[Care and nursing in remodeling long term care insurance].

Long term care insurance was changed in 2006. The main purpose of remodeling is to support preventive care and to develop community comprehensive care center and community based services. Community based services are composed by group homes, night care services, small multi-function complex care services, day care services for dementia, satellite nursing homes. Preventive care in long term care insurance is composed of muscle training, oral care and improvement of nutrition. Visiting nurse services can provide day care at nurse stations. These arrangements are strongly expected to support care workers and visiting nurses. An assessment for dementia, Center version was developed by the Tokyo Center for Dementia Care Training and Research. It is intended to lead to person-centered care for elderly people with dementia. An act to prevent abuse of the elderly has been started in 2005. This was established to protect the property of the elderly, even if they might have cognitive dysfunction. A support doctor system has been started to educate primary care doctors and to make early diagnosis for dementia. These changes are expected to provide better care for old people.

[Reconstruction of the long term care insurance system in Japan].

The Japanese long term care insurance has started since 2000. After 5 years' experience, it is scheduled to change in 2006, the most important point is preventive care which means to stop the deterioration of ADL or cognitive function. Prevention is thought to be best way to cut the cost of care services. The preventive care system will start in April, 2006, over 1 million people with supportive care needs will receive muscle training or oral care and nutritional support from care workers in the community. New comprehensive community centers will open and these should which make assessments for preventive care, and provide consultations for care givers and families, and comprehensive care management in the community, and protect the dignity of the elderly will newly start. To improve quality of care services is important, and each prefecture has to evaluate all services and to publish the data with internet, so that everybody can see it and select the most appropriate care or company. Also, the government will start a new system of community based services including group homes, small and multifunctional care services, and day care services for people with dementia. These services should have one room available for each individual.

Effectiveness of a clinical pathway for the diagnosis and treatment of dementia and for the education of families.

AIMS: Clinical pathways (CPs) are rarely used in the treatment of dementia. We established a CP for a series of medical practices (diagnosis, treatment, establishment of a care system, and caregiver education) for patients with dementia hospitalized for a three-week period, and evaluated its usefulness. METHODS: The length of hospital stay and hospital costs were compared between 23 consecutive patients with dementia hospitalized and treated using a CP and 20 controls treated by conventional medical practice without using a CP in a special ward for dementia patients. In the CP group, at the time of discharge, primary caregivers, physicians, and nurses were given a questionnaire to obtain their comments about the impression of treatment with the CP. RESULTS: The questionnaire survey indicated that the CP deepened the caregiver's understanding of the sequence of medical practices for the inpatient, the disorders of the inpatient, the treatment methods, and the methods for coping with the disorder. The CP was also useful for facilitating inpatient medical practice and promoting the establishment of a care system after discharge. The use of the CP significantly shortened the length of hospital stay and decreased hospital costs during hospitalization but increased the amount of work per day and made the medical staff feel that their freedom to choose medical procedures had been restricted. CONCLUSIONS: The CP was useful for execution of inpatient medical practices for patients with dementia.