This study examines the impact of healthcare restructuring on care in inhabited areas of isolated islands from a spatial perspective that is based on a case study of Shin-Kamigoto Town, Nagasaki Prefecture.　The intensification of hospitalization and the availability of dialysis facilities and home-visit nursing care services have increased the dependence on Kamigoto Hospital for care resources.　Contrastingly, the districts of Wakamatsu and Narao, which have exhibited a decrease in accessibility to these services, have become increasingly marginalized.　Efforts of Shin-Kamigoto Council of Social Welfare and the incorporated nonprofit organization Home Hospice Ohana have improved accessibility through the launch of elder-care taxis and home-visit nursing care services as new enterprises.

Shin-Kamigoto Town, with its historical background of being heavily populated by Catholics, has been much in demand for home-visit nursing care services.　However, triumph over marginalization is restricted by the shortage of nursing care workers and volunteers in the peripheral areas.　It is particularly difficult to address the needs of the elderly living alone with dementia despite it being necessary to monitor them as they lead their daily lives.

A community-based integrated care system requires networking resources in the interior and exterior of isolated islands and their management.　The system must consider regional differences within the municipality and links between events at different levels on the geographical scale.

This paper is an attempt to examine the transformation processes of Leavenworth, Washington, from a small rural town with a resource-based economy to an ethnic-theme tourist town and consider its cultural meaning referring to cultural theory of tourism.

Leavenworth, located in the east side of the Cascade mountain range, started its original settlement in the late 19th century and began to blossom with the arrival of the Great Northern Railway line.　The town was flourished by local timber and fruit industry.　In the 1930s, the town began to suffer from economic down, and its built environment fell rapidly into disrepair by the 1950s.　In the 1960s, Leavenworth was struggling to search ways out of this difficulty, and, among other things, an idea of transforming the town into a Bavarian theme town had occurred to people to attract many tourists to the area. This idea of “Bavarianization” was first proposed by two entrepreneurs, Ted Price and Robert Rodgers from Seattle, and after many disputes among stakeholders the first group of remodeled Bavarian-front buildings appeared in 1966, and the second group soon followed.　The earlier renovations into Bavarian style were done without any strict codes or regulations.　In the 1970s, the council of Leavenworth created an advisory Design Review Board, and the design review guidelines for downtown buildings were written.　In the 1980s, however, it grew evident that many renovated or newly-built buildings deviated from the ideal style, and the voice to desire stronger enforcement of design regulations had been growing.　After the years of struggle, a new more freestanding Design Review Board was established in 1995, and the new strict design guidelines were enacted in 2001.　Nowadays, Leavenworth is well known as a “Bavarian Village” in America with a unique townscape in its downtown and a thriving tourist economy.

The examined facts are interpreted around the following three viewpoints; 1） symbolic economy and tourist space for consumption, 2） authenticity of culture and nature of ethnicity, and 3） symbolization process to alleviate sociocultural stress.　As a result of Bavarian town-making, Leavenworth was recreated into an intensive tourist space for consumption.　There, while special merchandise and food are sold, the visually unique built environment is itself consumable. Authenticity of culture which has been emphasized in the process of Bavarianization can be interpreted as what MacCannell（1973） called “staged authenticity” or that negotiated by stakeholders in a social context （Cohen, 1988）, and the ethnicity shown here can be viewed as culturally “invented ethnicity” suggested by Hoelscher（1998）, because the town lacked any discernible German heritage in its history.　It is particularly noteworthy that the process of place-making in Leavenworth can be viewed as a symbolizing response to alleviate sociocultural stress.　We can observe there that the symbols became condensed, widely accepted, formal, structural, or institutional changes became to emerge to maintain the symbolic system, and the flexibility became reduced as suggested by Rowntree and Conkey（1980）’s ecological continuum model of stress-symbolization.　Leavenworth is a unique example in a sense, but it definitely shows some universal aspects of the place-making processes through which a themed tourist space is generated.