【Hidamari Home Care Clinic】

【Hidamari Home Care Clinic】

In April, 2023, I established a small clinic, called Hidamari Home Care Clinic, in Kashiwa, City, Chiba, Japan, after the retirement from Irahara Primary Care Hospital. I started this clinic, together with excellent nurse Yuko Tanigawa. In October, 2023, excellent medical clerk Isako Yoshii joined our clinic. The clinic is located in the periphery of Kashiwa City, very close to the border of both Nagareyama City, Chiba, and Matsudo City, Chiba. Therefore, we are mainly taking care of patients who are citizens of those 3 cities.
It is our great pleasure and honor that we can take care of many patients who have had strong trust relationship with me or Ns Tanigawa for very long time.  Some patients have been coming to my medical office for more than 30 years. Some patients have been getting care of Ns Tanigawa for more than 20 years.
We are engaged in outpatient practice as well as home-based medical practice. In the outpatient services, we are actively and tirelessly accepting those patients with fever or upper respiratory symptoms.
In home-based services, we are taking care of home-bound patients due to age-related frailty, dementia, terminally ill cancers, cerebro-vascular diseases, neuro-degenerative diseases, serious congenital disorders etc. In implementing support for those bed-ridden patients, we are often affiliated with various nursing, pharmaceutical, and care-giving facilities in the community, mostly those subsidized by public long-term care insurance. This kind of collaboration is the key for constructing successful support for individuals with serious social difficulties.
In this clinic, we are especially focusing on support for socially vulnerable patients. We welcome patients supported by public assistance system. Public assistance is public system of the central government to assist the poor persons based on the Article 25 of the Constitution of Japan. Those individuals supported by public assistance often have various social problems including criminal histories. They sometimes have mental retardation, psychiatric disorders, or developmental disorders in need of various assistance. We are proud to not only give them medical care, but various non-medical support to make their life much easier for them.

Tadashi Wada M.D.

【Clinical Practice】

Outpatient medical services and visiting services in home-care settings are available. We are taking care of patients with medical, psychosocial, psychosomatic, and psychiatric problems including seizure disorders. Dr Wada’s main specialty is general internal medicine, and sub-specialty is psychiatry.
Regarding outpatient services for patients with fever or with upper respiratory symptoms, Dr Wada have experience of taking care of more than 1500 COVID-19 cases. In addition, Dr Wada is always taking care of patients with long COVID and those with disabilities due to coronavirus vaccination.
In home-based services, we are taking care of bed-bound patients due to age-related frailty, dementia, terminally ill cancers, neuro-degenerative diseases, serious congenital disorders, and disability caused by severe injuries.
We are very much experienced on utilization of various social welfare systems for disabled patients, especially long term care insurance and public assistance system for the poor.

[Outpatient services]
Outpatient services are available 10:00 – 11:30 am on Monday, Wednesday, and Friday.

[Home care services]
Home medical care services are available for home-bound patients.
Call 04-7142-6032(Japanese only) and consult Ns Tanigawa for admission.

[Outpatient services for patients with fever or with upper respiratory symptoms]
Outpatient services for infectious diseases are available 10:00–11:30 am on Monday, Wednesday, and Friday. Call 04-7142-6032(Japanese only) in advance and make reservation.

[Services for patients with long COVID]
Outpatient and home care services for patients with long COVID are available.
Call 04-7142-6032(Japanese only) and consult Ns Tanigawa for admission.

【Location】
Minami-kashiwa 1-8-10 TS Building 3F, Kashiwa, City, Chiba, 277-0855 Japan

【Social Activities】
[Services for abuse victims as well as support for perpetrators]
Effective Prevention of Abuse
In these several years, with Dr Suda, Dr Washiyama, I have been discussing about importance of construction of universal protection system for all ages. In Japan, there are 4 abuse prevention laws, including elder abuse, child abuse and domestic violence, and abuse of people with disabilities. These 4 laws are usually independently executed by separate sections of municipal government offices in most of cities in Japan.
Therefore, so far, in most cities, elder abuse, child abuse, domestic violence, and abuse of the disabled are independently reported and handled by different divisions of municipal governments. We are thinking this kind of independent coping by different divisions may be an obstruction of implementing effective measures for prevention of abuse. For example, in order to prevent child abuse, intervention to vulnerable pregnant women is effective. In order to prevent elder abuse, intervention to young domestic violence abuser or intervention to young caregiver seems effective. For these reasons, we are thinking about importance of implementation of universal protection system involving all ages.

Problem of Definition of Elder Abuse
　In Japan, we have a law for protection of older persons. That is the Act of the Prevention of Elder Abuse, Support for Caregivers of Elderly Persons and Other Related Matters (the Elder Abuse Prevention Act).
The Elder Abuse Prevention Law) was enacted in 2006. The law mainly defines “elder abuse”  as inflicted by caregivers. Elder abuse by non-caregivers is therefore rarely covered by the law, leaving many victims legally unprotected. We investigated domestic elder abuse cases reported in Matsudo City, Chiba, Japan, to determine the number of abuse cases excluded from legal protection but constituting elder abuse as defined by the WHO.
Matsudo City has a population of approximately half a million. From April 2017 to March 2020, the municipal elder protection services agency received 525 case reports of domestic elder abuse. We studied the effective records of 497 of these cases. Only 299 were confirmed to be elder abuse cases, with 198 not meeting the requirements of the law. However, 176 out of the 198 excluded cases constitute elder abuse as defined by the WHO. In all of these 176 cases, abuse was perpetrated by non-caregivers. Due to the current formation of the law, this abuse went undetected, and its victims were unprotected.
On the other hand, ‘abuse by caregivers’ or ‘abuse by persons living together with victims’ constituted 455 cases (96%) of actual abuse cases. If ‘abuse by persons living together with victims’ is added to the definition of elder abuse of the Act, most of the actual abuse cases will be effectively detected. We consider the definition of elder abuse of the act should be corrected in order to give appropriate protection for actual abuse cases by non-caregivers.

【Education】
Dr Wada is currently serving as Clinical professor of School of Medicine, Institute of Science Tokyo, and  Clinical professor of School of Medicine, Chiba University. Dr Wada has been long involved in teaching of clinical training of young physicians and medical students. He also tutoring in several study groups and research groups.

【Publications】(English)

“Let’s Start Home Healthcare!”
Ⅰ. The Mindset and Skills of Home Healthcare
Ⅱ. Actual Scenes of　Home Healthcare
Ⅲ. Response to Changes in Medical Condition
(Funded by FY 2012 Health and Labour Sciences Research Grants Project (Japan))
Study Group for Research on Region Medical
Study Group for Comprehensive Research on Aging and Health
(Funded by FY 2012 Health and Labour Sciences Research Grants Project (Japan))

“TEXTBOOK of HOME CARE MEDICINE (English version)”
The Yuumi Memorial Foundation for Home Health Care 2016
【Presentations】 (English)
“Strong opioid usage for patients with malignancy who died at home.”
The 7th World Congress of Psycho-oncology. Copenhagen, August 25-28,2004.

“Confronting elder abuse in a city in Japan”
The 8th Active Aging Conference in Asia Pacific & Busan International
Anti-Aging Expo, Busan, June 27-29, 2013

“Elder Protective Services of Matsudo City and Future Challenges”
The Gerontological Society of America’ 67thAnnual Scientific Meeting,
Washington DC, November 5, 2014

“Problems of difficulty to report cases of abuse, violence, and exploitation in Japan”　Symposium “The Outlook on Elder Abuse in Japan after 10 Years Experience of Law Enforcement”

The Gerontological Society of America’s 69th Annual Scientific Meeting,
New Orleans, USA 　November 16, 2016

“Promotion and Education of Home Medical Care in Japan”
Kaohsiung Medical University Chung-Ho Memorial Hospital
Kaohsiung, Republic of China(Taiwan)  May 5, 2017

“Implementation of a hotline for all abuse cases of any age”
Individual Symposium　“What’s Happening 12 Years After the Elder Abuse Prevention Law was Implemented in Japan? ”
The Gerontological Society of America’s 71th Annual Scientific Meeting,Boston, Massachusetts, USA November 15, 2018

“Payment and Revenue Models – Japan”
Symposium　“Payments and Revenue Models in Home Care Medicine”
The Gerontological Society of America　Annual Scientific Meeting,
Austin, Texas November 15, 2019

“Response to COVID-19 pandemic in home medical care in Japan”
American Academy of Home Care Medicine
Annual Meeting　October 23, 2020　Virtual

“Efforts for Construction of More Effective Prevention and More Inclusive Protection Systems in Matsudo City”
Symposia Session: (6070)　 “Challenges for Prevention of Elder Abuse in Japan: Viewpoints From Legal and Practice Settings”
November 5, 2020　The GSA 2020 Annual Scientific Meeting Online
“COVID-19 vaccination to homebound, frail older persons in Japan”
American Academy of Home Care Medicine COVID-19 Webinar –
Vaccinating Homebound Patient　 June 3, 2021

“Efforts to Improve Legislation against Elder Abuse in Japan”
ELDER ABUSE ISSUES AND RESPONSES
To Mark the World Elder Abuse Awareness Day
JUNE 15, 2022 Elder Abuse in India, Asia, around the World

“Detection Of Elder Abuse In Japan Not Covered By The Elder Abuse Prevention Act In Comparison With WHO Definition”
Symposium “What Needs to Be Done to Prevent Elder Abuse in Japan？”
GSA Annual Scientific Meeting, Indianapolis, Indiana, USA October 25, 2022

“Palliative Care in Home-Care Settings in Japan”
Keynote Speaker, 2023 Taipei International Symposium on Palliative Care
“Palliative Care in the Post-Pandemic Era.”
Taipei City Hospital, Taipei, Republic of China(Taiwan) December 20, 2023

“The Influence of the COVID-19 Pandemic on Domestic Elder Abuse in Japan”
Symposium “Trends in Elder Abuse and Initiatives to Prevent Elder Abuse in Japan During the Past 20 Years, Japan Academy for the Prevention of Elder Abuse”
GSA Annual Scientific Meeting, Seattle, Washinton, USA November 16, 2024