Interprofessional Work Model for Dementia Care in Hospitals for Community-Based Care

Full text

Health, 2020, 12, 1543-1561
https://www.scirp.org/journal/health
ISSN Online: 1949-5005
ISSN Print: 1949-4998
DOI:
10.4236/health.2020.1212112 Dec. 17, 2020 1543 Health
Interprofessional Work Model for Dementia
Care in Hospitals for Community-Based Care
Kenji Hamabata1,2*, Hideyuki Shiotani1, Keiko Sekido3
1Graduate School of Health Sciences, Kobe University, Hyogo, Japan
2School of Nursing, Jichi Medical University, Tochigi, Japan
3School of Nursing, Kyoto Prefectural University of Medicine, Kyoto, Japan
Abstract
In this manuscript the authors have studied interprofessional work model
for dementia care in hospitals for community-based care. As present situa-
tions and problems of dementia patients in hospitals for community-
based
care, 8 core categories (19 categories) were extracted and as actual situa-
tions of interprofessional work for dementia care, 8 core categories (13 cat-
egories) were obtained. The authors examined a function of interprofes-
sional work model and practice contents using these categories. The results
revealed that better interprofessional work can be expected by six specialists
of nurses rehabilita
tion specialists, MSW, pharmacists, dietitians and care
workers developing dementia care based on “Family handling function”
“ADL maintenance and improved function” “Staff member education and
empowerment function”.
Keywords
Dementia Care, Interprofessional Work Model
1. Introduction
According to the information data of Ministry of Internal Affairs and Commu-
nications [1], the population of elderly in Japan as of 2020 is 36,170,000 and the
ratio among the total population became 28.7%. This is a record-high number,
and it is known that the post-baby boom generation reaches the latter-stage el-
derly person of 75 years or older in 2025. As a measure for these social present
situations in Japan, Local Medicine Plan [2] was considered and developed in all
prefectures based on Act on Promotion of Comprehensive Securing of Medical
Care. The Regional Medicine Plan is intended to build up appropriate local
How to cite this paper: Hamabata, K.,
Shiotani, H. and Sekido, K.
(2020) Inter-
professional Work Model for Dementia
Care in Hospitals for Community
-
Based
Care
.
Health
,
12
, 1543-1561.
https://doi.org/10.4236/health.2020.121211
2
Received:
November 7, 2020
Accepted:
December 14, 2020
Published:
December 17, 2020
Copyright © 20
20 by author(s) and
Scientific
Research Publishing Inc.
This work is licensed under the Creative
Commons
Attribution International
License (CC BY
4.0).
http://creativecommons.org/licenses/by/4.0/
Open Access

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1544 Health
medical provision systems, and the number of required hospital beds is ex-
amined by classifying medical functions into highly acute phase, acute phase,
recovery phase and chronic phase. Local Medicine Plan Adjustment Meeting [3]
was launched in 2017, and the committees consisting of medical group repre-
sentatives from the local communities, medical institution managers, local gov-
ernment and insurer have discussed the above issue so far. Furthermore, hospit-
als for community-based care have been founded in accordance with the revi-
sion of medical service fees in 2014, and Hospital Fee and Hospital Treatment
Management Fee (hereinafter called Hospital Fee/Management Fee) I and II
were established. The increase in elderly to whom conventional acute phase
medical service is not adapted and the presence of elderly who require discharge
support through rehabilitation influence it in its background [4]. Roles in ac-
ceptance of patients after acute phase, support at the time of sudden change of
home care patients and support for patients who return home are required for
hospitals for community-based care. In particular, the support for patients who
return home has come to be performed through two phases of in-hospital and
local multi-job-title collaboration [5]. The in-hospital multi-job-title collabora-
tion assumes rehabilitation, eating function therapy, mouth care, nutrient in-
struction, dementia care, drug reduction adjusting, patient compliance instruc-
tion, discharge support and adjustment. In the local multi-job-title collabora-
tion, medical social workers (hereinafter called MSW) and care managers ar-
range home care service that enables patients to return home and resume daily
life. In this way, multi-professional collaboration is essential for hospitals for
community-based care, and its role in support for patients who wish to return
home is important. Medical service fees were also revised in 2018, and the hos-
pital fee and management fee of the hospitals for community-based care were
classified into four phases. In this revision, the home return rate was not
changed from 70% while the home return support was confined to Hospitaliza-
tion Management Fee I and II at the present. A final report on the present situa-
tion of the hospitals for community-based care has been submitted from Japa-
nese Association of Hospitals for Community-based Care [6]. According to their
inpatients survey, their average age was 76.6 years old, and their main diseases
were various such as musculoskeletal system, respiratory system, injury, burn
injury, poisoning, digestive system disease, kidney and urinary system diseases
and so on. The hospitals for community-based care aim to achieve patients’ dis-
charge within 60 days, though there is a concern that addition for dementia care
and nursing staff night assignment might make it difficult to treat their main
diseases. In particular, when acquiring the addition, dementia patients needing
care accounts for a half or more for Dementia Care Addition I, and the ratio of
dementia patient is to be more than 30% to acquire the addition for nursing staff
night assignment. In this way, since the hospitals for community-based care
were launched in 2014, actual scenes of discharge support for dementia patients
and their families presumably have become complicated. Further, Horinouchi
et

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1545 Health
al
. [7] reviewed literature from 2016 through 2019 for the trend of studies on
hospitals for community-based care. The study purposes of the literature they
had examined focused on discharge support, outcomes, readmissions, stress and
growth of the nursing professions, usability of the hospitals for communi-
ty-based care and pharmacists and so on. Therefore, this study analyzed the
present situations and problems of the dementia elderly hospitalized in wards
for community-based care and the qualitative data collected from reality of col-
laboration and cooperation for dementia elderly care, aiming at clarifying inter-
professional work model for dementia care.
2. Term Definition
Interprofessional work model: A team for dementia care, consisting of all sorts
of specialists including nurses, full-time rehabilitation specialists who are to be
assigned to the wards and staff members in charge of supporting home return
(MSW).
3. Method
3.1. Subject and Data Collection Method
For hospitals that the subject patients belong to, the authors selected hospitals
having 200 beds or less that acquired Hospital Fee/Management Fee I for the
hospitals for community-based care and Dementia Care Addition II. The reason
why the above hospitals were selected was that it would probably be possible to
reveal the real conditions of dementia patients who returned home in hospitals
that acquired Hospital Fee/Management Fee I. Furthermore, it was supposed
that the hospitals that acquired Dementia Care Addition II worked on dementia
care actively aiming at the acquisition of Dementia Care Addition I. For these
reasons, the present situation and problems of dementia care and multi-job-title
collaboration are visualized by discussion by plural different professionals
working in the hospitals for community-based care, which enables us to explore
interprofessional work model, we presume. Focus group interviews (hereinafter
called FGI) were performed for plural professionals in three hospitals in which
permission was obtained from their hospital presidents, senior nursing officers
and general chief nurses. Conditions for selecting subjects were arranged so that
nursing professions, rehabilitation specialists and MSW who were determined to
be assigned to wards for community-based care would participate in the study.
Decision for participation of specialists other than the above was entrusted to the
hospitals. The participants were 7 workers from 6 job titles in Hospital A, 5
workers from 4 job titles in Hospital B and 7 workers from 6 job titles in Hospit-
al C. The participants discussed on the interview items “The present situation
and problems of dementia elderly hospitalized in hospitals for community-based
care” and “Reality of collaboration and cooperation of dementia elderly care” for
60 - 80 minutes. We asked the hospitals to set the place for discussion and quiet
private rooms were selected. The data collection period was from December 4,

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1546 Health
2018 to March 15, 2019. The subjects’ basic attributes collected were job title,
gender, age, years of experience in the job title, years of experience in hospitals
for community-based care.
3.2. Data Analysis Method
The contents obtained in FGI were recorded verbatim, and the contents that
corresponded to the interview items “The present situation and problems of de-
mentia elderly hospitalized in hospitals for community-based care” and “Reality
of collaboration and cooperation of dementia elderly care” were extracted. First,
meaning of the data extracted from the three hospitals was read for each of the
hospitals and the contents were coded. Furthermore, similar codes were summa-
rized and categories were extracted. Moreover, core categories were extracted by
integrating the categories and codes extracted from the three hospitals. For the
analysis, we asked two study participants to check analysis results to secure
stringency and certainty. Further, it was necessary to examine the analysis
process for reaching core categories and therefore our study was supervised by
nursing researchers familiar with qualitative studies so as to raise the validity.
3.3. Ethical Consideration
The participants were explained about the study contents including the study
purpose, and were informed that participation in the study was based on free
will and they had a right to reject the participation both orally and in document
form before the interviews. Further, they were informed that the data would not
be used for the purposes other than those of this study, handled carefully and the
study results would be presented at conferences and published in magazines
with their personal information protected. Based on the above, consents were
obtained in document from the participants. Further, conversation in FGI was
recorded with an IC recorder upon agreement made beforehand. At the inter-
views, number cards were put on a table or a desk, and they call each other by
the numbers during the conversation to secured anonymity. This study was ap-
proved by the Ethics Committee of Kobe University Graduate School of Health
Sciences (approval number 418-1).
4. Results
4.1. Outline of the Hospitals
As shown in Table 1, for all of the three hospitals, four years passed since the
establishment of words for community-based care, they acquired “Hospital
Fee/Management Fee I” and “Dementia Care Addition II”.
4.2. Outline of the Study Subjects
As shown in Table 2, 19 study subjects were employed, and they consisted of 5
nurses (26.3%), 4 MSWs (21.1%), 4 rehabilitation specialists (2 physical therapists
and 2 occupational therapists) (21.1%) and 3 pharmacists (15.8%). In addition,

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1547 Health
Table 1. Outline of the subject hospitals.
Hospital
Hospital A
Hospital B
Hospital C
Region
Tohoku
Kanto
Hokkaido
Years since the establishment of the hospital for community-based care
4 years
4 years
4 years
Hospital fee and hospital treatment management fee 1 for hospitals for community-based care
Acquired
Acquired
Acquired
Dementia care addition 2
Acquired
Acquired
Acquired
Interview time
59 min 05 s
80 min 06 s
80 min 41 s
Number of job titles
6 job titles
4 job titles
6 job titles
Number of participants
7
5
7
Table 2. Outline of the study subjects.
Hospital A
Staff A
Staff B
Staff C
Staff D
Staff E
Staff F
Staff G
Job title Nurse MSW MSW PT OT Pharmacist
Clinical
technologist
Gender
Female
Female
Female
Male
Female
Female
Female
Age
40’s
50’s
30’s
30’s
40’s
40’s
40’s
Years of experience in the job title
25 - 30 yrs.
25 - 30 yrs.
5 - 10 yrs.
5 - 10 yrs.
10 - 15 yrs.
20 - 25 yrs.
25 - 30 yrs.
Years of experience in the ward for
community-based care
4 yrs. 4 yrs. 4 yrs. 4 yrs. 4 yrs. 4 yrs. 4 yrs.
Hospital B
Staff H
Staff I
Staff J
Staff K
Staff L
Job title
Nurse
Nurse
MSW
PT
Nurse
Gender
Female
Female
Female
Male
Female
Age
50’s
40’s
40’s
50’s
30’s
Years of experience in the job title
25 - 30 yrs.
25 - 30 yrs.
20 - 25 yrs.
30 - 35 yrs.
5 - 10 yrs.
Years of experience in the ward for
community-based care
4 yrs. 4 yrs. 4 yrs. 4 yrs. 4 yrs.
Hospital C
Staff M
Staff N
Staff O
Staff P
Staff Q
Staff R
Staff S
Job title
Nurse
Nurse
MSW
OT
Pharmacist
Dietitian
Care worker
Gender
Female
Female
Male
Male
Female
Female
Female
Age
40’s
30’s
30’s
40’s
60’s
40’s
50’s
Years of experience in the job title
10 - 15 yrs.
10 - 15 yrs.
10 - 15 yrs.
10 - 15 yrs.
35 - 40 yrs.
15 - 20 yrs.
20 - 25 yrs.
Years of experience in the ward for
community-based care
3 yrs. 3 yrs. 4 yrs. 4 yrs. 4 yrs. 4 yrs. 4 yrs.
*MSW (medical social worker), PT (physical therapist), OT (occupational therapist).
1 dietitian, 1 clinical technologist and 1 care worker participated in the study.
Their gender composition was 4 males 15 females and 9, 5, 4 and 1 subjects were
of 40’s, 30’s, 50’s and 60’s, respectively. The years of experience in their job titles
and those in wards for community-based care are as shown in Table 2.

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1548 Health
4.3. Contents of “The Present Situation and Problems of Dementia
Elderly Hospitalized in Hospitals for Community-Based Care”
The extracted core categories, categories, codes and law data are indicated with
[ ], < >, << >>, and “ ”, respectively. Eight core categories, 19 categories
and 42 codes were obtained by integrating the codes and the categories obtained
from the three hospitals. The extracted core categories were [Words for com-
munity-based care becoming complicated], [Difficulty of dementia care], [Fam-
ily who cannot understand dementia], [Difficulty of discharge support], [Lack of
required energy amount], [Difficulty of adjustment of medicine], [Dilemma re-
garding ethical problems such as suppression] and [Disincentive of interprofes-
sional work]. The details of the categories and codes are as shown in Table 3.
[Words for community-based care becoming complicated] consists of <<Treat-
ment of the main disease can hardly progress in a dementia patient>> and
<<Diagnosis and treatment of dementia to be performed by a physician remain
unclear>>, and <Treatment of both the main disease and dementia is required>.
Further, as for the addition in medical fee, the codes <<Thirty percent of hospi-
talized patients show dangerous behaviors, and do not understand instructions
and therefore their social hospitalization is increasing>> and <<Home return is
difficult in the case of 60-day hospitalization>> were obtained and one subject
narrated “You know, you need to make a cast for a brace and it would take 3 to 4
weeks to revise it... it would be too short if we try to have rehabilitation for 7
weeks, for instance”. Here, <Dementia patient case harder than expected> is
added to the above, and <<Being unable to be discharged worsen the dementia
as an another hurdle to be cleared>> is obtained. Furthermore, the comment
<<Respite and social hospitalization are seen because of the priority given to
treatment, and the ratio of dementia patients rises>> was obtained. For [Diffi-
culty of dementia care], <Dementia patients who are confused> has been sug-
gested, as seen in <<The patient themselves cannot be aware of dementia of
them>> and <<The patient cannot accept themselves becoming unable to un-
derstand and become unable to make decisions themselves>>. Furthermore,
<<Diagnosis for dementia classification is difficult, and the patient becomes ir-
ritable after around 30 days>> was obtained and a subject narrated “One month
after the patient’s hospitalization, kind of a turning point, I know I have to be
able to see something after reaching the goal, you know before the patient be-
comes irritable, for instance”. For [Family who cannot understand dementia],
<Difficulty that the patient’s family feel> was captured as seen in <<Family of a
dementia patient does not want to come to the hospital and it is difficult for
them to return to their daily life>> and <<Family of elderly or a dementia pa-
tient cannot accept them>>. Furthermore, <<The patient’s family does not rec-
ognize initial symptoms and minor symptoms as those of dementia>>, <<Family
cannot recognize correctly if the mark, color or company of the medicine are
different>> and <<Family believes dementia is transient even though they do
not look at the patient being conscious about it>> were obtained. A subject

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1549 Health
Table 3. The present situation and problems of dementia elderly in hospitals for community-based care hold.
Core category
Category
Code
Wards for
community-based
care becoming
complicated
Treatment of both the main illness and
dementia is needed
Treatment of the main disease can hardly progress in a dementia patient
Diagnosis and treatment of dementia to be performed by a physician remain unclear
Lack in information on the patient’s dementia before hospitalization
Dementia patient case harder than
expected
Thirty percent of hospitalized patients show dangerous behaviors, and do not
understand instructions and therefore their social hospitalization is increasing
Home return is difficult in the case of 60-day hospitalization
Difficulty in returning home
Being unable to be discharged worsen the dementia as an another hurdle to be cleared
Respite and social hospitalization are seen because of the priority given to treatment,
and the ratio of dementia patients rises
Difficulty in
dementia care
Dementia patients who are confused
The patient themselves cannot be aware of dementia of them
The patient cannot accept themselves becoming unable to understand and become
unable to make decisions themselves
Stress by being unable to have place
where the patient is discharged to
Diagnosis for dementia classification is difficult, and the patient becomes irritable
after around 30 days
Family who
cannot
understand
dementia
Difficulty that the patient’s family feel
Family of a dementia patient does not want to come to the hospital and it is difficult
for them to return to their daily life
Family of elderly or a dementia patient cannot accept them
The family believes that the patient
will be recovered
The patient’s family does not recognize initial symptoms and minor symptoms as as
those of dementia
Family believes dementia is transient even though they do not look at the patient
being conscious about it
Family cannot recognize correctly if the mark, color or company of the medicine are
different
The patient’s family cannot understand
dementia without an opportunity
Family can understand dementia only after the patient is hospitalized
Difficulty of
discharge support
Control such as suppression, medicine
and diet is not performed well
Suppression, medicine, diet and ADL influence where the patient is discharged to
Conditions of a dementia patient vary even in one week
While thinking that we must not let the patient leave, we need to think about their
next place to live
The patient does not have money
living alone, and there is not a network
to support them in the local
community
Resources for supporting the patient’s single life or their family after discharge are
short
The patient lives alone and there are no guarantors and money while the number of
facilities is insufficient
The local community needs to be interested in dementia patients and it is necessary
for neighborhood residents to support them
I feel worried with the situation that
the patient’s sleep hours in the
daytime are long while results are
demanded
Dementia patients do not often reach the goal of their rehabilitation
Activity of the dementia patient cannot be increased
Lack of required
energy amount
The patient’s food intake decreases
under the influence of cognitive
function degradation and medicine
Information on the patient’s diet is insufficient since they are hospitalized
The patient’s eating function does not have problems, but their preference is
unconfirmed and food intakes do not increase

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1550 Health
Continued
Difficult for us, including the eating swallowing team, to find reasons for appetite
decreased and not eating
Food intake decreases under the influence of oral medicine
It is necessary to watch calorie intake
It is necessary to think about the meaning of food intake and calorie intake
Difficulty of
adjustment of
medicine
The patient is re-hospitalized for being
unable to do self-management
It is difficult for a patient to manage medication by themselves and therefore the
nurses cannot leave it to them
Psychotropic drugs used from
hospitalization exerts an influence on
the patient’s life
Psychotropic drugs for stable hospitalization life influences the patient’s life after ADL
and discharge
Psychotropic drugs influences rehabilitation
Roommates are also influenced by the unrest state of the patient
Worried for prescription
When psychotropic drugs is prescribed, pharmacists may hesitate but there are not
places where they can share it
Dilemma
regarding ethical
problems such as
suppression
Dilemma occurs for setting a limit to
the patient’s behaviors
Use mitten or sensor mat for being unable to respond to the symptoms of the
dementia patient
Limit dementia patients’ behaviors for their safety
Cannot provide the cares that I want
because of restriction in the duties
time
Sedative is used to suppress the symptom but the nurses feel dilemma
The nurses’ duties are divergent and dilemma occurs for ADL maintenance
Rehabilitation specialists’ involvement is short, which causes dilemma for prevention
of dementia progress
Negative things occur for activities to be performed by each job title or multi-job titles
Disincentive of
multi-
professional
cooperation
The dependence on specialist prevents
cooperation
Knowledge of local and home care is short due to the dependence on specialists for
discharge
Nurses feel that the dependence on specialized job titles is the disincentive for cooperation
mentioned “The patient’s family can understand that it’s not kind of degrees that
they can manage by themselves. I feel maybe it’s difficult unless there is an epi-
sode that promotes their understanding”, and <<Family can understand demen-
tia only after the patient is hospitalized>> was obtained. <The patient’s family
cannot understand dementia without an opportunity> was found. For [Difficulty
of discharge support], as a subject narrated “Information is transmitted to the
care manager beforehand and she make a plan based on it and prepare for a
meeting. What often happens at a meeting is, you know, we find the information
is different from the last time”, <<Conditions of a dementia patient vary even in
one week>> was obtained. Further, <Control such as suppression, medicine and
diet is not performed well> was extracted and influenced where the patient is
discharged to. In addition, <<The patient lives alone and there are no guarantors
and money while the number of facilities is insufficient>> was obtained, and
some subjects mentioned “It would be nice if there was an environment in which
we can take care of such patients. But the local itself does not grasp that there are
such patients living in the local.” and “It’s quite normal that we have never seen
the neighbors’ face”. Furthermore, other subjects narrated “The presence of de-
mentia greatly affects the situation.” and “I’m worried everyday for how I should

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1551 Health
work to have better outcomes”. The code <<Dementia patients do not often
reach the goal of their rehabilitation>> was obtained. For [Lack of required
energy amount], narrations such as “Some dementia patients cannot open their
mouth easily.” and “Patients’ preference is the biggest problem. We can serve
only the taste they prefer. So it’s difficult to handle such requests in mass feed-
ing.” were obtained and the code <<It’s difficult to determine the cause of appe-
tite decreased and refusal to eat, including the eating swallowing team>> was
obtained. Moreover, <<Food intake decreases under the influence of oral medi-
cine>> was obtained as seen in the comment “They need a lot of water to take
medicines. Their stomachs get swollen with it. Then, they need to take a break
and cannot go further. This often happens”. One subject narrated “You know,
nurse follows the patients’ intake. I wonder... we do not think much about the
amount of calories the patient needs and <<It is necessary to think about the
meaning of food intake and calorie intake>> was obtained. For [Difficulty of
adjustment of medicine], subjects narrated “It’s too risky to leave adjustment to
the patients. They didn’t take medicine quite often” and “Medication of psycho-
tropic drugs mostly begins while the patient is hospitalized” “For having stable
life. Maybe” and <<It is difficult for a patient to manage medication by them-
selves and therefore the nurses cannot leave it to them>> was obtained. Moreo-
ver, the codes <<Psychotropic drugs influences rehabilitation>> and <<Room-
mates are also influenced by the unrest state of the patient>> were obtained.
Further, a one subject narrated “We cannot easily share such stories. You know,
there is not such a place. Patients are given medicines for delirium but the
pharmacist may hesitate to give psychotropic drugs the elderly in some cases”
and the subcategory <Worried for prescription> was obtained. For [Dilemma
regarding ethical problems such as suppression], the narrations “We all know,
for rehabilitation and for the hospital, it’s not good to calm a patient down using
medicine” and “When we find a patient removing injections, we need to have
them wear mitten. But for healthcare workers it is a constraint for the patient
while they wish to give priority to the treatment. Thinking about a risk for fall,
we need to take measure like having a sensor mat and so on” were obtained. As
seen in the narration “The patient’s goal can be set higher but maybe... you
know... we stop it, I feel...”, the code <<Limit dementia patients’ behaviors for
their safety>> was obtained. Further, one subject commented “The patient ac-
tually wants to go to the restroom but we cannot let him go... and I can see his
sadness and painfulness from his eyes. I was asking myself if it’s really good to
force him to live like that...”. The narrations “The patients basically live on bed
so the symptoms easily worsens. I want to stop such worsening....” and “I perso-
nally want to do it. We all knew it in these several years.... but you know we are
lack human resource in addition... and it makes it even more difficult” were ob-
tained. The category <Cannot provide the cares that I want because of restriction
in the duties time> was obtained. For [Disincentive of interprofessional work], a
subject narrated “When a patient has dementia, I cannot really afford to think

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1552 Health
about how their family are feeling... or the family does not know what they
should do and we always ask the local cooperation for their help. You know,
nurses’ knowledge is not enough for it. I feel we often leave some jobs to them
while we listen to their opinions”. Furthermore, the code <<The nurses under-
stand that their dependence on specialists is the disincentive for cooperation >>
was obtained as seen in the narration “It is nurses who might be missing it. The
nurses entrust things to the rehabilitation section so may not clearly understand
the extent that they can cover”.
4.4. “Reality of Collaboration and Cooperation for Caring
Dementia Elderly”
Eight core categories, 13 categories and 30 codes were extracted by Integration
of the categories and codes obtained from the three hospitals. The core catego-
ries extracted were [Dangerous behavior responded by multi-job-titles], [Diet
support by multi-job-titles], [Drug assessment and usage of medicine examined
by multi-job-titles], [Approach to increased activity in the daytime by mul-
ti-job-title collaboration], [Collective approach by multi-job-title], [Dementia
and its care in the local community and at home learned from multi-job-titles],
[Empowerment by multi-job-titles] and [Home support by multi-job-titles].
Details of the categories and code are as shown in Table 4. For [Dangerous be-
havior responded by multi-job-titles], the narrations “There is a team that sepa-
rate the patients by their arousal state to see drug effects”, “Like... this patient
moves actively during this time so this drug will be effective in that time rage...
you know” and “Patients with intense symptoms, those who often wander are
treated that way” were obtained. “Moreover, the code <<The rehabilitation spe-
cialists and pharmacists assume the role of observation of dementia patients and
their dangerous behaviors>> was obtained as seen in the comments “The reha-
bilitation staff takes care of the patients both morning and afternoon. They do a
lot of things” and “The pharmacist in charge of the ward takes care of the pa-
tients carefully observing the patients”. For [Diet support by multi-job-titles],
<<Usage of nutritional supplementary food mainly centered on diet is impor-
tant>> was obtained as seen in the narrations “Some patients cannot finish all so
they are given oral supplement to fix the calorie they take. The pharmacist pre-
scribes high calorie stuff like Ensure” and “The goal is, the patients take medi-
cine while they enjoy eating”. The code <<Discuss eating ability, tableware and
diet arrangement with multi-job-titles>> was captured as seen in the narrations
“We consult the dietitian for the form of the diet after a patient is hospitalized,
but we can probably do it at an earlier stage” and “We currently confirm the pa-
tient situation with nurses in a cooperation room at the time of hospitalization
and share information. For the patient’s eating ability, we assess it with STs from
the rehabilitation section and share what we do thinking about the form with the
dietitian”. For [Drug assessment and usage of medicine examined by mul-
ti-job-titles], polypharmacy was suspected as seen in the narrations. “I feel things

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1553 Health
Table 4. Actual situation of collaboration and cooperation of dementia elderly care.
Core category
Category
Code
Dangerous
behavior responded
by multi-job titles
Practice of observation of dangerous
behaviors and care by the prediction
Nurses examine dangerous behaviors of the dementia patient by separating colors to
confirm drug effects
The rehabilitation specialists and pharmacists assume the role of observation of
dementia patients and their dangerous behaviors
Diet support by
multi-job titles
Investigation of the diet forms and the
use of food and medicine
Usage of nutritional supplementary food mainly centered on diet is important
Multi-job title cooperation led by dietitians is required for food intake methods or
diet forms
Investigation of place for diet, sitting
position maintenance and tableware
sizes
Discuss eating ability, tableware and diet arrangement with multi-job titles
Adjustment of the diet environment is required for dementia care
Drug assessment
and usage of
medicine examined
by multi-job titles
Being able to arrange medicines at the
time of hospitalization and
information exchange with the
specialists in the local community
The pharmacist should be involved before and at the time of hospitalization
Hospital pharmacists and pharmacists in local community need to collaborate
The pharmacists cooperates with the specialists in the local community while sharing
medicines
Investigation of medicine effects and
medicine usage for the hospitalized
patients
Description of medication management in consideration of the patient’s living
conditions is required
Multi-job title cooperation led by the pharmacist is required for usage and
adjustment of medicines
Approach to
increased activity
by multi-job title
collaboration in the
daytime
Raise the patient’s activity by
collaboration of rehabilitation
specialists and nurses
Cooperate with other specialists and consider rehabilitation and life in the daytime
New ideas such as rehabilitation or walk in the daytime are required
Consideration of specific support
including transfer and portable
restrooms
Adjustment of the care environment through the conference by rehabilitation
specialists and nursing professions is required
Cooperation of MSWs, nurses and rehabilitation specialists is practiced mainly for
medicine and rehabilitation in the hospital
Collective approach
by multi-job title
Need of tracking support and
in-hospital daycare as staff member
education
Relation by groups is required as in-hospital multi-job title cooperation and
conversation between patients leads to prevention
In-hospital daycare will be part of the staff member
Practice of tracking support have an effect not only on patients but also staff education
Review of the patient’s livelihood time
and investigation of their relation with
others
New ideas are required for bathing time, how to spend after dinner and
communication between patients
Dementia and its
care in the local
community and at
home learned from
multi-job titles
Promotion of learning and workshop
of dementia
Need of new learning about dementia and learning for recapturing dementia
Staff members of hospitals should learn about cares in the local community and at
home and about characteristics of the places where patients are discharged to
Effects of dementia workshop and multi-job title collaboration are seen, and trainees
are also stimulated well
Empowerment by
multi-job titles Empowerment by multi-job titles
It is important to notice what the dementia patient can do
Find what the dementia patient can do
Encourage the dementia patient cooperating with multi-job titles
Home support by
multi-job titles
Predischarge visit and observation
rehabilitation of the local specialists
Provide the local specialists with an opportunity to grasp the situations of
hospitalized patients
Predischarge visit by collaboration of nursing professions, rehabilitation specialists
and MSWs
Respect for the patient’s ability and
self-determination at home
Support the dementia patient’s self-determination on the basis of the life they wish
Belief that positive power works when the patient return home
The patient can return home with understanding of their family and local

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1554 Health
would go more smoothly if the patient’s family could bring their medicine or
medicine note a few days before the hospitalization” and “You know, the medi-
cine increases as requested and cannot be arranged eventually... And they go
other hospitals and get.... you know... medicine for this symptom... Even if the
symptom gets better but go different hospitals. But the symptom got better with
this so this medicine cannot be reduced.....like this” and <<The pharmacist
should be involved before and at the time of hospitalization>> was captured.
Further, as seen in the narration “Hospital pharmacists like us would recom-
mend to crush the tablet if the patient became unable to swallow them but those
at dispensing pharmacies think about patients so they would think the patient
still may be choked even if the tablets are crushed and know that it would be dif-
ficult for them to take it three times a day”, the code <<Hospital pharmacists
and pharmacists in local community need to collaborate>> was obtained.
Moreover, <<interprofessional work led by the pharmacist is required for usage
and adjustment of medicines>> was captured as seen in the narration “You
know, it would be impossible to reduce the drugs of all patients. When the pre-
scription is changed, it would be nice if they could tell us.. or the word leader
about it”. For [Approach to increased activity in the daytime by multi-job-title
collaboration], the code <<Cooperate with other specialists and consider reha-
bilitation and life in the daytime>> was captured as seen in “I guess it’s about
role sharing. We entrust what we cannot handle to the rehabilitation sec-
tion....while sharing information, you know” and “When we give the ‘rehabilita-
tion’, patients would say they wouldn’t need it but without using the ‘rehabilita-
tion’, like...let’s take a walk with a nurse I experienced. You know, a little differ-
ent form of stepping exercise that can take”. Further, <<Adjustment of the care
environment through the conference by rehabilitation specialists and nursing
professions is required>> was obtained as seen in the comment “As for the pa-
tients risk of fall, you know, we want to assess together like.... location of the
portable restroom is good here or... we can reduce the risk doing this and that...
so that we can organize the environment”, and they worked on <Approach to
increased activity in the daytime by multi-job-title collaboration>. For [Collec-
tive approach by multi-job-title], subject described “If the hour of rising while
being hospitalized was increased, they would communicate with others” and
“Well, you know, when a patient meets another, although both have dementia
and weak hearing, they feel like talking. They do not really understand each oth-
er but seem to enjoy talking”. Further, subject commented “Although join a
good training session to learn a method to become part of the local society re-
source more, I seem to abandon various chances before very my eyes, being in a
team of professionals. In-hospital day care by multi-job-titles is really good, I be-
lieve” and “It does not happen like... this is what we do and this is not... because
our job title is this”, and <<In-hospital daycare will be part of the staff mem-
ber>> as captured. Furthermore, as seen in the narration “I think the tracking
support demonstrates a great effect. A slightly irritable patient shows calm face

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1555 Health
when I hear his story”, <<Practice of tracking support have an effect not only on
patients but also staff education>> was obtained. For [Dementia and its care in
the local community and at home learned from multi-job-titles], as seen in the
narration “Well dementia patients are increasing every year. Its symptoms wor-
sen continuously. You know, something is strong, or... the symptom itself is
strong... those patients become outstanding continuously. I feel it every year but
our learning about dementia is not catching up with such situations”, the code
<<Need of new learning about dementia and learning for recapturing demen-
tia>> was obtained. Further a subject described “You know, we launched a
project for improving response capacity for dementia, started a work shop, and
had training sessions twice a year. Our response got much better. There were
much less staff who nagged patients who tried to move themselves” and <<Ef-
fects of dementia workshop and multi-job-title collaboration are seen, and trai-
nees are also stimulated well>> was captured. For [Empowerment by mul-
ti-job-titles] and [Home support by multi-job-titles], subject narrated “BPSD
presents many peripheral symptoms but I don’t feel that there is nothing we can
do, you know. It’s only.. ah... there are many things we cannot do and I don’t
realize there are actually many things I can do for the patient” and “It’s really
good. You know, I always see what I cannot do so it’s really good to look for
what we can”. Moreover, as seen in the comments “Nurses and other staff often
talk to me caring about how I’m doing. They’ve come to give me words like ‘Oh
you’re doing good!’, you know” and “I feel many people talk to me and it really
encourages me”, <<Empowerment by multi-job-titles>> was captured. For
[Home support by multi-job-titles], as seen in the comments “They all say that
the interprofessional work is a discharge adjustment conference but there are no
others in which care managers join observation tour for rehabilitation work.
Unique aspect in our hospital” and “It’s highly rated that care managers can di-
rectly talk with other specialists. You know they can directly learn like, ‘this is
dangerous’ or ‘this risk is bra bra...’ all kinds of possible behaviors”, << Observa-
tion tour for rehabilitation by local specialists and visit before the discharge>>
was obtained. Furthermore, one subject commented “Once a patient goes home,
there are many things they can get back. If they are in a completely new envi-
ronment, they wouldn’t be able to pile up their energy but you know, going back
to their own home where they originally had their life, they could start their life
with some advantage. I believe such a power”.
5. Discussion
5.1. The Present Situation and Problems of Dementia Elderly
Hospitalized in Hospitals for Community-Based Care
This study was conducted in three hospitals that had had wards for communi-
ty-based care for four years. As a result of interviewing 19 specialists, the fol-
lowing eight categories were extracted: [Wards for community-based care be-
coming complicated], [Difficulty of dementia care], [Family who cannot under-

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1556 Health
stand dementia], [Difficulty of discharge support], [Lack of required energy
amount], [Difficulty of adjustment of medicine], [Dilemma regarding ethical
problems such as suppression] and [Disincentive of multi-professional coopera-
tion]. These categories correspond to “Rehabilitation, NST, dementia care and
polypharmacy” described in “Present situation and problems of the wards for
community-based care [8]”. First, for [Wards for community-based care be-
coming complicated], it was supposed that the actual sites were confused from
the following three points. First, specialists are pressed by care of the patients’
main disease and dementia during the hospitalization of up to 60 days. From the
interview conducted in this study revealed the opinion that 60 days are too short
because the number of days for rehabilitation after orthopedics is insufficient.
Secondly, unexpectedly hard dementia care is performed because of acquisition
of dementia care addition and addition for nursing staff night assignment, the
authors presume. Thirdly, the problem is not only that the patient’s dementia
turns worse and they cannot leave the hospital but the symptom of the dementia
patient who cannot leave the hospital turns worse, which makes the dementia re
even more difficult. Next, for [Difficulty of dementia care], dementia patients
feel difficulty in accepting that they are losing themselves. In particular, those in
an early period of dementia generally think that they cannot forget things. Such
a symptom continues for a while, while the patients show anger or denial re-
peatedly. The results obtained in this study have shown that such situations
overlap and the specialists working in the actually sites could not afford to re-
spond them, we presume. Moreover, what is the most difficult is that the pa-
tients’ family who are originally wished to be on the supporting side cannot
function. As symbolized by the words “elderly care by elderly” and “dementia
care by dementia”, it is difficult to obtain support from the patients’ family, and
in some cases their families need to be hospitalized socially. In this study, all
three hospitals reported that the patients’ family cannot understand dementia.
Furthermore, this complicates words for community-based care, we infer. In this
way, if a dementia patient and their family cannot understand dementia correct-
ly, explanation by specialists is really difficult for them. Furthermore, it is diffi-
cult for a dementia patient who lives alone to return home, and they cannot en-
ter facilities and therefore cannot leave the hospital. Moreover, if the dementia
symptom turned worse in the hospital, it would be a vicious circle, which makes
it even more difficult to be discharged. For [Difficulty of discharge support], the
patient’s diet decrease combined with this vicious circle, hospitals are forced to
choose to use the medicine prescribed for symptom control. Influence of de-
creased diet and the medicine’s side effects appear in this situation, which affects
the rehabilitation. In such a situation, it would be needed to set drip infusion,
nutrient and excretion tubes. At this time point, [Dilemma regarding ethical
problems such as suppression] occurs. The specialists want to do something
about it while they are pressed by daily duties. Here, it is wished to improve the
dementia patients’ QOL by smooth approach based on multi-job-title collabora-
tion. However, they are all pressed by their own duties and cannot avoid to de-

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1557 Health
pend on each other’s roles, which becomes [Disincentive of interprofessional
work]. The problems identified in this study that we have surveyed so far cor-
respond to the study by Horinouchi [9]
et al
. that aimed at [Clarification of the
present situation]. They also present [Usability of ward pharmacist]. As for
pharmacists, the results of this study show that they are necessary for interpro-
fessional work. Thus, there is a current situation in which appropriate profes-
sional staffing and systems are not yet in place to provide dementia care. In ad-
dition, it was found that there was a problem of not being able to secure a dis-
charge site in the community, and professionals were not able to develop case
management to connect the hospital and the community. Therefore, it was
thought that appropriate staffing and system development of professionals, se-
curing a discharge site in the community, and case management would have a
significant impact on dementia care.
5.2. Actual Situation of Collaboration and Cooperation
for Dementia Elderly Care
The following eight core categories were extracted from the results obtained in
this study: [Dangerous behavior responded by multi-job-titles], [Diet support by
multi-job-titles], [Drug assessment and usage of medicine examined by mul-
ti-job-titles], [Approach to increased activity by multi-job-title collaboration in
the daytime], [Collective approach by multi-job-title], [Dementia and its care in
the local community and at home learned from multi-job-titles], [Empowerment
by multi-job-titles] and [Home support by multi-job-titles]. [The core category
Dangerous behavior responded by multi-job-titles] means that all specialists
must keep dementia patients safe. Nakai
et al
. [10] developed Point Of Care
(POC) rehabilitation and reported that occupational therapists resided in a ward
for community-based care, and provided service at the time when a dementia
patient was unrest. Similarly in this study, not only nursing profession but also
rehabilitation specialists and pharmacists corresponded to dangerous behaviors.
Further, in this study, it has been found that there is a hospital that performed
drug effects measurement using colors.
It is a method to support dementia patients while observing drug effects on
their dangerous behaviors, and it can be a clue for dementia care based on inter-
professional work in each hospital. Moreover, for [Diet support by mul-
ti-job-titles], [Drug assessment and usage of medicine examined by mul-
ti-job-titles] and [Approach to increased activity by multi-job-title collaboration
in the daytime], dietitians, pharmacists and rehabilitation specialists need to play
a key role in urging specialists. Furthermore, for [Collective approach by mul-
ti-job-title]. In this study, one hospital already has started tracking support, and
it has been narrated that being able to secure time to talk led made the dementia
patients feel security. This indicates that it is important to have somebody who is
always near the dementia patient and snuggles up to them. One of the collective
approaches includes an in-hospital daycare. Yoshida [11] expected that it would
improve the relation with patients and ability to support them, leading to the pa-

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1558 Health
tient’ and their family’s confidence on their life after discharge. It is desired to
consider in-hospital daycare in accordance with characteristics of each hospit-
al. For [Dementia and its care in the local community and at home learned
from multi-job-titles] and [Home support by multi-job-titles], it is needed to
newly continue learning of dementia. In addition, it is necessary to learn more
about characteristics of the actual site of home medical care and place to which
the patient is discharged. Pre-discharge visit is a good chance for the specialists
to see local community and home and therefore it is needed for them to par-
ticipate in it positively. Further, for [Empowerment by multi-job-titles], Amagi
et al
. [12] describe that nursing to draw the patient’s strength is effective in any
treatment place and is an important factor for dementia nursing. Similarly in
this study, the codes <<It is important to notice what the dementia patient can
do>>, <<Find what the dementia patient can do>> and <<Encourage the de-
mentia patient cooperating with multi-job-titles>> were obtained. Those who
provide support and are supported can look at good points of each other and
therefore it is expected to be a good method. Furthermore, it is transmitted by
encouraging a dementia patient with multi-job-titles that many people need
the dementia patient. As we have seen so far, the actual situations of the mul-
ti-job-title collaboration are diverse, and it might support dementia patients
and their family.
5.3. Model of Interprofessional Work for Dementia Care
Table 5 shows a tentative plan of a model of interprofessional work for dementia
acquired by organizing problems of dementia patients and actual situations of
interprofessional work obtained in this study. Nursing professions, rehabilitation
specialists and discharge support specialists (MSW) are the arrangement stan-
dard for the wards for community-based care. In this study, actual situations of
cooperation among pharmacists, dietitian and care workers have been clarified.
Therefore, the authors propose dementia cares by 6 specialists, to which these 3
job titles are added. The reason why we propose the first “Family handling func-
tion” is because there were not many cases of the approach to family by mul-
ti-job-titles in this study. This is because there is a concern that when a family
has a dementia patient, they tend not to come to see the patient in the hospital.
Above all, such a family does not admit that the patient is dementia as a back-
ground. Therefore, it has been shown by the categories that even if the patients’
family talks with each job title, approaches are not made by multi-job-titles.
Therefore, it is necessary to build up a familiar-face relationship with the family
who are confused with the situation, and to respond to them by multi-job-titles
spending sufficient time. Secondly, we propose “ADL maintenance and im-
proved function”. Here, as practice contents of the dementia care, categories re-
lated to medicine, diet, rehabilitation and physical restriction were given. It has
also been revealed that they work on these problems based on interprofessional
work. Much of the content of the practice is taking place, suggesting the need to
continue to do so in the future. At the same time, it would be difficult to discharge

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1559 Health
Table 5. Interprofessional work model for dementia care.
The authors propose a dementia care special team consisting of six specialists below (nurse, rehabilitation specialist, MSW, pharmacist, dietitian, care
worker).
Reason for choosing the six job: The arrangement standard of nursing professions, rehabilitation specialists and MSWs includes “full-time work”.
Moreover, pharmacists and dietitians showed their wish to participate in wards for community-based care. Care workers are not only is adjacent to ADL
but also capable of collecting information including the family and the patient’s back ground.
Functions and practice contents of the multi-job title
cooperation
Base: The present situation and problems (19
categories)
Base: Actual situation of collaboration and
cooperation by the multi-job titles (13
categories)
1. Family handling function (family)
*Provide the family with an opportunity to learn dementia
correctly
*Explain that the patient is dementia spending time after
description is given by the physician,
*Have the family see the situation of ADL and treatment
during the hospitalization
*Confirm wishes about the medication management and
explain changes one by one
*Talk about the life after the discharge including the place
where the patient is discharged to
*Support the life of the family and the patient
comprehensively
Treatment of both the main illness and
dementia is needed
Difficulty that the family has
The family believes that the patient will be
recovered
The patient’s family cannot understand
dementia without an opportunity
Respect for the patient’s ability and
self-determination at home
2. ADL maintenance and improved function (dementia
patient)
*Grasp diet habit or internal use situation at the time of
hospitalization and provide the ward with it.
*Perform periodical assessment of ADL and share it among
specialists
*Reduce recumbency in the daytime and perform
investigation not to have the patient be confined to bed
*Regularly assess the influence of psychotropic drugs on diet
and rehabilitation
*For effect measurement of psychotropic drugs, examine
dangerous behaviors by separating them by colors
Control such as suppression, medicine and
diet is not performed well
The patient’s food intake decreases under the
influence of cognitive function degradation
and medicine
It is necessary to watch calorie intake
The patient is re-hospitalized for being
unable to do self-management
Psychotropic drugs used from
hospitalization exerts an influence on the
patient’s life
Worried for prescription
Dilemma occurs for setting a limit to the
patient’s behaviors
I feel worried with the situation that the
patient’s sleep hours in the daytime are long
while results are demanded
Cannot provide the cares that I want because
of restriction in the duties time
The dependence on specialist prevents
cooperation
Investigation of the diet forms and the use oft
food and medicine
Investigation of place for diet, sitting position
maintenance and tableware sizes
Being able to arrange medicines at the time of
hospitalization and information exchange
with the specialists in the local community
Investigation of medicine effects and medicine
usage for the hospitalized patients
Raise the patient’s activity by collaboration of
rehabilitation specialists and nurses
Consideration of specific support including
transfer and portable restrooms
Practice of observation of dangerous
behaviors and care by the prediction
Predischarge visit and observation
rehabilitation of the local specialists
3. Staff member education and empowerment function
(specialist)
*Provide places where staff can learn new knowledge about
dementia
*Provide information on cares in the local community and at
home particularly on characteristics of the place where the
patient is discharged to
*Respond to dangerous behaviors by tracking support
*Examine time zones and places which dementia patients can
be involved with each other safely
*Examine in-hospital daycare and increase activity in the
daytime
*Tell the meaning of the empowerment to the dementia
patient, their family and staff members
*Invite the local specialists to an observation tour of
rehabilitation and cooperate with them for discharge support
Dementia patient case harder than expected
Dementia patients who are confused
Stress by being unable to have place where
the patient is discharged to
The patient does not have money living
alone, and there is not a network to support
them in the local community
Difficulty in returning home
Empowerment by multi-job titles
Review of the patient’s livelihood time and
investigation of their relation with others
Need of tracking support and in-hospital
daycare as staff member education
Promotion of learning and workshop of
dementia

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1560 Health
the patient unless these problems are solved. Therefore, one method to connect a
hospital and local community is to have specialists in the local community watch
rehabilitation performed in the hospital a multi-job-title approach. Thirdly, we
propose “Staff member education and empowerment function”. For education
opportunity and training for dementia, each organization seems to be making
efforts. Furthermore, it is required to plan opportunities for specialists to learn
together as well as to activate tracking support and in-hospital daycare. In addi-
tion, the empowerment of patients with dementia, which is done in mul-
ti-job-titles setting, holds the promise of better interprofessional work.
5.4. Study Limitations
This study targeted specialists working in hospitals and wards for communi-
ty-based care and the number of specialists have variability. Further, analyses
covering the regional characteristics have not been performed. In the future, it is
necessary to examine the number of regional characteristics and specialists.
6. Conclusion
As present situations and problems of dementia patients in hospitals for com-
munity-based care, 8 core categories (19 categories) were extracted and as actual
situations of interprofessional work for dementia care, 8 core categories (13 cat-
egories) were obtained. The authors examined a function of interprofessional
work model and practice contents using these categories. The results revealed
that better interprofessional work can be expected by six specialists of nurses re-
habilitation specialists, MSW, pharmacists, dietitians and care workers develop-
ing dementia care based on “Family handling function” “ADL maintenance and
improved function” “Staff member education and empowerment function”.
Acknowledgements
The authors sincerely thank all professionals involved in dementia care, the hos-
pital presidents, senior nursing officers and service directors for their coopera-
tion with this investigation.
Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this paper.
References
[1] Statistics Bureau, Ministry of Internal Affairs and Communications (2020) Elderly
in Japan Seen from Information Data Statistics (Date of Browsing 9.20).
https://www.stat.go.jp/data/topics/topi1260.html
[2] Ministry of Health, Labour and Welfare (2016) Local Medicine Plan (Date of
Browsing 9.20).
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000080850.html
[3] Tsuchida, A. (2018) Local Medicine Plan That Has Begun to Change.
Nikkei Health
Care
, 350, 56.

K. Hamabata et al.
DOI:
10.4236/health.2020.1212112 1561 Health
[4] Nikkei Health Care Editorial Department (2016) Hospitals for Community-Based
Care that Bring Great Advantage—Income Rise and Ease of Use as Features.
Nikkei
Health Care
, 325, 26-27.
[5] Nakai, M. (2016) The Ideal Physician for Hospitals for Community-Based Care.
Ja-
pan Hospital Association Journal
,
Japan Hospital Association
, 63, 39-57.
[6] Asociation of Hospitals for Community-based Care (2016) Survey on Functions of
Hospitals for Community-Based Care
, 1, 25.
[7] Horinouchi, W. and Uchino, Y. (2020) Trend of the Studies on Medical Service and
Nursing with Hospitals for Community-Based Care as a Base.
Japanese Society for
Nursing Administration and Management journal
, 2, 11-16.
[8] Nakai, M. (2019) The Present Situation and Problems of Hospitals for Communi-
ty-Based Care.
Community Caring
, 21, 12-17.
[9] Horinouchi, W. and Uchino, Y. (2020) Trend of the Studies on Medical Service and
Nursing with Hospitals for Community-Based Care as a Base.
Japanese Society for
Nursing Administration and Management Journal
, 2, 14.
[10] Nakai, M., Ueda, Y. and Nishide, N. (2016) Strategy for Dementia in the Largest and
Strongest Hospital for Community-Based Care Strongest.
Japanese Psychogeriatric
Society Journal
, 27, 155.
[11] Yoshida, Y. (2016) Activities of “Dementia Support Team” Aiming at an Acute
Phase Hospital Kind to Dementia.
Nursing Prospects
, 41, 31-36.
[12] Amagi, N., Momose, Y. and Matsuoka, H. (2014) Dementia Nursing Practice for
Dementia Elderly Receiving Hospital Treatment in General Hospital—Judgment of
Authorized Nurse.
Japan Society of Nursing Research journal
, 37, 63-72.