This is a brief summary of their presentations in the seminar regarding group-home care to keep patient's life normal after suffering from dementia. The presentations were summarized and rewritten as below by our members. We are responsible for the content.

1) Comments by Ms. Stina Klala Hylstrom

The Vice President of the Swedish Dementia Society

Senile dementia starts from a slight failure of memory. A patient cannot remember why he comes to shop and what he wants to buy. He cannot find his way home. He cannot recognize his family members and even loses words. At first the family sacrificed themselves for the patient.Now we have to make highly developed programs of nursing for dementia.

Sweden has 15 years experience in a group-home implementation . The patients of dementia are refreshed in the group-home where they are able to live actively. It has become obvious that the period of living their lives with dignity will be prolonged. There is no more need for sleeping pills and tranquilizers. Also I know of a case where a patient stoped using diapers.

I want to see the patients' shining and smiling faces, on which satisfaction with their past happy lives is expressed.

There are many ways to care for the patients of dementia,but the nursing staff is most important. We need staff capable of reading a patient's inmost thought and being sensitive to the value of one's life. If I suffer from dementia, I would prefer to enter a group-home where good staff are employed, where the staff is sensitive to my life, rather than to live in one with big rooms / big kitchens.

Before the admission to the group-home, the patient must try to be as active as possible at home , taking advantage of homehelper's service, utilizing Day Service and Supporting Service of night the shift. When the stage of dementia exceeds the limit of family's supportability, then the patient is eligible to enter a group-home.

But it does not mean that all patients suffering from dementia are suited for living in a group-home. For a lot of patients it is impossible to have care there due to the stage of dementia. We must make appropriate plans to combine the merits of group-home with other facilities already existing.

Time flows slowly in a group-home. In a calm atmosphere, the patients finish daily works and act as they are as in a very common family house. The staff goes shopping with them and they prepare together for a meal. In other words, it is just like a pseudo family, it is no different from making a family.

As the stage of disease advances,the activities of patients decrease. In this satge, it is important to stimulate their nerves by imposing some role to each patient, by encouraging them with praise and by urging them to work together. As a result, their activities can be maintained.

In the group-home, all patients are assigned some role . A dance for those who likes to dance, the guitar for those who are skillfull in playing the guitar. There have been cases where the patient who cannot stand by oneself stands up and starts to dance when music begins.

A co-operative work assigned to the patient will be changed gradually to be simpler in accordance with his stage of dementia. They should not be cared for in a group but according to individual condition. Moreover, the care must be pleasant to them.

Though there is a distinct cultural difference between Japan and Sweden, the two countries confront the same problems in the field of dementia. Certainly there are common matters, which, if studied concurrently, can be solved quickly. I am sure it will be useful for solving problems regarding dementia if Japanese people deepen their understanding of experiences in Sweden.

This is my first visit to Japan and I am very much surprised to know that various programs have already started in Japan. When I find out how Japnease think about dementia, I am even jealous of their deliberate ways. Because the Swedish are egoistic. When I understood the Japanese care programs, I came to think that the Swedish must reflect on their way of life.

Education for nursing staff must be as fresh as milk. To continue such difficult work as nursing,it is essential to them.

The law obliges a would-be-staff-member to receive a 10 week training course. There is another way to become a nurse, learning by experience in practice. In our association, qualified nurses are to have received more than 2 years of education.

The patient who does not suit to care in the day-care center becomes a candidate for care in a group-home. They must be one who is able to feel the joy of living in several styles at a group-home. The most important matter is that the joy of the patient must be prolonged by the efforts of staff who work there.

If we can present patients with high standard care, they could live in a group-home until they die. If a patient becomes unable to feel the joy of living in group-home, then the responsibility of care would be passed on to a nursing home.

Nurshing home staff have a high standard of knowledge about dementia. As well as staff in group-home, staff in nursing homes must receive a high standard of education on nursing homes and nursing techniques.

The young must support the aged. the young must accept firmly that they will become aged in the future. Consequently it is important in our society to develop a system to support the patients of dementia.

It takes much time to develop such a complicated system, but Japanease people are endeavoring to do so

2) Comments by Mr. Solbey Freedel

Chief researcher of the architectual function analysis laboratory of the Swedish Royal Institute of technology.

A treatmet for dementia has not been established yet. But I believe that this situation will be amelliorated by the social environment. A big issue is how to build facilities that take into account patient's positions. It is said that a group-home is the best way to care for patients of dementia from a standpoint that the human rights of patient is highly esteemed .

A detached type group-home is preferable to a patient who has spent his life in a detached house. Also, there are condominiums in which all of the uppermost stories are provided as facilities for patients of dementia, who used to live in condominiums in urban regions.

In a group-home, it is desirable to provide for the patients circumstances that are the same as those they are used to. Moreover, it is most desirable that these group-home are located in a area where patients have lived. It is also good for them to live in rooms arranged as they were in their former residences.

In a group-home, one staff has charge of one unit consisting of six to eight patients. The staff lives with them under the 24-hour service system. Each of the patients is assigned a room with a toilet and a shower bath provided. Moreover, a kitchen, a sitting room , a washing room for common use and the a working room where the staff and the patients of dementia work together must be provided .

It is good for the patients to use furniture with which they are accustomed to. In addition, the staff room must be provided with a telephone and a desk .

When a toilet is visible, the patients will not miss it. Another important thing is the staff should not help the patients with their work when they are able to do by themselves.

Though a group-home is a facility which is founded to care the patients collectivly,each patient's privacy is respected. The patient will be furnished with a room similar to the one where he had lived. There are cases where married couples live together, while the husband is supporting his disfunctional wife.

The patients of dimentia never forget the old times of 1930's, 40's and50's, when they had lived most actively. When a talk goes far back in the old days, they become animated and their nerves are stimulated. Though they can't recall the occurences which happened not so long ago, they seem to firmly hold on to their memories of the times past of the decades when they lived actively. Therefore, in a group-home, furniture and interior decorations are provided in an effort to reflect an atmosphere of times past. Such a consideration is useful for nursing in rehabilitation.

If life in a group-home is kept similar to an environment of times in which they had lived, there are cases where the patient does not need to use sleeping pills or tranquilizers any more.

In 1989, when I first visited Japan, I felt Japanese spoke only of the bed-ridden aged. But this time, I visited many facilities and heard about their policies, and I rarely heard about the bed-ridden aged. It seems that great changes have come to Japan for the last four years.

It is natural that nursing should change to reflect a change of times and social change. I don't like the environment in 1940's.Of course I need a modern environment if I have senile dimentia.

For instance, the gtatamihmat is very meaningful to the Japanese aged of today, but the young might not take any particular interest in tatami when they become old. The environment will have changed.