The big question about dementia care is who is going to do it

IN A TWO-STOREY building in a suburb of Tokyo, eight old people are sitting around tables in a spotless living room with a kitchenette attached. They are enjoying a quiz game, which entails shouting out the word that completes a well-known phrase or saying. One woman is first to all the answers, with nobody else getting a look-in. But, say staff at this care home, one of 280 run by Nichi Gakkan, a medical-services company, she forgets what happened ten minutes ago. The residents’ spartan rooms, with just a few keepsakes from home, have their photographs on the door, to make it easier to go to bed in the right one.

The house has 18 beds. All residents have dementia—mostly Alzheimer’s, but some cases of vascular dementia and one of the rarer fronto-temporal sort. The youngest is 69; half are over 90. They are encouraged to help with chores, such as folding their own laundry. Volunteers teach ikebana (flower arranging) and origami (paper folding). They watch, or sit through, a lot of television.

Most have families. But some never visit. To be honest, says one of the staff, it makes little difference. Residents often do not recognise loved ones. The best that can be hoped for is to offer a “safe and ordinary everyday life”. This is a top-of-the-range facility, with a lower...