Abstract
The impact of dementia and Alzheimer's disease extends far beyond the healthcare needs
of the person with dementia. As the disease progresses, individuals with dementia
often require ongoing formal or informal care for their basic daily routine because
of behavior changes and continuing loss of cognitive function. Most of the care for
people with dementia takes place at home, and the unpaid, informal caregivers are
often spouses or other relatives. Providing long-term informal care at home for someone
with dementia is psychologically, physically, and financially draining. The tragedy
described in this case elucidates the far-reaching societal impact of dementia care
and the implicit health policy considerations.
In 2007, a 91-year-old Japanese man with dementia was in the care of his wife when
he wandered from home, was hit by a train, and died, immediately affecting the Central
Japan Railway Company operations and, subsequently, legal practice as well as Japanese
elder care policy. The railway sued the man's wife and son for negligence and lost
revenue, winning both trials at the local and district courts. This ruling shocked
families and caregivers in Japan, where care for elderly parents traditionally falls
on the oldest son, and brought attention to the complex issues related to dementia
care. A decade later, we revisit this case to provoke a renewed dialogue about the
matrix of responsibilities and liabilities associated with caregiving; to illuminate
the unmet needs of the person with dementia, as well as his or her informal caregivers;
and the financial implications related to long-term care policy. We close with 2 practical
suggestions which preserve the dignity of the individual and provide reassurance for
caregivers.
Keywords
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Article info
Publication history
Published online: March 27, 2018
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© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
