JAPAN: Dementia Care Still Poses Challenge

OSAKA (Daily Yomiuri), February 18, 2008: A Yomiuri Shimbun survey on care facilities for the elderly that have in-house nursing staff showed that while more than 60 percent of such facilities said they were capable of providing sufficient care for dementia patients, they still faced problems dealing with such patients. According to the survey, 63 percent of the facilities said they were capable of providing sufficient care. Four percent said they were not, and 32 percent said they could not answer either way. Meanwhile, 10 percent of the facilities said they had asked dementia patients to move out over the past year. One of the facilities that takes care of dementia patients is Esteem Life Gakuenmae in Nara, where about 70 percent of the people accommodated suffer from the condition. Staff members at a recent monthly meeting discussed how to treat a woman in her 90s who suffers dementia. One of the staff members said: "She likes housework. Maybe we should let her take part in the cooking activities." Another said: "I'm not really sure about that idea because she'll put anything in her mouth. It might be OK if we just let her dry the dishes." Ryu Miura, director of the nursing care home, said: "When we see problematic behavior such as violence and wandering off, our team of staff first try to find out what has made the patient act that way. By giving appropriate care that suits the patient, problematic behavior often disappears." According to the facility, before an elderly person is admitted, staff members visit the person's home to ask family members about their life and the hobbies they enjoyed when young. "Dementia sufferers often regress to their youth, and hints about the best way to provide good care are often hidden in their memories of that time," Miura said. In another example, Century City Omiya Koen in Saitama has compiled a manual based on case studies of elderly patients who needed extra attention. The facility also holds frequent meetings with residents' family members and doctors. ___________________________________________________ Early diagnosis important The survey also found that 68 percent of the nursing care facilities said they try to detect dementia at an early stage, and ask doctors specialized in the field to conduct examinations. Seventy-eight percent said they do not physically restrict dementia patients or use restraints. Eighty-nine percent said they followed guidelines prohibiting physical restrictions when providing care for dementia patients. Meanwhile, many facilities raised concerns and problems regarding the care of dementia sufferers. The most common issue was problems between dementia sufferers and nonsufferers in the same facility. For example, an all-single-room nursing home in Hiroshima Prefecture reported that one dementia sufferer had been wandering into other people's rooms. Another common issue concerned diagnosis of the condition. A nursing home in Osaka Prefecture said: "There aren't many doctors specialized in dementia. General practitioners just tend to prescribe tranquilizers." A nursing home in Aichi Prefecture said: "There's a large number of people who haven't been properly diagnosed. Not many [doctors at] regular medical institutions can tell the difference between dementia and brain damage caused by accidents and other external factors." _____________________________________________________ Grounds for expulsion? One facility in Osaka Prefecture asked two dementia patients to move out during the past year after one assaulted other residents and staff members in the facility, and the other broke windows. The facility said it did not have enough staff to provide 24-hour care for these patients. Many nursing homes have a clause in residents' contracts stating that they may cancel the contract if the resident harms others or causes problems that cannot be contained in the course of regular care. The head of a nursing home in Tokyo said: "[The clause] is necessary for group accommodation. Otherwise we'd have to restrain them or drug them." But some facilities avoid use of such a clause. Hydemoer Tama Plaza in Kawasaki stopped putting such a clause in its contracts two years ago. A facility spokesman said: "The worst scenario for the elderly and their families is to be told to move out of the facility. If we can't take care of them until the end, how can we say we'll provide them with the last home they'll ever need?" Akiko Konoma, former chief researcher at the National Consumers Affairs Center, said: "The national guidelines say facilities should enable the elderly to 'continue their lives in the facility even after they come to need nursing care.' So it's a problem if facility operators put general clauses in their contracts allowing them to be canceled in the event of any problematic behavior resulting from dementia. If facilities have certain problems they can't handle, they should specify exactly which problems are liable to result in expulsion." By Takeharu Yasuda and Soko Nakadate / Yomiuri Shimbun Staff Writers © The Yomiuri Shimbun.