Global Dementia Legacy Event Japan

- New Care and Prevention Models-

Site Visit Tour Kyoto

Welcome to “dementia-friendly city” Uji

November 7th 2014

Chihaya-Hime Mascot character of Uji City

1. Greetings

Welcome to Uji City.

My name is Tadashi Yamamoto and I am the Mayor of Uji City. In Uji

City, we are working towards ensuring that our residents enjoy the “longest

healthy longevity in Japan” and towards developing “a dementia-friendly

city.”

Uji City has long been a forerunner in pursuing various projects

regarding dementia, and we have worked hard to create a network for the

care of dementia. We have also started a new initiative to provide care for

early-stage dementia, by utilizing the outcomes developed through our

initiatives so far. In order to ensure that people with dementia are able to

continue living at ease in the community they are used to, it is necessary to

involve not only local government, medical-care, welfare, and nursing-care

services, but also, most importantly, the community as a whole.

We firmly believe that achieving a “dementia-friendly Uji,” where all

residents come together to support people with dementia and their families,

is one of the keys to ensuring that Uji residents enjoy the “longest healthy

longevity in Japan.”

We will now introduce Uji City’s initiatives regarding dementia.

I hope that visiting Uji City will be a meaningful experience for you all.

Tadashi Yamamoto ( The Mayor of Uji City)

2. Overview of Uji City

Uji City is located close to the southern edge of Kyoto Prefecture. It boasts picturesque scenery, centered on the Uji River, as well as numerous historical and cultural resources, including World Heritage sites the Ujigami Shrine and the Byodo-in Temple. It is also known for its production of Uji-cha, one of the most popular brands of Japanese green tea. The city has a population of approximately 190,000 people, of which 48,000 people—that is, around 25%—are people aged 65 or older.

Byodo-in Temple Ujigami Shrine Uji-cha

2-1 Uji City’s approaches to projects regarding dementia

For a number of years Uji City has worked on providing preventive measures for dementia from an early stage and has conducted projects from each of the perspectives concerning dementia. These can be divided into three main areas: preventive measures, raising awareness, and family caregiving. In order to promote dementia prevention, we host classes in which participants learn about dementia and improve their lifestyle habits through exercise and games, interacting and having fun at the same time. As a means of raising awareness regarding dementia, we run courses to train people to provide reassurance and support to people with dementia and their families. We send instructors out into the community to provide course participants with a sound knowledge and understanding of dementia, so that they act as supporters across the community who assist people living with dementia in their area. Alongside these courses, we also conduct projects to train people to act as course instructors. We also run a program to support families caring for relatives with dementia. With the support of the Alzheimer’s Association Japan, the program supports such families by providing courses for dementia carers and social opportunities so that carers can interact with other people who are experiencing similar situations. We also provide assistance for the alumni group formed by former participants who have already completed the program.

Elapses of dementia-related businesses

◆2003～2005

The model implementation dementia prevention

Dementia prevention classroom was in reference to the "three A method".

◆2006～2008

As a means of raising awareness regarding dementia,

we run courses to train people to provide reassurance and support to people

with dementia and their families.

Training courses in the city 6 venue

⇒２５０ people participated

◆2009～2011

Dementia community support system construction model project contract

Uji dementia community support business start

2-2 The dementia care network in Uji City

The infrastructure which facilitates dementia measures in Uji City is made up of the city’s six Community General Support Centers, two “Medical Centers for Dementia-related Illnesses,” the regional medical association and long-term care insurance service providers. Local government, medical-care, welfare, and nursing-care services and the Alzheimer’s Association Japan cooperate with each other to create a network which supports dementia patients.

These initiatives have led to the creation of two tools which are now essential facets of dementia care in Uji City: the “Memory-loss Check Sheet,” which can be used to diagnose the form of dementia and its degree of severity based on the symptoms of the person concerned, and the “Case Book” which is a compilation of information on the progress of support for dementia.

3. The “entry problems” that must be overcome to change the public

image of dementia

Due to progressive population aging, there is growing interest in dementia. However, there is still a negative image surrounding dementia, which prevents people from forming a correct understanding towards it.

Many people with dementia and their families finally find their way to medical treatment and care when the symptoms of dementia are already moderate to severe. As a result, it is difficult for them to continue living in their own homes. The fact that many people associate dementia with such a severe state may be one of the factors explaining the negative image surrounding the condition.

In order to change such perceptions of dementia, it is important to show people that dementia is by no means a special condition and to establish means of providing support for people with dementia. In order to do this, it is necessary to ensure that people with dementia begin to receive care at an earlier stage, while their symptoms are less severe.

Dementia specialist Dr. Toshio Mori refers to the obstacles that prevent people with dementia from arriving at medical treatment and care at an early stage as “entry problems.”

There are two types of “entry problem”: “problems involving access to care” and “problems involving insufficient capabilities to provide care.”

Problems involving access to care are cases in which people with dementia and their families do not have access to a doctor who regularly provides them with care, such as a “family doctor,” who would help them to receive medical treatment, or do not have access to a Community General Support Center, which would arrange for them to receive care. There are a number of factors which cause such problems, such as the negative image of dementia, as well as solitude, poverty, isolation, people with dementia refusing intervention, and complex family issues.

Problems involving insufficient capabilities to provide care are cases in which, even when people with dementia arrive at a source of medical treatment or care, they are excluded from receiving such treatment or care. There are a number of potential reasons for this, such as the fact that having dementia may prevent people from receiving appropriate care for physical complications, the fact that support frameworks may be underdeveloped, or, in the case of younger-onset dementia, the fact that support itself may not be available.

In Uji City, we recognize that overcoming these “entry problems” is the key to changing the image of dementia and we are committed to tackling these problems.

4. The “Comprehensive Counselling and Support Project for

Early-stage Dementia”: Uji City’s initiative to tackle “entry

problems” In order for people with dementia to be able to go on living in the community they

are used to, it is important for services which provide medical treatment, nursing care, and lifestyle support to form a coordinated collaborative network, and to develop communities which provide effective support for people with dementia and their families.

In 2013, Uji City started the “Comprehensive Counselling and Support Project for Early-stage Dementia” to promote dementia care by strengthening collaboration between medical and nursing-care services and to work towards establishing a support framework in the community.

This project was outsourced to the “Uji City Welfare Service,” a jointly-financed public and private sector venture established by Uji City. Full-time dementia

coordinators have been assigned to the project, which is being run with the cooperation of the city’s Community General Support Centers and Kyoto Prefectural Rakunan Hospital and Uji Obaku Hospital, which are both Medical Centers for Dementia-related Illnesses. The project has established events known as “Dementia Cafés” as well as “Early-stage Dementia Intensive Support Teams,” in order to provide means of reaching out to people with dementia at an early stage, and act as another means of solving the “entry problems” in addition to the family doctors and Community General Support Centers which are the conventional means of entry to care. These schemes ensure that we do not simply establish an “entry” and wait for people with dementia and their families to come to us, but that we provide a system for working with people with early-stage dementia and their families, by creating a place in the community for people with dementia and their families to spend time at ease, and for medical and welfare specialists to go out to people who are thought to have dementia. In conjunction with this project, based on the responses to a lifestyle questionnaire aimed at city residents aged 65 or older, we go out to visit city residents who need preventive care for dementia and spread awareness of the “Dementia Café” events, the “Early-stage Dementia Intensive Support Teams,” and other dementia related projects, in order to lead these people towards the “entry” to support. We also run a ten part series of classes aimed at promoting a sound understanding of dementia, as another project to raise awareness regarding dementia. There are currently almost 100 city residents and medical and welfare specialists taking the classes. As these projects demonstrate, a significant feature of Uji City’s initiatives regarding dementia is the fact that a number of different projects are being carried out as a series of integrated measures, with dementia coordinators at the center.

We will now introduce two projects which are key parts of our measures regarding early-stage dementia.

5. The “Intensive Support Teams for Early-stage Dementia” The “Intensive Support Teams for Early-stage Dementia” have been introduced as another means of tackling the “entry problems” mentioned in the previous sections. There are a number of cases in which people with dementia may not be able to receive proper care until “critical situations” have already arisen due to their behavior or psychological symptoms. For example, there are people who do not receive care at a medical facility until their condition has worsened due to delays in early-stage treatment and has begun to result in certain behavior or psychological symptoms, and there are also people who are not receiving appropriate dementia care because they do not receive sufficient ongoing assessment at their place of care. Selected as a national model project in 2013, Uji set to work on developing “early-stage, proactive measures,” to establish “functions for early-stage support” and “functions to support the prevention of critical situations” aimed at preventing critical situations from arising, and preventing care from being limited to “reactive measures.” The Uji City teams are made up of professionals from a range of fields, including specialist doctors, medical practitioners, and welfare specialists. The teams are organized around each specialist doctor at Kyoto Prefectural Rakunan Hospital and Uji Obaku Hospital, and meet to review case studies and propose the course of support to be provided in each case.

The process for providing support is as follows: 1. Finding people who need support and collecting information

People who need support are identified on the basis of consultations from and information provided by the Community General Support Centers, family doctors, or other related people. People who need support may include people who are living in their community and are concerned that they have dementia symptoms but who are not receiving medical treatment or nursing-care services, or people whose dementia has already progressed but who are not receiving the appropriate support due to factors such as their own rejection of treatment or weakness in their family relationships.

2. Conducting assessments on the first visit A medical care specialist and welfare specialist from the team then visit the family as a pair and conduct an assessment of the person concerned and their family situation using the prescribed assessment tools. At this stage, Uji City’s uniquely developed “Memory-loss Check Sheet” is used to ascertain their symptoms and assess which dementia-related illness the person may have and the level of severity of their condition. In addition, the pair checks what kind of support the person concerned and their family do and do not require. 3. Holding a team meeting A team consisting of a doctor specializing in dementia and medical and welfare specialists then comes together for a meeting. The results of the initial assessments are reported and the cognitive functions of the person concerned are assessed and differential diagnosis is conducted to a certain extent to determine which dementia-related illness the person may have. The team then devises a course of support and support plan, also taking into account the situation of the case. If necessary, the family doctor or care manager of the person concerned, or the person themselves or their family may take part in the team meeting. Sharing related information allows the team to provide more effective support. Moreover, if the person already has a family

doctor and images of their brain can be taken, the image data is also reviewed, as the images allow the team to provide support based on a more accurate diagnosis.

4. Conducting early-stage intensive support (visits, collaboration with related organizations, support for medical consultation)

Following the course of support devised at the team meeting, the dementia coordinator cooperates with the people involved to provide intensive support. The support may include not only coordinating services provided by long-term care insurance service providers and support for medical consultation, but in some cases may also cover assistance

which goes beyond the boundary of public services, such as lifestyle support.

5. Reporting and reviewing at the team meeting and ending the support process At the team meetings held at a later stage reports are given on the progress and results of the intensive support, and the course of support is reviewed as necessary according to the progress being made. If the goals of the support are considered to have been met, the early-stage intensive support is ended, and ongoing support is entrusted to family doctors and long-term care service providers. Even after the support is ended, the person is monitored at regular intervals, to check whether or not the service is still being provided. The early-stage intensive support services are all provided free of charge.

The support provided by the “Early-stage Dementia Intensive Support Teams” can be said to have the following three characteristics: 1. Outreach As demonstrated in the explanation of the “entry problems,” a major characteristic of the work of the teams is that they take the medical care and nursing-care out to the people who need support, rather than waiting at the “entry” to medical and nursing-care for the people who need support to come to them. (The people providing the support make the move, as opposed to making the person concerned or their family seek support.) 2. Specialist assessment tools for dementia The assessment tools specially designed for the assessment of dementia make it possible to ascertain and assess the condition of the person with dementia and organize tasks at an early stage, allowing appropriate support to be provided.

3. “Intensive” support The support that the team provides differs significantly from conventional approaches to supporting people with dementia and their families in the fact that, as the name “intensive” suggests, focus is placed on reconstructing the lifestyle of the person concerned to put them on the right track to the support they need, in some cases strongly intervening and adjusting environments, in line with the course of support established on the basis of consensus between the medical care and welfare specialists in the team. The support is characterized by the fact that it is developed “horizontally,” seamlessly bringing together various parties from different fields, organizations and groups, and standpoints, rather than imposing the support “vertically” at the convenience of systems and organizations.

6. “Dementia Café” (Lemon Café) events

Another means that Uji City has adopted to tackle the “entry problems” is the series of events known as “Dementia Cafés.” The “Dementia Café” events in Uji City have three objectives.

Firstly, the events aim to create a place where people with dementia and their families can spend time at ease. Secondly, they provide a place where people who have concerns about dementia and related issues or their family members can casually seek advice without having to visit a medical facility or nursing-care information service. Thirdly, the events act as a forum for community residents and specialists to learn and develop a sound understanding of dementia by meeting and interacting with people with early-stage dementia. Together these objectives create a place in the community which brings together people with dementia, family caregivers, specialists, and community residents, which in turn develops into a visible care network. The “Dementia Café” events in Uji City, which are all called “Lemon Café,” are held at six locations around the city. Events are held in each district of the city either once a month or once every three months. As a result, each month events are held at around two to three locations in Uji City. The events are held at cafés, restaurants, community welfare centers (public facilities) and community social spaces in private residences. The Lemon Café events are divided into three sections. The first section is a “mini-lecture” on dementia by a doctor specializing in the field. This is followed by a “mini-concert” performed by a local musician. In the third section, participants have free time to socialize with each other while enjoying a cup of coffee. After the event is

finished, specialist staff also provide individual counselling as requested. The people who attend the events—including people with dementia, their families, community residents, and medical and welfare specialists—all wear everyday clothing, so that there is no distinction between people affected by dementia and medical specialists. Any community resident is welcome to participate in the events. However, careful consideration is given towards people with dementia and ensuring that they are able to enjoy the events at ease. Later on today you will have the opportunity to participate in one of the café events and interact with people with dementia and their families.

7. Aiming towards a “dementia-friendly Uji” Through the projects described, Uji City is currently preparing to issue a declaration

aimed at creating “a dementia-friendly Uji,” under the leadership of the Uji City Mayor, Tadashi Yamamoto.

What does a “dementia-friendly Uji” involve?

A city which does not exclude people with dementia from the community A city which comes together as a community to support families providing care for people with dementia A city where people with dementia feel comfortable to talk about their condition A city where people with dementia can receive the medical treatment and care which are correctly suited to their respective symptoms while they are still at an early stage A city where people with dementia can participate in community activities A city where people with dementia can be themselves A city where people with dementia can live at ease

Alongside developing the aforementioned “Comprehensive Counselling and Support Project for Early-stage Dementia” and further establishing it in the community, in the future it will be necessary to speed up initiatives to create a truly “dementia-friendly city.” Here in Uji City we are currently developing an environment for initiatives to ensure that the approaches to creating a “dementia-friendly city” are not discussed without involving those directly affected, such as creating working teams to allow people who are directly affected by dementia to make proposals. We are also aiming to establish a Dementia Action Alliance which transcends the fields of medical care, welfare, and nursing, to involve a number of different organizations, including various organizations and companies in fields such as commerce, industry, and tourism.

8. In closing Kyoto has developed Japan’s only independent plan for pursuing comprehensive

dementia measures. The greatest feature of this plan is that its results indicators are based on ten “I-messages” aimed at achieving a community and society where people with dementia can live at ease, which were devised from the perspective of people with dementia and their family members. The declaration for a “dementia-friendly Uji City” also reflects our resolve to work as a local government to ensure that these “I-messages” become a reality in Uji City.

1. I am leading an active life, in which all the people around me have a good understanding of dementia and give sufficient consideration to my human rights and individuality, allowing me to get on and do the things I can, and supporting me in the things I cannot.

2. I am able to receive diagnosis while my symptoms are still mild, understand my condition, receive the appropriate support, think and make decisions about the future, and live at ease.

3. I am able to receive medical treatment as soon as I experience ill health, and apart from the times when I am feeling unwell, am able to live a healthy life in the place I am used to with continuous ongoing medical and nursing care.

4. I participate in society as a member of the community, contribute to society to the extent of my abilities and live life with a feeling of purpose.

5. I am able to enjoy my life and do the things that I want, such as hobbies and recreational activities.

6. I am able to live my life without worrying that I am troubling others, because sufficient consideration is given to the lifestyles and lives of the family that supports me.

7. I am able to live to the end of my days knowing that my wishes and preferences will be respected, as the people around me understand that there are times when I cannot express my own feelings accurately in words.

8. I am able to find the information I need, someone close to me whom I can confide in about anything, and a place where I can feel at ease, regardless of where I live in Kyoto.

9. I am able to live my life and feel motivated to get involved, because there is a service to suit me even if I have younger-onset dementia.

10. I am able to live in hope because various forms of research are being conducted to develop means of curing dementia, as is my own wish and that of my family.

“Dementia-friendly city” Uji Staff

★Kyoto Prefectural Rakunan Hospital

Toshio Mori Psychiatrist

★Uji Obaku Hospital

Takashi Hikawa Psychiatrist

★Uji City government office Health and welfare division

Yoshinari Fujita The Vice- Director

Eri Yokoyama The chief of a subsection Public health nurse Mayumi Hara The chief Public health nurse Kazuhiro Takahashi The chief

★Uji City Welfare Service Public Corporation

Yuichiro Kawakita The Vice-Director at secretariat Certified Social Worker

Miaki Tatemichi The chief of a subsection Leader Care manager Namiko Monobe Public health nurse Tomomi Sano Certified Social Worker Keiko Matumoto Certified Social Worker Saki Ohnishi Certified Social Worker Shotaro Konishi Picture editor

It is Uji City welfare service public corporation to have made this document

You can see today's picture.

http://www.poppo.or.jp/

Poppo Mascot character of Uji City Welfare Service Public Corporation