With the world’s fastest ageing population, where one in four are over 65 and there are 4.6m people (15% of the older population) living with dementia, Japan is struggling to find sustainable and affordable solutions.
With the world’s highest level of debt – 230% of national GDP – these solutions to the challenge of dementia must be both innovative and cost-effective.
While political leaders take the stage in Tokyo to promote their “big” dementia policies, at ground level grassroots initiatives are helping to make communities dementia friendly.
The sophisticated long term care insurance system, which is universal and funded partly by tax, partly by insurance contributions, ensures robust national provision for dementia care and support. It is part of the overall drive for an integrated community care system by 2025, when people aged 65 and over will exceed 30% of the population.
But fresh new voluntary approaches are supporting the publicly-funded health and care provision.
Free from bureaucracy (exacting health and safety legislation, risk assessments, evaluation-driven inspections and safeguarding), Japanese families, carers and wider community members are providing low key, informal and seemingly effective social care, compassion and support.
Across Japan, 5.4 million trained volunteers known as “dementia friends” are being efficiently managed by only four full-time paid 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 programs.
Across Japan, 5.4 million trained volunteers are being efficiently managed by only four full-time paid staff.
Such initiatives include the “open house” provision together with neighbourhood-watch style networking.
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. The scheme takes places in volunteers’ own houses, or in low-cost, empty rented houses. There are 8.2m empty properties in Japan – 13.5% of the national housing stock.
In Kobe the “Sakura-chan” – a variation on the scheme – has privately rented residential dwellings to receive dementia patients and their carers for lunch, day-trips, dementia awareness raising and education. Carers are offered respite by peer carers along with a 24-hour help line. Situated next door to the Kobe local authority offices, lunch is always on offer to officials and care managers. Through informal but successful lobbying the start-up funding for 12 more open houses has been approved.
Neighbourhood-watch style networks specifically look out for 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, the network helps to steer wanderers safely home. It is also an essential safety net for those living with dementia. 61.3% of Japan’s 1,741 local authorities embrace the scheme. Taken seriously, wanderer alert drills are practiced on a regular basis – and the scheme is officially endorsed.
Mayumi Hayashi is a Leverhulme Early Career Fellow at King’s College London.