An elderly patient propelling her wheelchair along a corridor at Copper Ridge Institute in Sykesville unwittingly provided Seiko Katayama with an instant look at differences in dementia treatment here and in Japan.
"In Japan, she would sit still in the wheelchair until a caretaker came and pushed it for her," said Katayama, 32, who helps run the first long-term nursing facility specializing in dementia care in northern Japan. "Here, there is such a degree of freedom. The patient propels herself."
During a work-study tour the past two weeks, Katayama, Hideki Hirose and Mariko Katayose have learned how Copper Ridge, an affiliate of the Johns Hopkins University School of Medicine, identifies memory-impairment behavior and provides care while researching improvements in dementia treatment.
"In Japan, caretakers do everything for the patients no matter what their abilities," Katayama said. "Here we have found there are ways to let them be independent, to have good quality of life. We treat the physical problems but do not do much to enhance the memory."
The health-care administrators, all from the northern city of Yokohama, also played bingo, horseshoes and dominoes - games designed to challenge the patients' memories.
"Horseshoes is a pretty popular backyard game here," said Stephen M. Vozzella, Copper Ridge's activities director. "Even someone with memory impairment can swing his arm and aim for a target."
They can play miniature golf, plant an herb garden, bake cookies or paint a picture - all activities the visitors observed.
Copper Ridge often shares its experience and programs with other organizations serving the memory impaired.
Hirose, 36, is vice president for facilities at Shinkokai Corp., which owns a private nursing facility in Yokohama. In Japan, private care costs about $1,500 a month. Government-subsidized facilities charge about $250 a month.
Copper Ridge has more than 120 patients requiring varying degrees of care. Typical monthly charges are about $4,500. Patients at Shinkokai facilities would have financial resources similar to those of the patients at Copper Ridge, Hirose said.
Hirose said he was struck by Copper Ridge's program that "stresses the strengths of patients and not the deficits. You really focus on the remaining strengths."
National long-term-care insurance became available in Japan about a year ago and has made a huge change in the country's awareness of the problems of the elderly, Hirose said. Yokohama, a city of about 3 million, has a waiting list of 3,000 elderly people for beds in public nursing homes, he said. Another 3,000 live in those facilities.
"We are seeing the ideal for treatment here where each person is followed by a physician and a psychiatrist," he said. "The degree to which care is available is astounding. We are wondering realistically how possible it is in another country."
Katayose, 39, supervises the nursing staff at a government-run home. She said she likes the sense of community at Copper Ridge.
"There is a tremendous effort to keep patients socialized, to keep them in community," she said. "This helps them avoid further memory losses as much as possible."
A memory game with oversized black and white photographs of former presidents, world leaders and movie stars can usually raise a patient's interest, Vozzella said.
"We help our patients look for milestones," he said. "One patient saw Einstein's picture and remembered walking down the street with him. Sometimes, we can get them talking, asking questions. Typically, we can learn a lot about our patients in these activities."
Vozzella has printed identifications on the backs of the photos so that a younger staff can recognize Clark Gable, Charles de Gaulle or Will Rogers.
Vozzella showed the visitors a closet full of toys, hand tools and sports equipment. Beanbags in various animal shapes, hand exercisers and tossing games stimulate the senses and memories. Long-forgotten fads such as a lava lamp or a rubber chicken - popular in vaudeville skits - often generate a response.
The visitors also met with the institute's social workers, administrators and several Hopkins physicians and neuropsychologists.
"I was most impressed with the strength of the assessment techniques and with the holistic approach to treatment," said Hirose. "I am very aware that Copper Ridge is not the common practice in the United States but it is as close to the ideal as possible. It is all about treatment with emphasis on the quality of living."