As medical care continues to be tight due to the spread of the new coronavirus, it is especially difficult for people infected with "dementia" to be hospitalized.
At medical sites in Tokyo, it has become clear that there are a number of people who are delayed in hospitalization and whose symptoms worsen.
Dementia-infected persons who are delayed in hospitalization
Tokyo Metropolitan Matsuzawa Hospital, located in Setagaya Ward, Tokyo, is a medical institution that specializes in psychiatric care and has been accepting people infected with the new coronavirus since last year.
There are 18 dedicated beds in Corona.
So far, about 180 people have been infected with mental illness or dementia.
It is one of the few hospitals that specializes in accepting infected people such as dementia, and requests from emergency services and patients' families throughout Tokyo that they have been refused acceptance because of dementia and want to be hospitalized somehow. Are one after another.
A 101-year-old woman with dementia who was hospitalized on the 23rd of last month is one such patient.
A cluster occurred in a group home in Tokyo where I lived.
A local health center searched for a place to stay, but was refused by several hospitals because of dementia, and was finally able to be admitted to this hospital nine days after the onset.
The woman developed pneumonia and was brought in with difficulty breathing on her own and is still receiving oxygen.
The woman's son said, "My mother was in danger of life and I was worried about when I would be able to find a hospital. It was hard for me to be refused just because of dementia because I was too old to move around." I was talking.
Abandoned acceptance due to full floor
On the other hand, Matsuzawa Hospital itself has been almost full since the end of last year, and there is no room for acceptance.
We gathered medical staff from general beds to secure more beds than planned, but there are still cases where we have to decline due to a series of requests for acceptance.
Another challenge facing hospitals is the “exit” problem, where patients who have completed treatment have nowhere to go and stay in the hospital.
A man in his 60s who was infected with a corona due to a cluster in the nursing care facility he was using still cannot find his next destination more than two weeks after admission.
My symptoms have subsided and I am able to leave the hospital, but I cannot enter the facility I was originally using due to the outbreak of clusters, and my male wife is also infected, so I cannot return to my home.
It is said that the nearby special elderly nursing home is full and full, and even if you look for other facilities, you cannot find a place to accept people infected with corona.
At the hospital, patients who cannot find a destination even after recovering are asked to move to a general dementia bed to avoid the strain, but it is said that there is a limit to how they can be dealt with.
Hiromi Kikuchi, chief technician of the Tokyo Metropolitan Matsuzawa Hospital Rehabilitation Support Office, said, "Many people cannot go home because they continue to be bedridden while in the hospital and their physical and cognitive functions deteriorate. The current situation is that it is difficult for people to accept it, and there are cases where the destination cannot be found. "
Reasons for refusing hospitalization and system issues
Why are people infected with dementia denied hospitalization?
It has also been pointed out that general hospitals cannot afford to accept people infected with dementia.
According to Kentaro Sakashita, the director of internal medicine at Tokyo Metropolitan Matsuzawa Hospital, it is difficult for people with dementia to take thorough measures against infection by themselves, and they may move around, and they cannot understand the need for oxygen administration and intravenous drip. In some cases, it is pulled out.
On the other hand, severely ill people do not move around even if they have dementia.
However, some general hospitals cannot afford to grasp the situation of individual patients carefully, and they are reluctant to accept just because of "dementia".
Medical system for vulnerable dementia
In addition, Dr. Sakashita points out that the medical system for dementia was originally weak, and the new corona made the situation even more serious.
It is said that some psychiatric hospitals do not have sufficient systems for internal medicine and surgery, and conversely, general hospitals do not have sufficient cooperation with psychiatric specialists.
For this reason, it is said that there are only a few hospitals in Tokyo that specialize in accepting patients with dementia corona.
It is estimated that the number of people with dementia now exceeds 6 million nationwide, and it is expected that the number will continue to increase in the future.
Dr. Sakashita points out that "people with dementia and mental illness find it difficult to receive medical care and are in an unequal state," and argues that the medical and long-term care system should be enhanced in the first place.
Local long-term care facilities accept discharged patients
A patient with dementia corona who has nowhere to go.
How can we expand the acceptance system?
In Tokyo, efforts have begun to accept local long-term care facilities for patients with dementia who cannot be discharged from the hospital.
We started an association created at the Long-Term Care Health Facility in Tokyo.
The Long-Term Care Health Facility is a facility that not only cares for the elderly but also rehabilitates them, and has full-time doctors and nurses in addition to long-term care workers.
The association has decided to actively accept people who have completed treatment for the new corona and meet the discharge criteria at the Long-Term Care Health Facility, and is calling on member facilities to respond from this month.
Of these, the facility in Bunkyo-ku, Tokyo has accepted several elderly people who have completed corona treatment since the end of last year.
It is said that there is no risk of spreading the infection, but just in case, the facility will ask you to enter a private room for the first 10 days, and the corresponding staff will wear protective clothing for long-term care.
The floors are also divided so that people with dementia can leave the private room by any chance.
Ten days after admission, you will receive rehabilitation with general users in the presence of doctors and nurses.
By striving to recover the physical and cognitive functions that have declined during hospitalization, it will be easier to return to your home or the original facility.
Mr. Junkata Omori, President of the medical corporation Tatsuokakai, said, "Although the risk of infection is low, the psychological burden on the staff is heavy, so we take care to prevent infection. It costs a lot, but I want to accept it as a social mission. "
The Tokyo Metropolitan Health Facility Association for the Elderly will publish acceptable facilities on its website later this month.
The number of receiving facilities is still limited to a few, but we will continue to call for cooperation and hope to increase the number to dozens in the future.
Hiroyuki Hirakawa, Vice Chairman of the Tokyo Medical Association and Chairman of the Tokyo Metropolitan Health Facility Association for the Elderly, said, "I would like to play a role as an intermediate facility between medical care and long-term care in order to improve the tightness of the medical system as much as possible. The psychological burden on the staff is heavy, and I would like to ask the government for financial support in order to increase the number of facilities that cooperate with us. "