Table 1. Barriers to achieving high-quality, community-based integrated dementia care.

Thema	Category	Meaning unit
Little attention given to patient wishes		In some cases, care providers favor family preferences over elderly patient wishes
Lack of time and space to provide quality care	Family caregivers are too busy to properly take care of their loved ones with dementia	Family caregivers are so busy with work and daily life constraints that they are at times irritated with their elderly relatives with dementia
		Family caregivers unavoidably get angry with their elderly relatives with dementia even though they recognize that dementia is the cause of their behavioral disorder
		Caregivers often feel unappreciated and stressed because elderly people with dementia are unable to show gratitude
	Frequently shorthanded, hospital nurses often feel sorry for not being able to properly care for dementia patients	We are not really sure that physically restraining elderly patients with dementia is a sound treatment option
		There are few opportunities for hospital nurses to discuss dementia-specific care at daily meetings
		Hospital nurses are too busy caring for severe patients to properly look after elderly patients with dementia
		If I had enough time to listen to patients with dementia I could get a better grasp of their situation and that of their family caregivers
		Elderly patients with dementia often display behavioral and psychological symptoms of dementia (BPSD) at our busiest times, such as meal time, early morning or midnight.
Disturbing hospital environment	We need to make the hospital environment suitable and comfortable for patients with dementia	We think that the hospital environment triggers anxiety and fear in people with dementia
		We need to create an area where people with dementia can enjoy communicating with others in our hospital
Poor compensation	Dementia-related medical service fees are too low to ensure quality dementia care	The current home-visit medication counseling system for dementia is not adequate to ensure that patients properly adhere to their prescriptions
		We hope dementia-related medical service fees increase
Refusal to visit outpatient clinic	People with dementia often refuse to visit outpatient clinics and it is difficult to convince them to go	Because people with possible dementia often refuse to visit outpatient clinics, it is difficult to take them there.
		We hope that dementia specialists carry out home visits because it is difficult for caregivers to take people with dementia to outpatient clinics
Hospital admission refusal	Behavioural and psychological symptoms of dementia (BPSD) are a possible cause of hospital admission refusal	The hospital environment can at times worsen the behavioral and psychological symptoms of dementia
		People with dementia are often refused admission for safety reasons
Daily life support by family and carers	Improved collaboration between hospitals, integrated comprehensive care centers, and care service providers is needed	A person with possible dementia can be introduced to a hospital integrated comprehensive care center by a nurse and start receiving care services
		Some hospitals or care service providers monopolize elderly clients with dementia and do not share information in the community
	Ensuring the safety of people with dementia in the community is a pressing concern	In order to locate older people with dementia who have gone missing, we want to use a GPS (Global Positioning System)
		Following the recent rise in dementia-related train and car accidents, we worry about the safety of people with dementia and ordinary citizens
	Specialist physicians should show more interest in the daily lives of people with dementia	At general hospitals, physicians focus on their own specialty and do not offer comprehensive dementia care
		Physicians show little interest in the daily lives of people with dementia
		We want physicians to share information on elderly patients with dementia
		Dementia education should be mandatory in schools and companies
		It is difficult for people with dementia to handle financial matters properly
Dementia care team	We need dementia care consultants at our hospital and wards	Chief hospital administrators are not familiar with the educational needs and methodology of dementia care
		We need a dementia specialist in each hospital ward
	There is a severe shortage of dementia specialist physicians	In addition to visits from a psychiatrist three times a week at our hospital, we need a doctor to consult on daily basis
		Our hospital requires a full-time geriatrician or a psyciatrist to take care of dementia patients
Community bond	We cannot collect information on people with dementia living at home unless family caregivers provide it	People with cognitive impairment who live on their own or with a spouse tend to be overlooked
		It is difficult for health care providers to closely monitor the dailiy living situation of people with dementia who live on their own
		Families are reluctant to let others know that their loved one suffers from dementia