With the world’s fastest ageing society where 1 in 4 are now 65+ and there are 4.6 million (15%) living with dementia, Japan is struggling to find sustainable and affordable solutions to the challenge of dementia. With the world’s highest level of debt – 230% of Japan’s GDP – the solutions have to be as ingenious as they need to be innovative and essentially cost-effective.
While political leaders take the stage in Tokyo, a year on from the 2013 G8 Dementia Summit, to promote their ‘big’ dementia policies, deep down in the community – in Kyoto and Kobe – at ground level, grassroots initiatives are being embedded within the evolving sense of dementia friendly communities. Central government is beginning to take notice – and appreciate, indeed promote – these community-rooted and volunteer-led examples of dementia care and support. This positive response no doubt reflects the overriding economic pressures and concerns – along with the search for low-cost, effective solutions – to defuse the ‘ticking time-bomb’ of dementia.
The sophisticated Japanese public and universal Long Term Care Insurance system has been funding a robust national provision for dementia care and support – and is part of the overall drive for an integrated community care system by 2025 when Japan’s 65+ population will exceed 30%. Fresh approaches bring, through their voluntary basis, added-value to public funded health and care provision.
Free from labyrinthine bureaucracy (exacting health and safety legislation, risk assessments, evaluation-driven inspections and ‘safeguarding’) Japanese families, carers and wider community members are rolling their sleeves up and getting on with the tasks of providing low key, informal and seemingly effective social care, compassion and support.
Across Japan, an overall reservoir of 5.4 million lightly trained volunteers known as ‘dementia friends’ are being efficiently managed by a mere 4 full time paid HQ staff. Many of them are beginning to form task forces and are enjoying a free hand as they introduce an imaginative range of dementia care and support programmes which are friendly and flexible – and which can flourish in the established climate of trust.
The approval of a benign central government along with the laissez-faire approach of local authorities has enabled fresh, distinctive forms of grassroots care and support models to emerge and flourish. Such initiatives include the ‘open house’ provision (i.e. ‘Suzu-no-ya’ and ‘Sakura-chan’) together with the neighbourhood-watch style networking. The key feature of these – and other initiatives – is that they are local, are based on voluntary support and are unencumbered by restrictive bureaucracy.
Created in early 2014, the latest example of the ‘open house’ (Suzu-no-ya) scheme is run by volunteers who offer local residents with dementia – and their carers – the weekly opportunity to access all-day care including lunch and tea. Drop-in facilities also include informal advice and peer-support for carers, backed up by a 24 hour phone carer support line. The ‘open house’ concept embraces ‘normalisation’ through familiar, relaxed and friendly surroundings which are invariably provided by volunteers’ own premises – or ‘low cost’ rented local vacant dwellings. There are currently some 8.2 million empty properties in Japan – 13.5 % of the national housing stock.
In Kobe the ‘Sakura-chan’ – a variation on the ‘open-house’ scheme – has privately rented residential dwellings opened up to receive dementia patients and their carers for lunch, day-trips, dementia awareness raising and education. In addition, carers are offered respite by peer carers along with a 24 hour carer help line. Situated next door to the Kobe local authority offices, lunch has always been on offer to officials, multi-disciplinary professionals and care managers – with the result that through informal but successful lobbying the start-up funding for 12 more ‘open houses’ has been approved.
The neighbourhood-watch style networks specifically look out for the care and needs of the 10,300 ‘wanderers’ – people with dementia who become lost and confused away from home.
Led by volunteers – who act in partnership with the police, local businesses and charities to steer ‘wanderers’ safely home – the ‘watch’ network provides invaluable support and reassurance for carers and families – as well as the essential safety net for those living with dementia. Evidence of its need and success is reflected in the fact that 61.3 % of Japan’s 1,741 local authorities embrace this scheme. Taken seriously, ‘wanderer alert’ drills are practiced on a regular basis – and the scheme is officially endorsed.
Japan hosted the November 2014 Global Dementia Legacy Event – during which Prime Minister Abe promised even more dementia policies “to realise the creation of a dementia integrated community care system…an all party approach…reflecting the views of those with dementia and their carers”. Big policy promises – again. Perhaps the solutions can be found in the low key, low cost, apparently high impact initiatives carried out with quiet dignity and little fanfare out there in Japan’s dementia friendly community.
This article can be seen on The Guardian blog.