Dementia and Home Care｜What can we do from now on - Summary

 

Dementia should be "cured," but it is difficult to do so.

It's hard to do.

In 2018, a wealthy American man has publicly announced that he will offer a "$400 million" prize to researchers who show a cure for Alzheimer's, yet there is still no answer to the question.

https://nakamaaru.asahi.com/article/12074188

It will take another 10 years or more for the drug to go from practical use in the U.S. to being used in Japan.

Japan, which lags behind in psychiatric care, still has a long way to go.

What other measures should we take now?

Facilities, Increase the number of dementia day services

---------------------------------------------------------------------------

The usual "day service" under long-term care insurance is open to healthy people.

There are two staff members and 40 to 50 residents.

People from other municipalities can also come to the service.

Day services for dementia are focused on "dementia" users.

Four staff members are required, and the number of residents is limited to 12.

In addition, they are bound by the community-based system.

It cannot be used in other municipalities, even if they are adjacent to each other.

The most efficient is by far the regular "day" service.

There will be a proliferation of "day" services.

Regular day care services also have healthy general users.

In the case of users with dementia, there is no need to say

In the regular day services, there are also healthy general users, who complain to the dementia users, "Shut up, stop making noise, kick me out."

The dementia patients are banned from the day service (because there is no way to improve their behavior even if the staff intervenes).

How to keep dementia users at ease.

The number of "dementia day services" needs to be increased.

"There are only dementia patients in "dementia day services.

Even if there is a complaint that the service is too noisy

Even if a complaint such as "noisy" is raised, it will be forgotten after a few minutes or hours in a separate room.

The government needs to provide additional support to the dementia day service.

The shortage of dementia day services will result in forcing people to take care of themselves at home.

The burden falls on the family.

Medical care | Expansion of day care facilities

----------------------------------------------------------------

If they are hospitalized, various measures must be taken to keep them in bed and out of the open air.

Patients who are drugged will lose their resistance and will need more help from others. If the patient is able to go to a hospital, he or she will be able to live a more "independent" life.

People who frequently self-injure or harm others (suicide, violence) are

They can be confined to a hospital, medicated and restrained.

However, it is not necessary to confine them to the hospital just because they talk or try to go outside.

It is enough to prepare a "space" where such behavior is not a problem.

Medical Care | Increase the number of day care centers for severe dementia

--------------------------------------------------------------------------------

Medical day care (psychiatric day care) is a type of day care that can be used with medical insurance.

Medical day care (psychiatric day care)

However, because it manages alcoholism, gambling addiction, and mild forgetfulness together, it has the same "complaints from others" problem as regular day care.

If an ordinary user says to a dementia patient, "Shut up, don't make noise, or kick out," he or she will be banned (even if a staff member intervenes).

There is a day care service for severe dementia that focuses on dementia.

However, the number of hospitals that provide this service is decreasing and there are few of them.

It may not be profitable, or it may not be possible to include general addiction patients.

In many cases, the day care centers are turned into regular psychiatric day care centers by including general addicts.

Dementia patients are not allowed to attend.

They are kicked out at the first sign of complaint from others.

They need to be drugged to the point where they can't even speak.

If we can subsidize day care for severe dementia, or increase the number of hospitals that provide it, or expand the areas where people can go to it

The burden on families would be greatly reduced by subsidizing day care for severe dementia, increasing the number of hospitals that offer it, and expanding the areas where people can go.

Care from the perspective of the patient's family

-------------------------------------------------------

Prolonging the patient's life

Protect the patient's health.

There is no need for hard-headed doctors who can only act from the perspective of

The hardest part of dementia is the family members around the patient.

When a person has dementia, the hardest part is the family members around him/her, who are unreasonably restricted in their freedom, unable to work.

Relationships break down, and mental illness sets in.

The most important thing is to provide care that makes the "patient's family" feel comfortable.

This also means letting the family do what they want to do.

It's not always best to keep them in the hospital.

In some cases, it may be better to keep the patient at home.

Even in that case, the family's mental health should be the priority.

There is no need for a doctor to be verbally abusive, to put the family in a bad mood, or to make them feel uncomfortable.

Doctor should at least feel comfortable writing a letter of referral.

University hospitals cannot be visited without a referral.

If you are a doctor, you should know that university hospitals do not treat you as a family doctor.

If you're a doctor, you probably know that.

Eliminate the "three-month" limit on hospitalization at mental hospitals

------------------------------------------------------------------

In the Showa era (1926-1989), hospitals were called "geriatric hospitals.

In the Showa era, people with severe dementia and those who had no relatives sometimes spent the rest of their lives in such hospitals.

Sometimes, they were hospitalized at the discretion of the doctors.

Of course, this was not always a good thing.

They didn't put all the responsibility on the children as we do now.

Forced out after three months

A three-month interval is required for readmission.

No readmission to the same hospital (in some areas)

There were no restrictions such as these.

I heard that this is because of the current government subsidies.

The reason for kicking them out is that after three months, their remuneration will be reduced.

In areas where there are no facilities to accept the patients, they are left to be cared for at home with their advanced condition.

Some of them need to be hospitalized.

Some of them are very violent and abusive.

However, I do not recommend hospitalization for three months.

I would like to see a responsible medical system in place.

Increase the number of hospitals and facilities for Young onset dementia

----------------------------------------------------------------------

Dementia is defined as

Alzheimer's disease

Lewy bodies

Cerebrovascular

Frontotemporal (Pick)

There are many types of dementia such as Alzheimer's, Levy, Cerebrovascular, Frontotemporal (Pick), etc. Younger dementias (often frontotemporal) have more intense symptoms, are more energetic, have more fluctuations in symptoms, and require a completely different response from those of other dementias.

In contrast, medical care is geared toward the average senile Alzheimer's patient (in their 80s), so it is not fully responsive.

The number of specialists should be increased.

And to reduce the burden on the patient's family and

To reduce the burden on the taxpayers.

In order to reduce the burden on the patient's family and to reduce the tax burden, I would like to see more specialists available, and for the patient's family to be able to cross the border to a distant hospital for consultations, hospital visits, and hospitalization.

Provide "financial" "support" to home-based caregivers.

It's not a lot of money.

-----------------------------------------------------------------------

It's not a lot of money, but if a child abandons care or runs away

If the child abandons the care or runs away, the government can't just throw the "dementia patient" out on the street.

The price is not cheap.

For a Young onset dementia, it could be 20,000 to 30,000 yen a day. More than that.

As a result of skimping on tens of thousands of yen in support, the loss of that amount of money is going to be huge.

This loss will continue until the dementia patient himself dies.

The government tells us that we should apply for "welfare".

The government says you can apply for "welfare" by moving into an "apartment" with your dementia parent (if you can do that?).

And give up the car, and take the bus and train.

Is it "right" to continue receiving welfare until your parents die?

If you fall to welfare, it is very hard to climb up from there.

They become helpless, dependent on the taxpayers for the rest of their lives.

Some caregivers have a life, a job, and children.

It is best to "support" them "financially" without dropping them on welfare.

Support should also be given to those who have no family and no relatives.

Don't let parents be left alone and have to support themselves with large amounts of taxpayer money.

To reduce the "loss" of taxes.

Government｜Stove-piped administration with no one to take responsibility...

-------------------------------------------------------------------------------

The Ministry of Health and Welfare is responsible for the prefectures.

Ministry of Health, Labor and Welfare to prefectures, prefectures to public health centers, public health centers to cities.

Ministry of Health and Welfare to prefectures, prefectures to public health centers, public health centers to cities, cities to comprehensive health centers.

The Ministry of Health and Welfare to the prefecture, the prefecture to the public health center, the public health center to the city, the city to the comprehensive health center, the comprehensive health center to the care manager.

The prefectural government to the public health center, the public health center to the city, the city to the comprehensive care manager, and so on.

It's like an endless loop of blame shifting.

The city staff changes every few months to a year or two.

If there is no system, they say, "There is no system.

If there is no system in place, the only response is, "There is no system in place.

If there is no system, the city simply says, "We don't have a system," and does nothing to create or improve it.

There is a government subsidy, but the city refuses to pay it.

The reason why the city refuses to pay for it is because the municipality owns half of it.

So even though it is a government program.

They try to cut welfare as much as possible even though it is a national system.

This is because it saves the municipal budget.

But as a result of this stinginess.

If a family member abandons care, collapses, or runs away.

They can't just throw the elderly out on the street.

Because that is the rule.

If a person with dementia is left alone, without any blood relatives.

If a dementia patient is left alone without a blood relative, the municipality has the authority to admit him to a fee-based home, using the "welfare quota" and other means, and the taxpayers' money will be used to support him.

The cost is not cheap.

The cost is not cheap. More than that.

It will be much more expensive than before, and taxpayers will have to pay for it until they die.

Helping families while they are still alive will save taxpayers money.

Do you understand that?

Government Allow facilities to be used across city and county borders.

-----------------------------------------------------------------------

Community-based" facilities, such as dementia-friendly day services, have a fixed scope of operation.

The scope of the facilities is limited.

Even if it is located in an adjacent municipality

You can't use them even if they are located in a neighboring municipality, even if they are within your commuting range.

If it becomes possible to "cross the border" between municipalities and use it as a "long-term care insurance service," the options will expand.

At present, if there are no facilities in the city or prefecture, there is no choice but to move.

Let the "dementia specialist" certify the level of care required.

-----------------------------------------------------------------------

You cannot apply for a special nursing home unless you have been certified as needing Care Level 3 or more care.

The certification of needing nursing care is based on paperwork.

For the purpose of more stringent screening.

In order to make the screening more strict, they have non-specialists such as pediatricians and dentists make the judgment.

As a result, they are judged more strictly than the actual situation and are not allowed to apply.

Repeatedly wandering = fine! health!

Noisy from morning till night = Active! That's a good thing!

Young onset dementia, as well as those who wander a lot, stop at the second level of care.

And by the time the Cure level 3 of care is granted, the symptoms have progressed to the point where they can't get in.

The family members have lost their jobs or are exhausted and it is too late.

We should have "doctors who actually see dementia" or "care managers/facility staff" who know more about the actual situation determine the level of care required.

If the nursing care level and the nursing care insurance system are to be continued as they are.

There is a lack of media coverage of dementia.

-----------------------------------------------------------------

Dementia is scary, nursing care is miserable, the future is bleak...

The media is full of sensationalism.

The media is full of sensationalism like this, but they don't tell you what to do when the symptoms appear.

The only thing that comes to mind is a sense of fear.

It's like we're forcing each other to be afraid.

The japanese people have lost their moral sense.

The one who runs away wins.

Even among family members, the first one to run away

In many cases, the one person left behind (wife, only child, youngest child, etc.) is the one who is doing it.

This is no longer a situation that can be encouraged playfully.

Nor is the "cheap" talent in Southeast Asia.

They don't bother to come to Japan where prices are rising, salaries are low, and there is no future.

The foreign care workers that we have been looking for will not come as expected.

Taxes will rise and subsidies will be cut.

I think the nursing care industry will collapse sooner or later.

We will be forced to provide in-home care.

It is information that will prepare us for when that happens.

It is a means to use the system. If there is no system, what are the problems?

What should be improved?

I would like you to convey this information well.

"Dementia is bad!

That's not enough.

Many people think that

If you don't get dementia, it doesn't matter.

Many people think that if they don't get dementia, it doesn't matter, or that they can just "run away" if they find themselves in a nursing care situation.

In this situation

Many people are divided and suspicious of each other.

It's okay to live a life that only thinks about yourself.

But if you fall into a hole, there is no one to help you.

It also means that you have no choice but to die.

----------------------------

Caution.

I am Japanese. The text is from DeepL automatic translation. Please understand that some parts may be difficult to read.

Final Addendum: September 28, 2021