This pillar aims to provide healthcare and long-term care services that can collaborate effectively and provide timely and appropriate services for each stage of dementia progression. This pillar is for replacing the system which responded to the Behavioral and Psychological Symptoms of Dementia (BPSD) and physical complications of dementia with hospitalization in medical institutions and nursing homes with a system that consistently provides appropriate services at suitable facilities with a specific focus on early diagnosis and prevention.

• Example 1: Training primary care doctors to improve their capabilities for responding to dementia

For people receiving healthcare, primary care doctors are reliable first points of contact for medical issues and are sources of advice on health concerns3. They can introduce people to more specialized medical centers when necessary. Prefectures and designated cities have implemented training programs for primary care doctors (who will specialize in various fields in the future) in order to improve their ability to respond to dementia and so that they can become mediators between people seeking healthcare and medical specialists.

This initiative aims to train 75,000 primary care doctors by 2020.

• Example 2: Training dementia support doctors

These doctors exist between primary care doctors and doctors specializing in dementia. This training project began in 2005 in hopes that these dementia support doctors can become drivers of regional cooperation. The training course is similar to the course for training primary care doctors and is centered on prefectures and designated cities. Dementia support doctors are not primary care doctors. The aim of the program is to train dementia support doctors who can be leaders in regional coordination efforts involving dementia specialists and specialized medical institutions.

This initiative aims to train 10,000 dementia support doctors by 2020.

• Example 3: Establishing medical centers for dementia

These medical institutions will be bases for the dementia medical provider system within communities. They will provide differential diagnoses and other diagnoses. Dependent on their function, their number of hospital beds, and the doctors working there, these centers are divided into three categories: Basic, Community, and Clinical. All three types will have medical facilities for providing comprehensive examinations related to differential diagnosis.

This initiative aims to establish 500 medical centers for dementia with at least one center in all secondary medical areas.

• Example 4: Establishing the Initial-phase Intensive Support Team system

These teams consist of several specialized professionals including doctors and nurses. They support independent living by visiting people with dementia and people who are suspected of dementia (upon family request) to assess their condition and provide comprehensive and concentrated initial support to the families. This initial-phase support is provided for approximately six months. This system has been established in every municipality as of 2018.

• Example 5: Establishing dementia care pathways

Dementia care pathways show which services are appropriate to provide according to the condition of the person with dementia. Every municipality is responsible for establishing such pathways. This initiative aims to understand local resources to build seamless support frameworks and cross-occupational, coordinated frameworks that take both the stage to which the condition has progressed and the disease timeline into account.

• Example 6: Training community dementia support promoters

Because community dementia support promoters fulfill a central role in efforts to construct healthcare and long–term care support networks, improve dementia response capabilities, and provide advisory support, they have been established in each municipality. To become a promoter, one must be a medical or welfare professional or have one’s level of knowledge and experience recognized by the municipality as equal to a professional.

In addition to the issues that are common among elderly people with dementia, people with early-onset dementia face hurdles in maintaining employment and daily living as well as providing support for their children. To provide people with early-onset dementia with support that is more well-suited to them, counseling service counters for people with early-onset dementia and their families were established in every prefecture. Support for the families of people with early-onset dementia, their care workers, and the companies that employ them is essential.

• Example 1: Establishing the national early-onset dementia call center was established and training early-onset dementia coordinators

• Example 2: Publishing and distributing handbooks and guidebooks on early-onset dementia

Because providing direct support for dementia caregivers will improve the quality of life for people with dementia, the physical and mental burdens placed on the people providing care to people with dementia must be reduced.

• Example 1: Holding events called “Alzheimer Cafés”

These café-based events have been set up all over the country to provide places for people with dementia and their families to share information and exchange opinions with the community, their supporters, and specialists. Although they are mainly held by community comprehensive care centers, in some cases, they are held by local NPOs and private enterprises that have started initiatives in elder support.

Communities that are friendly to elderly people including people with dementia can be promoted by establishing systems to provide support for daily living as a soft goal and by constructing comfortable environments to live in as a hard goal. Fulfilling these goals will make it easier for the people receiving support to participate in employment and in society.

Elucidating the causes of dementia and the mechanisms of BPSD will promote research and development on prevention, diagnosis, cures, rehabilitation models, and care models for dementia.

In all the initiatives listed above, the perspectives of people with dementia and their families are to be prioritized. To this end, people with dementia and their families have participated in meetings on dementia held by the national government and local governments in recent years. In addition, opportunities for people with dementia and their families to be involved in community-building activities have increased in several regions. One example of these activities are special conferences where people with dementia discuss experiences and challenges together with other people with dementia.