Mr. Doni is a widower in his 70s who lives by himself. His son works in a bigger town 4 hours away by bus from his town. Recently, his neighbour informed his son that Mr. Doni often forgets to lock the gate and turn off the garden lights. The son notices that his father often repeats the same questions on the phone.

It is difficult for his son to take his father to the doctor since they live in different towns. His son finally took two days leave from work to take him to the hospital. As Mr. Doni is accessing services using the JKN and it is not an emergency, he was taken to Puskesmas to be seen by a GP, who then referred him to a 2^nd level referral hospital. The neurologist in charge performed several examinations, such as laboratory tests and MRI. Upon examination, the neurologist also found that Mr. Doni has diabetes and hypertension.

To Mr. Doni’s son’s understanding the changes in his father are due to the diabetes and hypertension. Despite having the lab and MRI results, and the neurologist explained that Mr. Doni’s MRI showed a ‘shrinking brain’ and ‘minor old strokes’, he did not understand the neurologist’s explanation very well.

The doctor gave Metformin for his diabetes and Captopril for his hypertension, and asked Mr. Doni to come for regular assessments. He sent him for a back-referral to the Puskesmas for the diabetes and hypertension medications, which he can refill monthly. Mr. Doni’s son thinks that by taking the medication provided, Mr. Doni will get better and able to care for himself again. However, because Mr. Doni’s son had to go back his work in another town, he could not take his father for this regular appointments with the GP in Puskesmas. With his cognitive function declining, Mr. Doni cannot go to the Puskesmas by himself, so his son asked for a neighbour’s help to take him there monthly. However, with the current pandemic, the neighbour (who is about the same age as Mr. Doni) is scared to go to the Puskesmas, and Mr.Doni could not get his drug refills on time, which resulted in uncontrolled diabetes and hypertension. Moreover, even before the pandemic, the care the Puskesmas provided is just focused on his diabetes and hypertension. The GP did not mention that anything could be done about his dementia.

The son had thought about the possibility of sending his father to a nursing home, but he was concerned that there would generate a negative response from the extended family. Worried that his father might fall when alone or the risk of fire due to his father forgetting to turn off the stove in the kitchen, he finally installed a CCTV at his father’s home to help monitor him remotely. Mr. Doni’s son contacts his neighbour (the same one who used to bring Mr. Doni to Puskesmas) whenever he noticed anything concerning. In the past 5 months, Mr. Doni has been having trouble sleeping at night, and there was several instances that he wanders outside the house. Fortunately, security guards around the area found him.

Concerned about Mr.Doni’s safety and health at home, his son tried to find a male live-in nurse for him, but he could not find any. There are fewer male nurses in the home care workforce, especially in that small town. Moreover, the cost is too expensive for Mr. Doni’s son to bear.

Because his father lives alone, hiring a live-in female nurse is less preferable, as in the community it would be frowned upon. At the moment, the community around Mr. Doni is supportive towards him. The community think these problems related to memory problems or getting lost are something common for an ageing person, and thus the neighbours are willing to help keep an eye on Mr. Doni.

His son happened to read an article in a popular online media, covering about dementia. The article also refers to a link on a video of common symptoms of dementia. When he saw the video on common signs of Alzheimer, he felt that this is similar to what he sees in his father. He went on the internet to search for more information, and learnt about Alzheimer Indonesia online. He has since joined several of the organisation’s activities. He signed up for the Care Navigator programme and had a few online consultations with experienced family caregivers. They recommended him to do video calls with his father regularly and make a logbook/journal to keep track of his medical history, medications, day-to-day events, and future appointments. He was advised to strengthen his support system by involving neighbours to help look after his father, starting by providing information regarding dementia to them. He was also advised to hire someone as a carer to help Mr. Doni in his daily activities such as buying groceries and household chores, preparing food, taking daily medication and getting the drugs refilled at the Puskesmas. The carer does not necessarily have to be a nurse, and he was also informed that Alzheimer Indonesia has a dementia care skills training module he could enrol the carer to, if needed.

Mr.D’s son work fulltime and is away all day, so moving Mr. Doni to live with him is not feasible. There are no day centres yet in the town where the son works. Mr. Doni’s son has been looking for a live-in male carer, but still has not been able to find any in his father’s town. Later on, Mr. Doni’s son hired a younger male neighbour to come help clean the house and prepare food for Mr. Doni on weekday mornings. This neighbour could not stay during the rest of the day or come on weekends due to another job. Mr.Doni’s son tries to visit and stay over at his father’s during weekends, or arrange for another neighbour to come help when he cannot come.

When the neighbour comes to clean the house in the morning, he rarely sees and communicates with Mr. Doni, because he thinks Mr. Doni is not very approachable. Mr. Doni prefers to be alone in the room and doing almost all of his activities, such as eating, in the bedroom. He has also grown a bit irritable, easily angered by small things. Therefore, although the young neighbour is polite towards Mr. Doni, he prefers not to see him if not needed and to just do the household chores.

Mr. Doni’s friends and other elderly neighbours often invited him to join social activities before the pandemic, but he kept refusing. During the pandemic, there are an online meetings and health education organised by their local Posyandu Lansia, but due to the complexity of accessing online meetings, Mr. Doni become even more isolated. His son continues to look for a full-time live-in male carer, in hope that the carer could be a company to his father too, besides looking after his wellbeing.