At Japan’s dementia cafes, forgotten orders are all part of the service
Posted in Senior Health Care Tips
By Michelle Ye Hee Lee and Julia Mio Inuma, 2023, The Washington Post – September 19, 2023
TOKYO — The 85-year-old server was eager to kick off his shift, welcoming customers into the restaurant with a hearty greeting: “Irasshaimase!” or “Welcome!” But when it came time to take their orders, things got a little complicated.
He walked up to a table but forgot his clipboard of order forms. He gingerly delivered a piece of cake to the wrong table. One customer waited 16 minutes for a cup of water after being seated.
But no one complained or made a fuss about it. Each time, patrons embraced his mix-ups and chuckled along with him. That’s the way it goes at the Orange Day Sengawa, also known as the Cafe of Mistaken Orders.
This 12-seat cafe in Sengawa, a suburb in western Tokyo, hires elderly people with dementia to work as servers once a month. A former owner of the cafe has a parent with dementia, and the new owner agreed to let them rent out the space each month as a dementia cafe. The organizers now work with the local government to get connected to dementia patients in the area. 
It’s a safe space where they can interact with new people, be productive and feel needed — key to slowing down the progression of dementia, a neurodegenerative condition that has no cure.
“It’s so much fun here. I feel like I’m getting younger just being here,” said Toshio Morita, the server, who began showing symptoms of dementia two years ago.
A condition of unending indignities and financial burdens, dementia is a global phenomenon that every society is confronting. But in Japan, the world’s oldest society, dementia is a pressing national health challenge.
About 30 percent of the Japanese population of about 125.7 million is over 65. More than 6 million Japanese people are estimated to have dementia, and the number is expected to grow as high as 7.3 million — or 1 in 5 people over the age of 65 — by 2025, according to the Health Ministry.
Japan’s chronic lack of caregivers and the soaring costs of elderly care mean it needs to find creative ways to empower these dementia patients so that they can be mentally and physically active for as long as possible, rather than isolated at home or at a hospital.
Dementia cafes are a way to fill that gap. The concept was introduced in Japan in 2017 through pop-up events, but more permanent efforts are now cropping up throughout the country.
In June, Japan passed legislation to enact a slew of new programs and services to help those with dementia, which Prime Minister Fumio Kishida has identified as an urgent national project. The Japanese Health Ministry estimates that new counseling and research efforts for dementia will cost about $96 million in 2024 alone.
Kazuhiko, a 65-year-old diagnosed with dementia five years ago, has been working at the cafe every month. His wife wanted to find him a place where he can interact with people aside from those he sees at his day care. Kazuhiko’s family asked that he be identified by his first name for the family’s privacy.
At one point, Kazuhiko was heading to a table with an order but became distracted when the construction crew outside made a loud noise. He proceeded to leave the cafe and move toward the sound, and the staff rushed to bring him back in.
“How long have you been working here?” asked one visitor. “Is today your first time?”
“Yes,” answered Kazuhiko, except it wasn’t his first time.
Kazuhiko rarely talks or shows emotion anymore. He usually doesn’t make eye contact with customers until he sees them multiple times. But that day, he showed a smile.
The smile was directed at Tomomi Arikawa, 48, and her 16-year-old daughter, Sayaka, who visited around noon for a piece of chiffon cake and a citrus jelly dessert. Sayaka is working on a summer research project at school and chose as her topic dementia, in memory of her grandfather, who suffered from the illness for four years before he died in the spring
Kazuhiko brought them their orders. Sayaka thanked him and smiled, and he smiled back. “It felt really special,” she said.
“There are always a lot of difficult things for both sides [the patients and their families] … but there are these moments where you know a real connection has been made,” Arikawa said.
“When we saw him smile after our ‘thank you’ earlier, it reminded us of those moments we had [with my father], which nearly brought me to tears,” she said.
Since April, the Cafe of Mistaken Orders has opened once a month around lunchtime. One dementia patient works as a server per hour, wearing an apron that is bright orange, the color associated with dementia care. There is a chair set aside for them near the kitchen so they can rest in between orders.
Younger volunteers help the elderly servers as they mark customers’ orders on the order forms, which are simple and color-coded.
Table numbers were difficult for the elderly to remember, so the staff switched them out for a centerpiece with a single flower, a different color for each table.
The cafe’s administrators wanted to help the community see that dementia patients can prolong their active years, with a little bit of understanding and patience from those who interact with them.
“A lot of elderly people are either in nursing homes or are just sort of shut away in their homes, so I hope that our initiative will give people with dementia something to look forward to,” said Yui Iwata, who helps run the cafe. “If people get a deeper understanding, it would become easier for people with dementia to go out, as well.”
Morita, the 85-year-old, can’t stop chatting with customers, and it’s no surprise that he was an insurance salesman and longtime chairman of his neighborhood association. But two years ago, he suddenly couldn’t remember names of his neighbors. He wanted to keep working but didn’t know where.
The morning of his shift, Morita asked his wife every 10 minutes when they were scheduled to leave in case they might be late, his wife said. He kept forgetting their departure time, but his enthusiasm was uninterrupted. He doesn’t remember directions to the cafe, so his wife brings him there and has a piece of cake while he works.
As soon as he arrived, he greeted the young staff members and spread out his arms. They put on his orange apron and fastened his bandanna.
“He’s always so excited about coming here and says that once a month isn’t enough,” said Masako, 80, his wife.