Mr. Hugo has a private health insurance and have regular health checks with his geriatrician. Once his wife convinced Mr Hugo. to go for an appointment with his geriatrician, they would easily be able to book an appointment for the next week or so. The clinic he normally goes is close by and Mr. Hugo and his wife can go by car. The geriatrician would do a neuropsychiatric assessment and would refer Mr. Hugo for further exams, such as a CT scan. Mr. Hugo would not need to wait very long for these, and if so, he would be able to pay for it privately. In few weeks or months Mr. Hugo would return to his doctor and a diagnosis would be given. Another possibility is that because of his reluctance in seeing a doctor, by the time Mr. Hugo had finally accepted to seek a consultation, his dementia symptoms would have advanced.

His doctor would say that his symptoms are a typical problem with older adults and that he should just go home, live his life as usual, and “follow up” from time to time. However, he would forbid Mr. Hugo from driving. Mr. Hugo would become depressed and would have trouble to make sense of his condition.

His wife would try to do everything for him, which would make him feel even more incapable. After taking the doctor’s letter to the Human Resource (HR) Department at his place of employment/work, Mr. Hugo would be “invited” to take an early retirement. As Mr. Hugo  became more dependent, the housemaid would become to help him with his daily tasks more and more. Mr. Hugo’s wife would try and hire a home care worker, to which Mr. Hugo would probably be resistant to.

At some point Mr. Hugo cannot decide for himself anymore, and home care workers (paid for by the family) would come and stay full time caring for Mr. Hugo. He would only go to his geriatrician/psychiatrist only once in a while for to adjust his medication. As Mrs. Hugo’s dementia advanced, the domiciliary healthcare team would start visiting him for nursing, nutritionist, and physiotherapist care and assessments. All the care, however, is very focused on Mr. Hugo physical care needs, and little about promoting his independence.

Mr. Hugo’s children rarely visit and people they knew stopped visiting. His wife is retired and has her own health issues. She feels very isolated and miss having more intimacy with her husband as her house appears to have become a hospital – full of health professionals coming and going, hospital bed, diapers, etc. She is suffering from anticipated grief and she misses the husband she once knew. They had many dreams for their retirement, but now she feels like she’s lost all of that. She feels that she is expected to cope and feels very lonely. However, the domiciliary care team or doctors have never asked her how she feels or what her needs are. In addition to that, they live in a house with stairs and she is faced with the decision of moving somewhere else so that her husband can leave their bedroom. Even with all these difficulties and feelings, Mr. Hugo’s wife has never considered moving him to a residential as these institutions are very stigmatised in Brazil.