HGPI Policy Column No. 12 From the Dementia Policy Team – Working Towards New Daily Routines
date : 6/29/2020
• We have now entered a phase in which we must develop new daily routines for living in the post-COVID-19 society.
• Dementia policy must be updated to reflect the new realities of everyday life.
• COVID-19 demonstrated the importance of two key dementia care values to all of society: deciding one’s affairs independently and focusing on the things one can do.
Movements Towards Establishing New Daily Routines
Novel coronavirus (COVID-19) infections started spreading in Japan in March 2020 and have caused great changes to our everyday lives. To respond to the growing pandemic, the Government issued a nationwide state of emergency on April 16, 2020, setting every region and municipality of Japan as the target for special emergency measures and signaling the beginning of unfamiliar routines for everyone. We were asked to avoid unnecessary and non-essential outings and comply with strict measures for telework while various businesses were suspended, starting with eating and drinking establishments. Unfamiliar sights started appearing in every region in Japan and we lived with a continuous sense of unease.
Then, on May 21, 2020, the nationwide state of emergency was lifted. Certain periods for movement were established, requests to shelter-in-place were relaxed, restrictions placed on facility use were removed, and it was decided that there would be a gradual return to the normal level of socioeconomic activity. To balance infection-preventing measures and maintain socioeconomic activity while preparing for the second and third waves of infections, we have had no choice but to establish new everyday routines. It is safe to say that instead of returning to our previous, familiar routines, we are now in the process of adapting to a new normal.
Changes in the Environment Surrounding Dementia
In response to the current circumstances, HGPI and the Designing for Dementia Hub co-hosted a special online seminar entitled “Considering the Effects of the COVID-19 Pandemic on the Lives of People with Dementia” on May 29, 2020. As we expect to continue feeling the effects of the pandemic for some time, we held this special seminar to provide people with dementia, their family members, and care providers an opportunity to share their current circumstances to start discussions on the appropriate measures that will be required from government, industry, academia, and civil society.
Starting with people with dementia, we invited various stakeholders in the field of dementia to speak at this meeting. After they reported on the current situations that COVID-19 has placed them in, we held a discussion on the best way to structure society moving forward. We believe the reason these participants could come together at the same time for a discussion despite their extremely busy schedules was because the meeting was online.
For details concerning that seminar, please keep an eye out for the event report which will soon be published on the HGPI website. In addition to the summary, we will also take this as an opportunity to provide more details about the situation in Japan to the rest of the world by sharing a video of the meeting with Japanese audio and English subtitles for everyone who was unable to participate on the day of the event.
Visualizing Dementia Policy in Society After COVID-19
As part of the effort to create new daily routines, various related policies must be updated, including policy for dementia. There are many points that must be reconsidered to define our everyday lives moving forward, particularly efforts we have emphasized in the past like maintaining close interpersonal contact and holding large community gatherings.
For example, one item to reexamine is the best way to hold regular community gatherings. The Framework for Promoting Dementia Care that was presented in June 2019 said, “Increase participation for regular community gatherings, which are considered beneficial for preventive care, by around 8%,” establishing their importance within the dementia framework. This was meant to promote efforts that are beneficial to preventive care and that can be provided independently by civil organizations at locations like community centers and parks. However, the current circumstances facing society force us to create physical space between each other and prevent us from gathering in large groups. To help ease this situation, the Government immediately allocated 400 million yen for “Communication and ICT support for preventive care measures to replace regular community gatherings when shelter-in-place requests are in effect” in the first supplementary budget for FY2020. A translation of the relevant section of that budget is provided below.
Communications and ICT support for preventive care measures replacing regular community gatherings while shelter-in-place requests are in effect – 400 million yen
While engaging in activities to publicize information needed by elderly people who have fewer opportunities to participate in regular community gatherings while at home due to the COVID-19 pandemic and other causes to help maintain health (for topics such as exercise or social exchanges), improve functions supporting regular community gatherings such as exercise management tools that include functions that support outdoor walking and similar activities, smartphone use for elderly people, and applications with guidance functions and similar functions.1
Examining information about each municipality, it seems to me that most of these efforts are currently focused on introducing video guides for home exercises. Supplementing these efforts with effective use of online tools in the future will have the potential to help people develop deeper interpersonal connections than before. (Please note that the Ministry of Health, Labour and Welfare published guidelines for resuming regular community gatherings for event operators and participants on June 4, 2020. 2)
In terms of healthcare policy, another point we must keep in mind right now is the expansion of online medical examinations. On April 10, 2020, the administrative circular presented by the MHLW loosened time restrictions and granted special exemptions concerning the use of online medical consultations within healthcare institutions and pharmacies. Expectations for the use of online medical examinations after society is no longer constrained by COVID-19 are high. Combining online services with normal, face-to-face medical examinations will allow for even more points of contact to be created between people with dementia and professionals from various disciplines. In addition to examinations conducted by physicians, allowing for a multidisciplinary approach that includes professionals such as clinical psychologists and certified psychologists, mental health professionals, nurses, and welfare specialists might make it possible to provide even better support. We look forward to future opportunities to conduct hearings with people with dementia or their families that have used online medical examinations and to advance the creation of implementation frameworks or model enterprises for online medical examinations.
Transitioning to an Era in Which Society Keeps up with Trends in Dementia Care
The recent discussions held on the situation surrounding COVID-19 reminded us once again how important it is for us to independently decide our own daily routines and behaviors. The fact we were so accustomed to enjoying various freedoms like going out when we wanted to go out and seeing who we wanted to see that we took those freedoms for granted has been thrust into the forefront.
During our online seminar, one of the speakers said, “We must not focus on what we can no longer do because of COVID-19. Instead, we should focus on what we can do right now.” We must focus on new possibilities that are opening up before us and continue the activities we can continue as we undertake various endeavors to define a new normal. Everyone in the world is doing their best to find how they can do that and to uncover new possibilities.
Taking a look back, everything we mentioned here was also mentioned when people with dementia and other related parties shared the situations they are facing due to COVID-19. Experiencing COVID-19 might allow society to finally catch up to current trends in dementia care.
1 Ministry of Health, Labour and Welfare. 2020 “The Outline of the Supplementary Budget of the Ministry of Health, Labour and Welfare (MHLW) of Fiscal Year 2020.” Last retrieved June 22, 2020. https://www.mhlw.go.jp/wp/yosan/yosan/20hosei/
2 Ministry of Health, Labour and Welfare, 2020. “Guidance for the Novel Coronavirus Prevention for the Elderly – 4. Resuming Visits to Regular Community Gatherings.” Last retrieved June 22, 2020. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hukushi_kaigo/kaigo_koureisha/yobou/index_00013.html
About the author
Shunichiro Kurita (HGPI Manager; Steering Committee Member, Designing for Dementia Hub)