Health Conditions, Treatment, and Care of Residents with Dementia in Group Living-Based Care Facilities (Group Homes): Perspectives of Group Home Managers

By Takada, Junko; Sekita, Yasuyoshi et al. | Care Management Journals, October 1, 2014 | Go to article overview

Health Conditions, Treatment, and Care of Residents with Dementia in Group Living-Based Care Facilities (Group Homes): Perspectives of Group Home Managers


Takada, Junko, Sekita, Yasuyoshi, Meguro, Kenichi, Care Management Journals


Group living-based care facilities for patients with dementia (group homes [GH]) aim to support patients to live with dignity in a familiar environment in their community. However, although some residents may be cared for well, their dementing disease may be untreated because of insufficient differential diagnosis and a lack of consultation with specialists. We previously sent a questionnaire on the status of GH management to 550 facilities in Tohoku District to investigate the effects of the 2006 revision of Long-Term Care Insurance. This study is a secondary analysis performed to evaluate the relationship of health conditions in residents with treatment and care. The results showed that resident-related factors of "physical dysfunction" and "health care" were not related to medical factors of "working with a supporting physician" and "working with a supporting physician and nurse." Similarly, the resident-related factor, "progression of dementia," was not related to the medical factor, "working with a dementia specialist." However, significant relationships were found between "progression of dementia" and a care-related factor, "support for going out"; between a resident-related factor, "progression of abnormal behavior," and a medical factor, "hospital visit assistance"; and between care-related factors of "support of hobby activities" and "support for going out." This analysis was performed based on data from a survey of GH managers. We conclude that it is important for GH managers and medical staff to understand each other and work together to strengthen the link between treatment and care of GH residents.

Keywords: dementia; group home; medical cooperation

Dementia is in part defined as boke in Japan, a Japanese term different from the biomedical definition of dementia. As Traphagan (2006) reported, boke is conceptualized as a condition over which people may have some degree of control. By engaging in activities that involve physical and mental exertion within the framework of social gatherings which encourage interaction with others, it is widely believed that one may be able to delay or even prevent the onset of the condition. A social education on the difference between boke and dementia as a "disease" did positive effect for better understanding (Meguro, Ishii, & Sekita, 2002). However, apathy is frequently noted in cases of dementia because of concomitant cerebrovascular disease (Meguro et al., 2002; Nakamura et al., 2013). Such persons are often considered not to be demented but boke, defined loosely as "just an idle attitude."

Long-Term Care Insurance (LTCI) started in April 2000 in Japan, a mandatory system providing long-term care for older adults in need. The background of LTCI included decreasing birthrate and aging population, decreasing the aging of caregivers, increasing number of older adults needing long-term care, and the young generation's changing perspective on filial piety (Traphagan, 2006; Traphagan & Nagasawa, 2008). For these reasons, quite a few kinds of services are available (Ministry of Health, Labour and Welfare of Japan, n.d.).

Among the services are group living-based care facilities for patients with dementia (group homes [GH]). These aim to support patients in living worthwhile and peaceful lives in a smallscale and homelike environment in a familiar community, with particular attention paid to familiar relationships and each patient's lifestyle. The capacity of a GH is nine persons or less per unit, and at least one staffmember per three residents is allocated as full-time personnel. Staffmembers live together with residents (Ministry of Health, Labour and Welfare of Japan, 2013). More sensitive personal care in GHs improves behavioral and psychological symptoms of dementia (BPSD; Finkel, Costa e Silva, Cohen, Miller, & Sartorius, 1996) and helps with recovery from decreased daily activities (Meguro, 2008). A "person with dementia" is the current definition of a resident in a GH (Ministry of Health, Labour and Welfare Japan, 2006), but it is possible that dementia in residents who otherwise receive excellent care may remain untreated because of insufficient differential diagnosis of dementing illness and lack of consultation with specialists. …

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