ILC-Japan Hypothetical Cases 2017

As a research project commissioned by Japanese Ministry of Health, Labour and Welfare, we are
conducting a study to compare long-term care schemes and support for older people in Japan and in
other countries. In this study, we are exploring ways to promote empowerment of older people rather than
comparing the number or volume of services.
We would appreciate if you could read the 4 hypothetical cases regarding older people in the following
pages then answer the following 3 questions regarding each case.
We understand that systems are quite different from one country to another, which may make it difficult
for you to answer some of the questions. Yet, we will appreciate your response, to the extent possible,
regarding what kind of support each of these people, described in the hypothetical cases, might
experience based on your own experience.
Since this study is on long-term care schemes, you do not need to write about medical treatment by
doctors for cure. However, please include the information on the following: rehabilitation services, training
services for older people who are at risk of becoming or already being frail, services by local volunteers,
activities by older people themselves to build networks, and advice provided to older people.
As for the Cases 2, 3 and 4, we would appreciate if you could also provide information on whether
and how the consultation process and/or services might differ if the older person had dementia.
Please also indicate in your response if you would like your name or organization cited the final report,
or if you prefer to remain anonymous.

<Questions>
1. Consultation
(1) Where would this person go first for consultation?
(2) After the initial consultation, what would the process look like until he/she starts receiving
services (or what would the process look like until it is determined that he/she would not receive
services)?

2. Service delivery
(1) What kind of formal services and informal support do you think this person would be able to
receive? (excluding medical services by hospitals, family doctors, etc.)
(2) When this person receives services/support, who/what organization would conduct his/her
needs assessment, and who/what organization would decide on the content of
services/support?

3．Monitoring

(1) Who would conduct this person’s monitoring and how?

1
1．(Case 1) Becoming frail

Case 1 (Support Level in Japan)

Mrs. A is 80 years old. She has no child, and her husband passed away 5 years ago. She has no sign of
dementia. Her economic status is about the average in the community.
She visited a cardiologist 5 years ago because of dizziness; she was diagnosed with hypertension. She
has been taking medication since then but sometimes forgets to do so. Three years ago, she visited an
orthopedist because of foot numbness; she was diagnosed with spinal stenosis. The doctor told her that
surgery could be done, but she declined because she was scared. Recently, she tends to stay at home,
withdrawn from social life. While she can generally take care of herself, while slowly, it is becoming more
and more difficult to cook and clean the house. She is not currently using any service, but she started
making comments to other people like, “I used to do so many things. But now, gradually, I can’t do them
anymore.”
She keeps going to her chorus club (her hobby) once a month.

Partially
Independent Dependent Note
dependent
Slightly declining (pre-frail).
Decline of muscle
(e.g., she sometimes falls and
strength
gets caught in a carpet.)
May be at risk in the future.
Health
Nutritional status Partially yes Tries to eat healthy, but some
nutrients are insufficient.
Oral health,
swallowing
Rolling over Yes
Getting up Yes
Transferring Yes
ADL Walking Yes
Eating Yes
Bathing Yes
Toileting Yes
Cooking Partially yes
Can clean shelves but cannot
Cleaning Partially yes
wipe floors
Doing laundry Yes
IADL Moving around Yes
Going out Yes
Using a phone Yes
Managing money Yes
Managing medication Yes
Communication Can communicate Yes
Family’s capacity Live with/near/far from
None
to care the person
Social interaction She participates in a club activity. Some interaction.
Economic status Average
Medical conditions Spinal stenosis and hypertension

2
2．(Case 2) Becoming more difficult to go out

Case 2 (Care Level 1 in Japan)

Mr. B, aged 75, lives by himself at home; his wife passed away 2 years ago. The right side of his body is
paralyzed due to a stroke he had 1.5 years ago. He manages to go out with a cane. He needs some help
in bathing, such as taking off/putting on clothes and washing hair.
He used to enjoy exercising with friends at a park in the neighborhood, but he doesn’t go there anymore.
The oldest son lives in another prefecture, who visits Mr. B about once every 2 months. Mr. B’s economic
status is about the average in the community.
Partially
Independent Dependent Note
dependent
Decline of
muscle Declining strength
strength
Health Nutritional Tries to eat healthy, but some
status nutrients are insufficient.
Oral health, No problem so far, but he sometimes
swallowing chokes when not being careful.
Rolling over Yes
Can perform if he holds something for
Getting up Yes
support
Transferring Yes
Can go out w/ a cane. May need
Walking Partially yes someone to accompany him
ADL depending on where he goes.
No problem so far, but he sometimes
Eating Yes
chokes when not being careful.
Can be independent w/ home
Bathing Yes
renovation or assistive devices
Toileting Yes Can be solved w/ home renovation
Complex cooking is difficult. Can use
Partially
Cooking Yes a microwave and do simple cooking
yes
(e.g., heating, grilling)
Complex movement is difficult.
Partially
Cleaning Yes Difficult to bend over (losing balance)
yes
but can do simple cleaning
Complex movement is difficult. Uses a
Partially
Doing laundry Yes tool to hang washed clothes. Can only
yes
do simple tasks
IADL Can go out w/ a cane. May need
Moving around Yes someone to accompany him
depending on where he goes
Cannot use public transportation to go
Going out Yes
out. Can ride a car but cannot drive
Using a phone Yes
Managing
Yes
money
Managing
Yes
medication
Can
Communication Yes
communicate
Dementia No. Mild to moderate dementia in an alternative scenario.
Live with/near/far from the
Capacity to care None
person
Social interaction Little
Economic status Average
Medical conditions Paralysis due to a stroke. He goes to the doctor.

3
3. (Case 3) Becoming more difficult to live alone
Case 3 (Care Level 2 in Japan)

Mrs. C., aged 88, lives by herself at home; her husband passed away 3 year ago.
Since she was diagnosed with gonarthrosis 2 years ago, she has visited her doctor to treat symptoms.
However, her pain has gradually gotten worse. Now, she can do little housekeeping, and her daughter, who
lives close by, has provided support. Yet, the burden on the daughter is growing. Mrs. C also has diabetes,
but she takes medicines to control the condition. While she hopes to keep living at home, she now needs a
lot of help in daily living.
The oldest daughter lives in a neighboring town, but she works outside and visits Mrs. C about once a week.

Partially
Independent Dependent Note
dependent
Decline of muscle
Declining strength
strength
Nutritional status No problem
Health
Lost some Tends to choke due to loss of
Oral health,
teeth, cannot teeth and decline of the
swallowing
chew well swallowing reflex
Rolling over Yes
Getting up Yes
Transferring Yes
Walking Yes Partially yes
Eating Yes
Muscle strength started declining.
Unsteady due to knee pain.
ADL Bathing Yes Partially assisted while also using
assistive devices (shower chair,
etc.)
Needs
Muscle strength started declining.
assistance
Unsteady due to knee pain. Needs
Toileting when
monitoring and some assistance
transferring
when transferring
to a toilet
Cooking Yes
Difficult to move her body. Can do
Cleaning Yes simple tasks while sitting (wiping a
Doing laundry Yes table, simple cooking, etc.)
Moving around Yes
IADL Difficult to go out. Cannot use a
Going out Yes
mobility scooter
Using a phone Yes
Managing money Yes
Managing medication Yes
Communication Can communicate Yes
Dementia No. Mild to moderate dementia in an alternative scenario.
Family’s
Live with/near/far
capacity to Some
from the person
care
Social
Less interaction due to difficulty in going out
interaction
Economic
Average
status
Medical
Gonarthrosis, diabetes
conditions

4
4. (Case 4) Being somewhat difficult to live at home

Case 4 (Care Level 3 in Japan)

Mrs. D, aged 80, currently lives with her husband, who devotes himself to all the housework and care.
She was diagnosed with diabetes 15 years ago, and her condition has gradually worsened. Currently, she
has chronic renal failure (she needs dialysis 3 times a week), diabetic nephropathy, hypertension and
other conditions. In addition to her old age, osteoarthrosis in both knees, lumbar spondylosis and
osteoporosis are also becoming a burden. She falls more frequently even at home, and she does not go
out as much as she used to.
The oldest son lives separately but visits them once a month.

Partially
Independent Dependent Note
dependent
Declining strength. Sometimes
Decline of muscle
loses strengths suddenly
strength
(unconsciously)
Health? Declining. Tends to get
Nutritional status
dehydrated
Oral health,
Yes Cannot swallow due to paralysis
swallowing
Rolling over Yes
Getting up Yes
Transferring Yes Partially yes
Cannot keep standing. Difficult to
ADL Walking Yes
walk without support
Eating Partially yes Yes Can sit
Bathing Yes Cannot step over the bathtub
Toileting Partially yes Needs assistance in toileting
Cooking Yes
Cleaning Yes
Doing laundry Yes
Moving around Yes
Partially Can sit on a wheelchair by herself
IADL Going out Yes
yes if the seat moves
Using a phone Yes
Managing money Yes
Managing
Yes
medication
Somewhat
Communication Can communicate
difficult
Dementia No. Mild to moderate dementia in an alternative scenario.
Capacity to
Some
care
Social
Only when her family members take her out.
interaction
Economic
Average
status
She has a lot of pressure sores and edema (because she always sits). Her heart is also weakening
Medical
(because she doesn’t move much). Her diabetes is also difficult to manage (visiting nurses are
conditions
needed).