Mr Frank and his family, current experience | Jamaica

23 Feb 2022

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Mr Frank and his wife are returning residents from the United Kingdom living between the parishes of St. Elizabeth and St Andrew in Jamaica. They operate a few residential rental properties located in both parishes where they collect rent monthly. They share three adult sons living in the parish of St Andrew, where job opportunities were more available. Recently, Mr Frank began forgetting routine activities such as collecting rent, driving routes, the time of day and is displaying unpredictable behaviours. As such, one of his sons decided to move in with his father to keep an eye on him. One night, Mr Frank’s son heard the front door open at 3:00 am and saw his father heading out, informing his son that he was on his way to work. Out of concern for his father, his son recommended that he sees a health professional. Mr Frank, described as stubborn, refuses to go and became aggressive with his son when he threatened to take away the car keys.

Mr Frank’s reluctance to visit the doctor and comply with the suggested changes put forth by his son will make it very difficult for his symptoms to be adequately addressed. Mr Frank’s wife and sons are likely to contact Mr Frank’s general practitioner, without him knowing, about these challenges and to seek advice. Mr Frank’s doctor will offer to contact Mr Frank on their behalf; however, Mr Frank will likely become upset with his family going behind his back and speaking about his condition. The family may then enlist the closest family member or friend of Mr Frank, someone he has listened to in the past, to encourage him to visit the doctor. Mr Frank, also noticing a decline in his functionality, will likely be in denial and will do as much as possible to avoid revealing his condition to his social network and other family members. Within Jamaica, men generally display poor help-seeking behaviour due to being socialised to think that they are “strong enough” to overcome health or general adversities and seeking help may be a sign of weakness, particularly health challenges without a clear physical origin.

The changes in the family arrangement and responsibilities include Mr Frank’s wife and children taking control of collecting rental income and managing the properties; however, this will be met with much resistance from Mr Frank. Additionally, given the safety concerns, the family may offer to drive Mr Frank to his desired destinations. However, this is likely to be met with much resistance, and as such, the family will likely hide the car keys. Unfortunately, Mr Frank is likely to locate these keys and possibly get into a motor vehicle accident. At this point, the authorities will then rule him to be a danger to himself and others. This decision will be supported by collateral information from his family. The family may also resign Mr Frank to one residence, more likely the home in St Andrew (predominantly urban), where the resources to support Mr Frank is accessible.

Realising the consequences of his condition going untreated, such as getting in an accident and realising that his tenants were taking advantage of his forgetfulness, Mr Frank may eventually agree to see a psychiatrist as referred by his general practitioner. The family, who is from the higher socio-economic strata, will be able to afford these doctor visits, follow-up on diagnostic tests and receive treatment, if applicable. Financing these services will come from Mr Frank and his wife’s pension from the United Kingdom (the exchange rate for GBP is about GBP 190.00 to JMD 1.00 as of October 2020) and their rental income. In the absence of any government support, the family will more than likely pay for the services out of pocket (OOP). As they have not worked in Jamaica, they would not be eligible for the National Insurance Scheme (NIS) pension. Additionally, the desire to address Mr Frank’s conditions and the burden of care, the family’s willingness to seek support/assistance will increase.

Despite receiving psychopharmacological treatment, the family may still require support in managing and caring for Mr Frank, especially if unpredictable behaviours like wandering persist and his symptoms worsen. As such, they will likely hire rotating live-in caregivers or nurses (at least two) to assist in activities of daily living, providing 24-hour care – an option typically affordable for the highest SES – with his wife spending on average 4 -5 hours daily on his care. These caregivers and nurses will be sourced through word-of-mouth – the main method of referrals. There is also a possibility that the family may hear from a friend who has interacted with STRiDE about the free memory care consultations they provide or from the Caribbean Community for Retired Persons (CCRP). Through these consultations, the family will be provided with advice on dementia care and management and directed to the most appropriate resources to support their care experience and increase their dementia awareness. The primary unpaid carer will remain his wife with support from paid carers and his three sons. His sons will likely take over the family business while their mother focuses on Mr Frank.