How Chile Cares for its Citizens with Dementia

Chris Kardish wrote an article for Governing on Chile’s Deceptively Simple Dementia Care Model: Treat Patients Like Adults. The article is one of the articles in Governing’s annual International Issue. The article describes a pilot project known as “Kintun” “which is from an indigenous language, [and]translates roughly to ‘searching.’”   The program is designed to reconnect individuals with dementia with their communities and the story uses as an example of a baker with dementia who is reconnected with a former customer, also with dementia, as well as with neighbors.

Kintun is an experiment in providing care to people with mild-to-moderate dementia. In a country that lacks a full-scale plan for the condition, Chile — much like the U.S. — is looking for worthwhile approaches to promote on a wider scale. Kintun is special in that it combines a host of services, from diagnosis to care coordination. In addition, there is a strong social underpinning, assistance for caregiving family members and a visible presence within a high-traffic community center near city offices, soccer fields and cultural mainstays.

The approach in this pilot in Chile is different than the U.S. with the emphasis on integration rather than separation. After citing the statistics on dementia worldwide, the article emphasizes the need for a global response.

Last December, the G8  forum of eight industrialized nations, including the U.S., met to discuss strategies and pledged to develop a “cure or treatment” by 2025. Similar goals already appear in the national dementia plans of many countries; the U.S. first released such a plan in 2012. Experts say that plan goes a long way toward setting goals, encouraging cooperation between sectors of the medical world and making sure the U.S. is the leader in researching a cure. Where it falls short, however, is in not doing enough to educate people about dementia or provide better care for the people who have it — exactly the kinds of things that are going on in the Chilean municipality … [where the pilot is being done].

The article discusses the development of the Kintun program and its operation. A number of professionals are included as a team who “ assess … [the patient’s] impairment and develop… care plans for [them]… After a full medical assessment, the [team] connects patients to specialists if they need them, recommends changes to the home environment and starts … patients [on] full-day sessions, which combine activities to improve cognitive functioning, physical abilities, social interaction and community involvement.”  

Also, and importantly, the program also offers educational programs for the caregivers so they can learn more about dementia and how to respond appropriately.  The program’s goals include (1) increasing awareness, (2) “helping patients maintain functionality to avoid institutionalized nursing care for as long as possible,” (3) making sure the patients take the right medications, and (4) avoiding patient hospitalizations. 

The article describes a “typical” day for patients participating in the program and mentions programs in the U.S. that also incorporate caregiver education. Discussing funding, the article notes the U.S. approach “is more on research than on treating people.”  Although “the U.S. is leading the way in understanding the genetics behind dementia and the breakdown of molecular pathways that fuel it…that emphasis and the fragmented nature of U.S. health care means America lags behind some other developed nations in critical areas such as diagnosis. In the U.S., more than 50 percent of dementia patients go undiagnosed.”

That is a sobering statistic and the article compares the U.S. diagnosis rate with that of Northern Ireland and Scotland, where 70% of the time the diagnosis is made. The article discusses Scotland’s “post-diagnosis care”, and Japan and England’s leadership in “public perception and promoting integration.”  Consider one of the steps Japan has taken: “Japan literally changed the word for dementia to remove the connotation of foolishness and launched a 10-year campaign of canvassing and seminars to educate people.” The integration concept is slowly catching on in the U.S., at least in Minnesota.  The article wraps up with a philosophy of Kintun: “a grassroots philosophy [where] [o]rganizers  educate local government workers, hold presentations and take advantage of media appearances, but their strategy for improving public awareness starts with the patients that spend two days a week in their company.”