| Challenge to Local Health Care and Welfare Promotion
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Kimiko Hirotsu,RD
Special Nursing Home for the Elderly
Suo lsland,Yamaguchi Prefecture,Japan
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I am working as a dietitian at a special nursing in the home for the elderly (or welfare facility for the elderly in need of long-term-care) on Suo Island, Yamaguchi Prefecture, west of Japan. Our area covers four towns on Suo Island. The proportion of the elderly aged 65 or over in the population of these four towns is 40.9 per cent, out of which the town of Towa records 49.5 per cent, the highest throughout Japan.
I started my career as a dietitian about twenty years ago. I first worked for twelve years at the local low-cost-care house for the elderly (or "care house" providing the elderly with non-medical care services at low cost) in Yamaguchi Prefecture, then I moved to the present special nursing home eight years ago.
It goes back about twenty years ago when the central and local governments introduced the policy to employ dietitians at local health care and welfare facilities for the elderly. Since our home was very new in the community at that time, I had to start by getting to know business people near the home, and work very hard every day for preparing menu and cooking meals suitable for the elderly in the home.
Being in my early 20s, it was very difficult for me to understand the dietary tastes of the elderly so that I often failed to make an adequate quantity of food and sometimes created problems for workers in the kitchen. However, I learnt a lot about health care and welfare services from registered dietitians and others who worked together with me.
Generally speaking, in those days, health care and welfare activities were not fully understood and supported by community people, and they were often had considered as the measures to help the poor. In addition to this, because of insufficient budget, workers and dietitians of the low-cost-care houses for the elderly based on contracts had to make efforts to invite newcomers to the homes. At our home as well, I was often accompanied by the heads of to local public bodies to ask their budgetary support for its sound management. Thanks to these activities, a-day-care facility was established as an annex to our home after about seven years. As a result, the management of the home became more stable.
In recent years, together with the improvement in health care and welfare services at the homes, dietitians have been required to play a more important role for the elderly in local communities. For instance, they are required to give more information and advice on nutrition and dieting not only for the elderly staying at the homes, but also for those staying in their own homes and in-home helpers.
At present, I prepare a menu every day for 50 residents in need of long-term care, 10 residents in need of short-stay medical care, 70 non-residents in need of day care, and 25 non-residents in need of meals-on-wheels service. In general, different from low-cost-care homes for the elderly, special nursing homes for the elderly are required to pay more attention to the variety and quality of meals to meet the requirements and taste of the elderly. In most cases, the oral intake of nutrition is normal for the elderly in need of medical care, but for those elderly who suffer from low-nutrition intake by dysphasia, dietitians must develop a comprehensive nutritional administration plan, which includes the details of nutrition assessment, food processing, and nutrient supply.
In April 2000, the Japanese Government introduced a new long-term-care system. Under this system, a new comprehensive plan for the elderly, including the establishment of the basis for long-term-care services, is expected to develop. This plan also requires authorized dietitians to work out the details of dietetic administration, including basic meal services, which will be submitted to local public bodies for budgetary support. Before the new system was introduced, dietitians at health care and welfare facilities were only requested to provide suitably rich meals for the elderly, but the new system requires them to do more intensified works such as the provision of more cost-effective meals.
In addition, as a part of local health care and welfare services, dietitians are required to provide meals with warmed-up plates to the elderly in need of in-home medical care and an opportunity for consulting with family helpers, in cooperation with in-home care support centers and care-service groups (e.g. long-term-care experts, home-visit nurses, and home-helpers). Furthermore, if necessary, they are asked to positively participate in local health care meetings (e.g. "care conferences") to discuss the matters concerning the needs of the elderly and to exchange information relating to them. As for the quality of food, I have been doing my utmost to provide meals as suitable as possible for the treatment of each elderly person in the home, bearing in mind the public relations of the home.
I often write articles on the meals for in-home-care helpers for a day-care-service magazine and, as a health exercise advisor, I would, at the request of the local government, take part in sports events to be held in neighboring towns and/or cities. My working area is thus gradually expanding.
Finally, I would like to point out that, as a result of the introduction of the new care system last year, the role of special nursing homes for the elderly has been largely diversified, and the new system has brought business opportunities and competition into health-care and welfare services as well. In spite of these circumstances, it is my belief that I will continue to work as a dietetic specialist for local health care and welfare facilities in the future in order to offer a higher quality of meal service for the elderly. |
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. The Japan Dietetic Association All rights reserved
