build a Dementia-Friendly Community
  • (e) 
    Support for ‘People with Dementia Network’
  • (f) 
    Care Management Fully Involving Dementia Patients and Their Families
  • (b)
    Promotion of education on dementia in primary and junior high schools

Education in primary and junior high schools would be promoted to make support for persons with dementia and their family common and natural.

  • 2
    Arrangement of the system where everyone can consult with ease

A call center would be placed in each prefecture and each government-designated city to support people with dementia and their families. It would provide counseling by specialists or experts in the community and would link people to local specialized institutions for dementia. In addition, experience exchange meetings with people who are affected by dementia and with families who experienced caregiving should be supported.

Measures for people with early-onset dementia

People with early-onset dementia and their families tend to suffer from various problems, including financial problems. To create systems that can provide tailored support corresponding to each situation through support for continuation of employment, early acquisition of a disability certificate and entitlement to the disability pension is a pressing issue. Specifically, the following measures would be provided.

Specialized consultation call center

A consultation call center would be placed, where everyone can consult with ease and where people with early-onset dementia would be connected smoothly to the adequate Medical Center for Dementia, the comprehensive local care center with a Dementia Coordinator, and job assistance agencies.

Tailored support system after diagnosis

After being diagnosed with early-onset dementia in medical institutions, including Medical Centers for Dementia, the person would receive tailored support from adequate support measures coordinated by the Dementia Coordinator of the comprehensive local care center.

Employment support networks

An ‘employment support network for persons with early-onset dementia’ would be created to bring support from the health and welfare side, and the employment side together under the coordination of the Dementia Coordinator based on the existing employment support network for people with disabilities in each prefecture. Each member of the network would be expected to accumulate know-how on maintaining employment and providing support through individual care experiences and training to enhance understanding of early-onset dementia that would be provided to member companies as well.

Research and dissemination of care services for people with early-onset dementia

Research through trial projects on care services suitable for the physical function and needs of people with early-onset dementia would be promoted to develop and disseminate specialized care.

Public information enlightenment about early-onset dementia

To promote early detection and early support for people with early-onset dementia, including that from companies, people should know more about early-onset dementia. Therefore, measures would be taken to increase public awareness on general knowledge about early-onset dementia, the importance of early detection, support provided for employment, support after diagnosis including services for the disabled, and consultation services.

BUDGET IN 2009

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. FUTURE BASIC POLICY FOR PERSONS WITH DEMENTIA
  5. CONCRETE CONTENTS OF MEASURES FOR PEOPLE WITH DEMENTIA
  6. BUDGET IN 2009
  7. THE 2009 REVISION OF THE FEE SCHEDULE OF THE LONG-TERM CARE INSURANCE SERVICES
  8. CONCLUSION
  9. ACKNOWLEDGEMENTS

The new measures for people with dementia, which are included in the 2009 Budget, based on the report of the ‘Emergency Project for Improvement of Medical Care and Quality of Life for People with Dementia’ are listed below.

Measure to reinforce coordination for persons with dementia

Placing a Dementia Coordinator in the comprehensive local care center that will provide support based on expertise in coordination with medical care.

Measure for collaborative training and research of multiple occupations on dementia care

Training workshops for medical and long-term care experts, and community network workshops to link people and facilitate the connection of people in the community related to the care of elderly people with dementia.

Measure for dissemination, consultation and support for people with dementia

Establishing call centers providing advice from experts.

Comprehensive promotion measures for people with early-onset dementia

Establishing a call center specialized for early-onset dementia, constructing a network for self-support for people with early-onset dementia, and carrying out research to investigate appropriate services suitable for characteristics of people with early-onset dementia.

In addition to the new measures described above, the budget includes an increase in the research fund for dementia, such as investigation of the actual situation and development of the regimen.

THE 2009 REVISION OF THE FEE SCHEDULE OF THE LONG-TERM CARE INSURANCE SERVICES

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. FUTURE BASIC POLICY FOR PERSONS WITH DEMENTIA
  5. CONCRETE CONTENTS OF MEASURES FOR PEOPLE WITH DEMENTIA
  6. BUDGET IN 2009
  7. THE 2009 REVISION OF THE FEE SCHEDULE OF THE LONG-TERM CARE INSURANCE SERVICES
  8. CONCLUSION
  9. ACKNOWLEDGEMENTS

The basic points of view in this revision are described below.

  • 1
    To secure human resources and improve their working conditions
  • 2
    To enhance coordination with medical care services and dementia care
    • 1
      To promote the division of roles and cooperation between medical care and long-term care insurance services
    • 2
      To promote dementia care based on an increased population with dementia
  • 3
    To provide efficient care services and review the newly introduced care services
    • 1
      Provision of efficient and prompt care services with preserved quality
    • 2
      Inspection and re-evaluation of the services newly introduced in 2005

As a result of consideration based on the proposal of the ‘Emergency Project for Improvement of Medical Care and Quality of Life for People with Dementia’, the long-term care insurance service fee schedule for persons with dementia was revised in April 2009. The aspects will now be evaluated in the service fees are as following.

Group homes for persons with dementia

To make the group homes the bases of community dementia care, counseling and support; to allow users leaving the group home continue their life at home or in their community is taken into account in the service fee evaluation, while allowing them to provide services for worsening conditions or death of the user through fee settings. Intense placement of night duty staff is also evaluated in the fee schedule.

Short-term intensive rehabilitation for people with dementia; long-term care and health service facilities for the elderly, long-term care medical facilities, and ambulatory rehabilitation services

Based on study results showing short-term intensive rehabilitation is effective for people with moderate to severe dementia, services for moderate to severe dementia in addition to mild dementia are evaluated in the service fee schedule; and the services in long-term care medical facilities and ambulatory rehabilitation services are evaluated as well in addition to the services in long-term care and health service facilities for the elderly.

Support for Behavioral and Psychological Symptoms of Dementia; facilities providing short-term stay and group homes for people with dementia

Emergency acceptance of people with acute onset of BPSD, who cannot live at home, into the short-term stay, is evaluated.

Measures for people with early-onset dementia; institution facility services, short-term stay services and commuting services

From a point of view to promote support for people with early-onset dementia and their families, acceptance of these people and the provision of care according to the demands of them and their families is evaluated in the fee schedule.

Measures to spread specialized dementia care; facility services and group homes for people with dementia

From a point of view to spread specialized dementia care, care services provided by staff that have experience in dementia care for a certain period and have finished training programs specializing in dementia care are evaluated in the fee schedule.

Promotion of definite diagnosis of dementia; long-term care and health care facilities for the elderly

From a point of view to promote the definite diagnosis of dementia and provision of more appropriate care services, introducing the user in long-term care and health care facilities for the elderly, who are suspected to have dementia, to the Medical Center for Dementia is evaluated in the fee schedule.

CONCLUSION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. FUTURE BASIC POLICY FOR PERSONS WITH DEMENTIA
  5. CONCRETE CONTENTS OF MEASURES FOR PEOPLE WITH DEMENTIA
  6. BUDGET IN 2009
  7. THE 2009 REVISION OF THE FEE SCHEDULE OF THE LONG-TERM CARE INSURANCE SERVICES
  8. CONCLUSION
  9. ACKNOWLEDGEMENTS

In 2009, various measures were introduced for people with dementia. It is necessary to monitor the implementation of these measures and to review the effects. Furthermore, the measures in the above budget and long-term care insurance service fee are not the entirety of what can be done. We must promote measures comprehensively to realize a society where people can live life safely without anxiety even after being affected by dementia.