Let’s Think About Life with Dementia #4 Keep asking yourself, “What would I do?”―Learning Through the Case Method

 When discussing the life of a person with dementia, it is essential that we recognize a variety of people involved in the person’s daily living. In particular, community dementia support promotion members, who are assigned in each municipality as key actors in community building, play a crucial role.

 

Over the past few years, I have had opportunities to work with these promotion members in several municipalities, including training programs and lectures. As I listened to the members about the challenges facing them in the field, I have come to realize the enormity and difficulty of their role more than ever.

 

Actually, most of the promotion members have experience mainly in supporting individuals. But once they become promotion members, they are charged with the huge mission of community building. Many members feel lost about the change in their roles.

 

I have heard urgent cries for help as I listened to the members in the field, including:

“The role of promotion members is not fully understood in the workplace.”

“I can barely handle the tasks at hand, so I don’t have enough time or energy to pay attention to the community.”

“I don’t know how to communicate ideas and concepts to people in the community. I can’t find my own words.”

 

Also, uneasiness and stereotypes about dementia are surprisingly persistent in the community, with such comments as, “Everything is over once you have dementia” and “What can I do to prevent (avoid) it?” Although these people in the community have no ill intentions, their words and stares can sometimes become “invisible barriers” for people with dementia and their families.

 

Faced with these barriers, promotion members have been asking themselves, “What can I do?” and “How can we gradually change these stereotypes?” What is essential in addressing these questions, besides listening to the person’s voice and obtaining knowledge, should be creating opportunities to picture themselves in real-world situations and think about what to do in their own words. Based on this idea, my colleagues and I applied and received a research grant from the Ministry of Education, Culture, Sports, Science and Technology (MEXT) (JSPS KAKENHI Grants-in-Aid for Scientific Research, JP21K01985) to develop training materials using the case method.

 

The case method is a learning approach also used in business schools and other settings. Picturing themselves in a difficult situation, participants will think about what they would do and discuss the ideas with their peers. This method is designed to help participants deepen their way of thinking rather than learning the correct answer.

 

As I teach the case method in graduate school, I find an extremely good match between this method and welfare work, which often addresses questions without the right answers. In the project to develop teaching materials, we created stories (cases) based on concerns and confusion often facing promotion members in the field.

Let me share an example here.

 

[Case material] Is Everything over once you have dementia…?!

l   Case summary

Ms. Saito is a certified social worker at a community general support center. Recently appointed as a promotion member without enough briefing by the predecessor, she has been struggling with this new role. One day, Ms. Saito finds that Mrs. Akiyama, a long-time regular at the community salon, has been diagnosed with dementia and isolating herself at home since then. Her family also begins to worry that the only choice may be to send Mrs. Akiyama to a care facility. Ms. Saito has a bitter memory of being unable to respond to a comment by a salon participant: “Everything is over once you have dementia.” How can she face this persistent stereotype embedded in the community? How can she take a step as a promotion member? Together with Ms. Saito, let’s think about what you would do.

 

In this case study, we had a discussion based on the following two questions:

(1) What challenges is Ms. Saito facing?

(2) How will she move forward with the support (and why)?

 

For the first question (challenges), participants exchanged various opinions from multiple perspectives, including not only Mrs. Akiyama and her family but also local residents, professionals, and the organizational structure.

For the second question (approaches), a variety of ideas were shared including the following:

l   Listen attentively to Mrs. Akiyama’s life story and feelings, and find what she would like to focus on from now on.

l   Talk with Mrs. Akiyama’s family, suggesting that Mrs. Akiyama may be able to stay in the community with support from others, as well as informing them about the availability of places for family peer support.

l   Approach the staff members and director of the community general support center to help develop a system, ensuring that Ms. Saito does not need to handle everything by herself.

 

In the case method, participants deepen their discussion as they carefully examine each idea, including its reasons such as why this particular approach is necessary and what meaning it has. Through this process, they understand situations from multiple perspectives and share practical learning.

 

Although the case method is not suited for a large group, it allows participants to take time together to deeply consider and discuss the issue. In this process, the experience each participant brings serves as a valuable textbook. By broadening their perspectives by finding new ideas and ways of thinking, participants can gradually find the “next step” in the community. This type of learning may benefit not only professionals but every one of us as well.

　　　　　　　　　

Taeko Nakashima

Faculty of Health Management　Department of Social Health and Business Management

Nihon Fukushi University

https://www.nfu.ne.jp/ (in Japanese)