[Steps toward an integrated and collaborative health care system for the community life of patients with dementia]

Abstract

In 2012, the Ministry of Health, Labour and Welfare published a report, entitled: "Direction of Policies on Dementia" (hereinafter referred to as Direction), and announced a "Five-Year Plan for the Promotion of Measures against Dementia (Orange Plan)". I first overviewed the issues with Direction. Direction aims to develop a standard dementia care pathway by establishing the coordination of agencies for patients with dementia and improve long-term care services to support the community life of patients with dementia. However, several objectives proposed in Direction appear to lack scientific grounds, and it is uncertain if they are feasible. In addition, fragmentation remains in the proposed dementia health care pathway. Health care services provided by psychiatric hospitals are undervalued in the proposed pathway. Inpatient and outpatient medical care for patients with dementia should be integrated in the dementia care pathway and complementary to long-term care services to achieve the smooth and safe transition of a patient from the hospital to their home (and from their home to the hospital) and support the daily lives of community-dwelling patients with dementia and their care givers. The wards in psychiatric hospitals need to be more specialized, in order to be able to contribute to comprehensive community care. I discussed functions of psychiatric hospitals and how a dementia ward can be specialized depending on the functions it should serve.