2024 HAPI Japan Best Practice Winner
THE PROBLEM
Long-term care needs are increasing rapidly, but while there are many quantitative discussions about things like securing human resources and efficiency, there has been less discussion on the methods of carrying out care to improve the quality of life and quality of death for older people. It has been about 20 years since the long-term care insurance law was introduced in Japan, and as a result of actual trial and error in the field, many good practices have been accumulated regarding care provision and the creation of spaces for older people. In particular, excellent examples of dementia care and palliative care practices have attracted attention both in Japan and abroad, and many have been featured in the media. However, such practices are regarded as unique, and they have not yet been adequately analyzed and shared in a form that can be replicated in other settings.
THE INNOVATION
In 2014, researchers at Keio University worked with the Dementia Friendly Japan Initiative to launch the “Travel Words” project. They created a pattern language—a concept derived from architectural theory that looks for patterns that represent “elements which are a collective memory of things which work in our surroundings”—for living better with dementia. Following up on that, in 2018, they launched a project to create a pattern language for “mutual care.” The concept of mutual care looks at the practice of care and place creation by focusing on a relationship of “living together” rather than a relationship between “those who provide care and those who are cared for.” The pattern language method, which had not been used in the welfare field before, was a good match to support practices specific to this field that could not easily be captured in a manual.
The researchers developed a “thinking aid” for caregivers at eldercare facilities to share better care practices. These tools were introduced on site to verify their effectiveness and ensure that the outcome offered practical solutions. After conducting extensive workshops and training programs, the results of which were utilized to further improve the thinking aid, the research was published as a book, Words for Mutual Care: Tips for Home Care and Place-Building for Older People (in Japanese) and as a set of cards that offer prompts to think about basic elements of care, such as how to ensure that the care recipient, caregiver, and family members’ thoughts are all heard and respected, or ways to ensure that the individual still feels that they are contributing to the household in their daily life.
Users of the thinking aid reported that they utilized these methods and saw positive results. For example, caregivers reported, “When I asked if the client could wipe the dishes, they smiled and said, ‘Let’s do it.’” “I played music for one client who spends most of the time in bed, and they had a lively expression and talked about their favorite singers.” “By paying attention to that person’s thoughts and listening to what they were saying, we were able to help them go out and visit the places they remembered.” The introduction of this method has made it possible for nursing care workers to verbalize practical knowledge in concrete terms and utilize it in their daily work, which is a major factor in its success.
The project was shifted from the university research lab to an incorporated entity to try to scale up the initiative and disseminate the findings overseas as well.
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