Transition of Dementia Policies in Japan

2000: Enforcement of “Long-term Care Insurance Act”

This was created in 1997, as a system that enables the society as a whole to provide long-term care to the elderlies, and was enforced in the year 2000. In Japan, before this enforcement, elderly care was expected to be managed within the households. However, due to increased participation of women, who were assumed to play an important role in long-term care, in the workforce, and the decline of extended families resulting into the shortage of bearers of long-term care, led to the need for socialization of care increasingly being expressed. At the same time, elderly care, which used to be a safeguarding system, changed to where elderlies were acknowledged as a “the insured” with an independent right, and the independence and their advocacy were valued (Refer to JHPN “Long-term Care Insurance Act” for more details).


2004: Change of terminology for “Dementia”

The Ministry of Health, Labour and Welfare set up the “Meeting convened to discuss a new terminology to replace Chihosho” in 2004. During the meeting, issues for the terminology such as it being an insulting expression, not expressing the true condition of dementia, and such terminology acting as a possible barrier towards the early discovery and diagnosis of dementia.[1] Subsequently, following the activities including the broad invite (recruitment) of opinions, the terminology for dementia changed to “Dementia”. At the meeting, they took the terminology change as an opportunity to promote the correct understanding for dementia and to raise awareness of their rights.


2008: Reports from the “Emergency Project for Improvement of Medical Care and Quality of Life for Persons with Dementia”

In 2008, in order to promote the future measures more effectively, the “Emergency Project for Improvement of Medical Care and Quality of Life for Persons with Dementia” was organized and its report was prepared. In this report, the promotion of appropriate response with early confirmation as a starting point was raised as a basic principle for policies for dementia. The specific correspondence items raised consisted of;

  1. Understanding of the true condition of dementia
  2. Acceleration of research and development
  3. The promotion of early diagnosis and the provision of the appropriate healthcare
  4. The spread of appropriate care and support for the individual with dementia and their families
  5. Enforcement of the measures for the younger on-set dementia.

2012: The direction of the future dementia measures

Taking the results from the report above, the report for “The Direction of the Future Dementia Measures” was prepared in aims for the re-examination of dementia policy so far and the proposal for the future foundation. This proposal was proposed by the “Dementia measures investigation project team” which belongs to the “An investigation team for the building of a new regional mental health care system” that was set up in 2010. This team was created in hopes for the deeper discussion on dementia measures. With the aims to change the way of thinking from the admission to a nursing home(institution), and hospitalization as being inevitable, to a society that respects one’s opinion, even after diagnosed as dementia, and that enables them to continue living in familiar regions and environments as much as possible, the basic aims were set to develop the “Dementia Care Pathway (A flow that provide appropriate service depending on the condition)” to replace the existing flow of inappropriate care, “home →group home →nursing home or general or mental hospital”. Furthermore, the plan to enhance the investigation and research for the promotion of such policy was noted.[2]


2012: Five-Year Plan for promotion of Dementia Measures (Orange Plan)

Based on the “Direction of Future Dementia Measures” published in 2012, “The Five-Year Plan for promotion of Dementia Measures (Orange Plan)” was developed in the same year. The Orange Plan consists of 7 pillars including;

  1. Making and spreading of standardized dementia care pathway
  2. Early diagnosis and intervention
  3. Improvement of a healthcare service in the community which will provide daily life support
  4. Development of long-term care services that support daily life
  5. Strengthening daily living and family support in the community
  6. Reinforcement of measures for early on-set dementia
  7. Acceleration of human resources in healthcare and long-term care.

2013: G8 Dementia Summit

The first G8 Dementia Summit was held in the United Kingdom in December 2013. In addition to the representative from every G8 nation, European Commission, WHO, and OECD that participated, the Senior Vice Minister of Health, Labour and Welfare from Japan participated, and explained the population ageing in Japan, the current situation with dementia, and the orange plan. During the conference, “A new international approach regarding dementia research, for example, not a single nation effort, but as a common goal for every nation and accelerating research” was agreed.


2014: Global Dementia Legacy Event Japan

In response to the G8 Dementia Summit, the “Global Dementia Legacy Event Japan” was held in Tokyo in November 2014, with the theme of new care and prevention model. Health and Global Policy Institution gave support to this event and Kiyoshi Kurokawa, who is the chairman of the institution, gave a speech. On this occasion, the formulation of a new strategy, which consists of three pillars; 1. The construction of a routine medical system that offer a seamless service dependent on one’s condition by having the healthcare and long-term care services to organically coordinate in addition to the early diagnosis and interventions; 2. To have a cross-ministerial and holistic strategy for the purpose of the development towards a dementia-friendly community; and 3. To prioritize the standpoint of persons with dementia and their families; was announced.

Also in accordance to the event, “Taking Action on Dementia: Opportunities for Social Investment- A G7 Global Dementia Legacy Event Private Sector Side Meeting” was held under the auspices of HGPI and OECD. A discussion between the private and public sector took place on the private sector-led strategies and approaches that are required to address the various existing issues related to dementia.


2015: Comprehensive Strategy to Accelerate Dementia Measures (New Orange Plan)

Based on the announcement at the Global Dementia Legacy Event Japan, in January 2015, the New Orange Plan was announced (presented). The New Orange Plan was framed with a standpoint of persons with dementia and their families, accordance to the holistic opinion gathered from the people with dementia and their families, and other people involved. Although this plan is set for 2025, the targets such as the numeral targets are deemed to be reviewed every three years. Moreover, having a cross-ministerial approach, with other ministries being involved including; the Cabinet Secretariat; Cabinet Office; National Police Agency; Financial Service Agency; Customers Affairs Agency; Ministry of Internal Affairs and Communication; Ministry of Justice, Ministry of Education, Culture, Sports, Science and Technology; Ministry of Agriculture, Forestry and Fisheries; Ministry of Economy, Trade and Industry; Ministry of Land, Infrastructure, Transport and Tourism; instead of only the Ministry of Health, Labour and Welfare putting in the effort when setting the plan is a unique feature of this plan.


References

  1. The Ministry of Health, Labour and Welfare “Report on the meeting convened to discuss a new terminology to replace Chihosho”http://www.mhlw.go.jp/shingi/2004/12/s1224-17.html (Accessed:June 18, 2018)
  2. MHLW ”The future direction of Dementia Measures” http://www.mhlw.go.jp/stf/shingi/2r9852000002fv2e-att/2r9852000002fv5j.pdf (Accessed:July 02, 2018)