Making each senior a star at the Robert Nimi Nikkei Home in Burnaby
Japanese-influenced program for elderly with dementia emphasizes adapting activities to suit abilities of each individual
Joe Buenacruz stares intently at the rectangle of green paper in his hands. He’s very focused on folding it into an accordion-like shape to make a Christmas tree for a card.
On a rainy Monday morning he’s one of six seniors taking part in a program for people with dementia at the Robert Nimi Nikkei Home, the Japanese-Canadian assisted living home in Burnaby.
The day program is called Iki Iki, a Japanese word pronounced “eeekee eeekee” that translates into lively, lively! It’s unique among Metro Vancouver dementia programs because it’s based on a personcentred, Japanese approach to dementia that focuses on the particular needs of each participant.
In Iki Iki, an activity might involve singing or catching a ball. But because dementia develops differently in each person, she or he might not be able to sing or catch. If that’s the case, volunteers will work with participants to create a variation to match their abilities so they feel included.
Iki Iki is also unusual in another way. Most dementia programs in care homes are for residents only. But Iki Iki is open to people in the community such as Buenacruz, who arrives for the day program by HandyDART.
Seated at the table with Buenacruz is Yoko Watase, the Nikkei Home’s outreach co-ordinator and one of the founders of the Iki Iki program.
“Can you glue here?” Watase asks Buenacruz, referring to the bent branches of the paper tree in the card’s centrefold.
He daubs the glue stick on the little rectangle of green to attach it to the card.
“Mostly finished,” says Buenacruz, 83.
At the centre of Iki Iki is the Japanese idea of omotenashi, a word that means serving someone without being servile. It’s a concept that’s at the heart of Japan’s reputation for hospitality. At Iki Iki, it means making each senior the star.
The Nikkei Home, which opened in 2002 with 59 units, is within Nikkei Place, a Japanese-Canadian village without fences. The village also includes a Japanese food store and Japanese restaurant, Hi Genki, which is open to the public and also serves meals to seniors living in the home.
Next door is the Nikkei National Museum and Cultural Centre, which holds exhibitions and organizes activities. Across the street is New Sakuro-so, a 34-unit, subsidized, independent-living apartment building.
At Iki Iki, being a star begins as soon as everyone arrives in the morning. Each senior is greeted individually.
“From the moment a participant arrives ... a volunteer is there to welcome them and continue the welcome with a series of hello and how are you, and perform a blood pressure and weight health check,” according to a tool kit for the program. “It is about providing welcoming, warm and friendly care to every participant.”
On the day Buenacruz attended, there was one volunteer for every three participants. When Iki Iki includes participants with more advanced dementia, the number of volunteers increases so there are as many as one for every two participants.
Gina Hall, Buenacruz’s daughter and the manager at Nikkei Place, said she likes the kind of physical and mental challenges that Iki Iki offers her father. In another dementia program her dad attended, the focus was on participants who knew the answers rather than on participation by everyone, Hall said.
She said it’s difficult to assess the impact of Iki Iki’s approach on her father because of the progression of his Alzheimer’s disease. During our brief interview, Buenacruz often laughed and smiled. “It’s definitely person-centred and has a lot more volunteers,” Hall said about Iki Iki. “It’s based on theories about dementia and levels of assistance that depend on that’s person’s abilities.”
Karen Kobayashi, a sociologist and gerontologist at the University of Victoria, was part of the team that helped develop Iki Iki.
The idea for Iki Iki is adopted from similar programs in Japan, where 28 per cent of the population is 65 years of age or older. By 2065, that’s expected to increase to 38 per cent, turning Japan into a “super-aged society” and what’s believed to be the world’s most-elderly country.
Japan has one of the highest life expectancies in the world: 84 years of age. It also has a significant number of people living with dementia: an estimated 4.6 million in 2018, increasing to 7.3 million by 2025.
Iki Iki was designed for Japanese-Canadians with cognitive challenges and mild to moderate dementia, said Kobayashi, who is also a research affiliate with the Institute on Aging and Lifelong Health.
“It’s expanded to include participants who come from other ethnocultural minority groups,” she said. “The universality of this program is what we’re trying to underscore.”
The program includes exercise, social interaction through games and singing, storytelling, participating in crafts and artmaking, and sharing through food.
Iki Iki has been adapted to fit the participants: on Mondays, the program is in English to accommodate people such as Buenacruz, who is Filipino-Canadian, and another participant, a third-generation Chinese-Canadian who speaks no Chinese language. On Wednesdays and Fridays, it’s in Japanese.
Kobayashi cited the Japanese island of Okinawa and its Blue Zone, one of the regions of the world where people live exceptionally long lives, as an inspiration for Iki Iki. She said one of the reasons why the Okinawan zone has the largest percentages of centenarians in the world is because of the varied social interactions among the seniors — along with physical activity and eating well.
On Monday at Iki Iki, Buenacruz and the other participants were served breaded salmon filets with white rice and vegetables.
“Dining together in Iki Iki allows them to feel like they’re part of a community,” said Kobayashi. “It’s an example of relational care: That means care between participants and staff, participants and volunteers, and participants and family members. “It’s all done to improve quality of life.”
Kobayashi said other health-authority-funded dementia day programs aren’t always as flexible as Iki Iki in adapting to the different needs of its participants.
“Health-authority programs or mainstream programs are more a one-sizefits-all kind of approach to dementia care that is very different from the person-centeredness of Iki Iki,” she said. “That’s the recognition of personhood. You recognize that someone is a person despite cognitive deficits.”
But matching activities to each person’s abilities requires trained staff or volunteers.
Iki Iki, for example, started out as a program for residents of the Nikkei Home in 2013 and only expanded to include non-residents when the program had enough volunteers. Iki Iki has since expanded even further, and now is offered at Japanese-Canadian community centres in Vancouver and Richmond. There is also a Roman Catholic faithbased version at Hall’s church, Our Lady of Mercy in Burnaby.
Simply translating material or having a volunteer who speaks another language isn’t always enough when it comes to running a successful multicultural dementia program, Kobayashi said.
Programs need to recognize the importance of cultural differences such as food. An immigrant or refugee from another country, for example, whose dementia develops may start to want to eat only the traditional foods they grew up with as youngsters in their country of origin.
“This is a program that addresses issues of inequality and inequity with regards to access to community-based care for visible minority, immigrant and older adults and their caregivers,” she said. “The Ministry of Health is actively promoting personcentred programs in longterm care facilities. In home and community care, this approach may be a little more costly. If you want to keep people in the community for longer with higher quality of life, this is the kind of program you need.”