After eighteen years working in Japanese elder care facilities, I have come to see wandering — what we call hai-kai (徘徊) — as one of the most misunderstood behaviors in dementia care. For years, I approached it the way many of us were trained to: as a risk to be contained. But the more residents I walked beside, the more I realized wandering is rarely random. It carries meaning, memory, and unmet need. Recently I have been researching how Japanese care culture has evolved its response to wandering, and I want to share what I have been learning, along with reflections from my own daily practice.
What you will learn
- Why Japanese caregivers are moving away from the word “haikai” itself
- The philosophy behind community-based wandering response networks
- Environmental design methods I have researched and partially tried on the floor
- Communication approaches rooted in validation and life history
- How technology could support — but not replace — human observation
- Honest challenges we face when trying to implement these methods
Rethinking the Word “Haikai”
One of the most striking shifts I have researched is a growing movement in Japan to stop using the word haikai altogether. Several municipalities, including Fuchu City in Tokyo and areas of Hyogo Prefecture, have officially replaced it with phrases like “going out on one’s own” or “outings by people living with dementia.” The reasoning is simple but powerful: the word haikai implies aimless, meaningless movement. But research shows that people living with dementia almost always have a purpose when they walk — returning to a childhood home, going to pick up a child from school, heading to a workplace they retired from decades ago.
In my own experience, when I stop labeling a resident as “wandering” and instead ask, “Where are you heading, Tanaka-san?”, the entire interaction changes. She once told me she was going to buy tofu before her husband came home. Her husband had passed away thirty years ago. But in that moment, her purpose was real, and honoring it opened a doorway I could not have reached by simply guiding her back to her chair.
The Community Safety Net Model
Japan has developed something quite unique: town-wide wandering response networks, often called SOS networks (SOSネットワーク). These systems connect police, taxi drivers, convenience store staff, postal workers, and local volunteers so that when a person with dementia goes missing, a coordinated search begins within minutes. Some regions run practice drills where community members role-play encountering a confused older adult and practice how to speak gently, offer help, and contact family without causing alarm.
I attended one of these drills last year in a neighboring city, and what struck me most was how ordinary shopkeepers were being trained in dementia-friendly communication. If we could build stronger ties between our facility and the local shotengai (shopping street), I believe we could prevent many of the frightening incidents we still experience when a resident slips out unnoticed.
Environmental Design: Working With the Behavior
Rather than locking doors — which raises both ethical and legal concerns in Japan — many facilities are experimenting with environmental adjustments that reduce the urge to leave without restricting freedom. I have been reading about and testing several of these:
Circular Corridors
Some newer facilities are built with looped hallways so residents who feel driven to walk can do so safely, passing familiar landmarks and returning naturally to common areas. Our building was not designed this way, but I have been rearranging furniture to create a small looping path through the day room, and I have noticed that one particular resident who used to press against the exit door now walks his loop three or four times before sitting down calmly.
Visual Cues and Camouflage
Research suggests that painting exit doors the same color as surrounding walls, or placing a bookshelf-patterned curtain over them, can reduce exit-seeking behavior. I tried a simple version — hanging a noren curtain with a traditional landscape print over our side exit — and while it is not a magic solution, several staff members noticed fewer approaches to that door in the following weeks.
Meaningful Destinations
Creating destinations inside the facility — a “bus stop” bench, a small shrine corner, a mock kitchen with real utensils — gives residents somewhere to go. This idea comes from the German “fake bus stop” concept, but Japanese facilities have adapted it beautifully by using culturally familiar spaces like a tatami room or an engawa-style veranda.
Communication Rooted in Life History
The most important tool I have in my work is knowing each resident’s story. When Sato-san stands up at 3 p.m. every day, insisting she must leave, I know it is because she spent forty years walking to pick her children up from elementary school at that exact time. Understanding this does not stop her wanting to go — but it lets me meet her where she is. I can say, “The children are staying late for cleaning duty today. Would you like some tea while you wait?” This is not deception; it is entering her reality with respect.
Japanese caregiving has been increasingly influenced by validation therapy and person-centered approaches, and I have been studying how to integrate these more consistently. It requires time — time we often do not have — but even a two-minute conversation grounded in life history can prevent an hour of distress.
What About Technology?
I want to be honest: our facility has not implemented AI monitoring, GPS shoes, or sensor mats. I have researched them extensively and visited facilities that use them, and I see real promise. GPS-embedded insoles, mattress sensors that detect nighttime rising, and AI-powered cameras that recognize unusual movement patterns could ease the anxiety of night staff and reduce serious incidents.
But I also worry. If we were to implement such systems, I would want to be clear that they support human judgment rather than replace it. A sensor can tell me a resident has gotten out of bed, but only I can walk over, sit beside her, and ask what she is dreaming about. The Japanese concept of ki-zuki — noticing, sensing, being attuned — cannot be automated.
Honest Challenges From the Frontline
None of these methods are simple to implement. Staffing shortages mean we rarely have time for long validation conversations. Family members sometimes demand locked doors, fearing lawsuits more than they trust our judgment. Some colleagues, especially those trained decades ago, still view wandering as a problem to be stopped rather than a message to be understood.
Changing culture inside a facility is slower than changing procedures. I have found that sharing small success stories at morning meetings — like the day Tanaka-san walked her corridor loop instead of pressing at the door — helps colleagues see that these approaches are not idealistic theory but practical, workable care.
Summary
Japanese approaches to dementia wandering are moving from containment toward understanding. The shift begins with language — abandoning the word haikai — and extends into community networks, environmental design, life-history-based communication, and the thoughtful potential of technology. After eighteen years, I am still learning, still experimenting, and still finding that the most powerful tool is the willingness to walk alongside a resident rather than block their path. Wandering is not the problem. Our misunderstanding of it is. And that is something each of us on the frontline can begin to change, one conversation at a time.
About the Author
Written by the operator of AI Kaigo Kaze, a Japan-based certified care worker (Kaigo Fukushishi), care manager, and social worker with 18 years of frontline caregiving experience.
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