[100-Year Brain Health⑩] "Respecting Dementia Patients with Korea's First 'Humanitude Care' Approach"

Interview with Director Kang Moon-cheol of Incheon 1st Municipal Elderly Dementia Care Hospital
Designated as a 'Dementia Safety Hospital' specializing in treatment and management of severe dementia patients
Medical staff including occupational therapists form a team to plan BPSD alleviation treatment
"Urgent need for caregiver cost coverage and training of dementia specialists"

On the 1st of last month, two new 'Dementia Safety Hospitals' specializing in the treatment and management of patients with severe dementia were designated and began operation in Incheon. This marks the first time in three years since the launch of the first Dementia Safety Hospital (Gyeongbuk Provincial Andong Senior Specialized Nursing Hospital) in September 2019 that a hospital specializing in the treatment of severe dementia patients with behavioral and psychological symptoms of dementia (BPSD) or delirium has been established in the metropolitan area.

Incheon First Municipal Senior Dementia Nursing Hospital was also designated as a Dementia Safety Hospital this time. Director Kang Moon-cheol (neurologist, photo), who has been treating dementia patients here for over 20 years, explained, "At Dementia Safety Hospitals, after assessing the patient's disease and physical and mental condition, a specialized and intensive treatment team is formed to develop medication and non-medication treatment plans that can alleviate the patient's BPSD." He added, "The team, including medical staff, occupational therapists, and mental health social workers, implements cognitive-emotional-centered therapy, sensory stimulation therapy, and behavioral therapy."

BPSD refers to symptoms such as violent behavior and paranoid delusions that accompany dementia. Most elderly dementia patients have chronic diseases such as diabetes, hypertension, and hyperlipidemia, and especially those with BPSD are at higher risk of serious complications such as malnutrition, dehydration, falls, fractures, and pressure ulcers. Therefore, expert care with specialized knowledge of chronic diseases and various side effects is necessary, but since patient compliance with treatment is significantly low, recovery is difficult with medication alone. Frequent occurrences of swearing or aggressive behavior make it difficult for medical staff or caregivers to treat and manage patients, and because it interferes with the recovery of other patients in shared rooms, some private nursing hospitals even hesitate to admit such patients.

Director Kang lamented, "The intention is for the state to take responsibility for these severe dementia patients who are difficult for families to care for, but this inevitably leads to a shortage of medical personnel and increased workload for healthcare workers." It is especially difficult to secure all the necessary specialized personnel such as neurologists, dementia specialist nurses, and mental health social workers in hospitals located in remote provinces, and it is extremely rare for local governments to support hospital operations as public projects, which is cited as a reason why Dementia Safety Hospitals have not spread widely. Moreover, as public hospitals responsible for regional public health, they must also provide inpatient treatment support for low-income groups, free caregiving services, and outreach medical services for vulnerable populations.

In particular, Incheon First Municipal Senior Dementia Nursing Hospital focuses on respecting patients as human beings until the end by maximizing consideration through the country's first 'Humanitude Care.' Humanitude care is based on four elements: 'to see,' 'to speak,' 'to touch,' and 'to stand,' building trust with patients. Caregivers make eye contact with patients, continuously talk to them, gently touch them, and emotionally connect with them, hoping to gradually improve the patient's condition. Also, even elderly dementia patients can experience worsening conditions due to decreased physical strength if they remain bedridden, so the hospital helps maintain or improve remaining functions through as much daily physical activity as possible. The approach does not force patients to do what they do not want and does not provide medical services according to predetermined times and sequences from the provider's perspective but decides on medical service provision considering the patient's current position and situation.

Director Kang said, "Severe dementia patients who were unstable in movement, exhibited violent behavior, and refused meals and medication became considerably more stable after admission through medication intervention combined with Humanitude techniques tailored to the elderly's perspective, reducing BPSD symptoms compared to when they were first admitted." He added, "We provide a human-centered care environment so that patients themselves can understand and accept their treatment situation."

An essential part of this treatment method is the caregiver who directly looks after the patient. However, unlike nursing facilities where employing care workers is mandatory, nursing hospitals have no regulations, systems, management, or educational responsibilities related to caregiver placement. There is also no government support for caregiving costs, so hospitals and patient guardians bear the full burden.

Director Kang identified the urgent tasks for expanding Dementia Safety Hospitals as the inclusion of caregiving costs in insurance coverage and the training of dementia specialists. He emphasized, "Just as the person who can best care for a baby is not a pediatrician but the mother, the person who can best care for a dementia patient is the caregiver who watches over them constantly." He stressed, "If caregivers can work in better conditions and receive improved treatment, allowing them to focus stably on patient care, medical staff can provide tailored treatment for each patient and quickly detect and respond to abnormal signs." He also added, "Unlike other diseases, dementia requires specialized preparation for nursing and caregiving. There is a need to introduce a national-level system for training dementia specialists who understand the characteristics of old age and provide professional dementia care."