Mrs Bhatt is in her 70s and lives in mid-size town in North India. She was a homemaker and lived with her husband in a small flat until he died twelve years ago. She receives a small government pension scheme. When her son got married eight years ago, she moved in with her son and his wife. For the last few years she helped the family by looking after the grandchildren and doing housework and cooking while her children were working in the business they own. About two years ago, Mrs Bhatt’s family became worried about her behaviour and memory. Now Mrs Bhatt mostly stays at home. She does not go out unless someone of the family accompanies her. Mrs Bhatt also stopped cooking, which she always enjoyed. Her daughter-in-law reminds her to take the medication she needs for other health issues and helps with dressing. Mrs Bhatt does not like being left alone in the house. Mrs Bhatt’s daughter-in-law is worried about her hygiene, but having to look after the business, taking over the cooking and shopping for the family as well as making sure that Mrs Bhatt is safe and well during the day takes a lot of her energy and so she postpones thinking about this aspect.

Once a week Mrs Bhatt’s son takes his mother to the temple. He also notices that his mother has become very withdrawn. Mrs Bhatt’s son talks to their local pharmacist, who gives a few over-the-counter medications that Mrs Bhatt’s son pays for out-of-pocket. Over the course of few months, Mrs Bhatt continues to have changes in her behaviour. She is suspicious of any guest that visits and makes comments that are embarrassing for her family. The neighbors noticing this behaviour commented that Mrs Bhatt may not be well taken care off. The accusations add to the family’s frustration and stress with the situation. They try to isolate Mrs Bhatt from community gatherings and reduce their social interactions with their relatives and friends. Mrs Bhatt’s son takes her to their local physician at a private clinic nearby, who examines Mrs Bhatt and suggests that what she is experiencing could be natural signs of ageing. However, the physician recommends that they consult a specialist in the city 40km (1-1.5 hours) away. The son pays for the family physician’s service out-of-pocket. On one weekend, the son and daughter-in-law take Mrs Bhatt via bus to the city for the appointment. The physician assesses Mrs Bhatt and suggests a CT scan. Mrs Bhatt’s son and daughter-in-law bring Mrs Bhatt to the city for the scan another day. On the day of the follow-up, Mrs Bhatt, her daughter-in-law and son travel into the city again with the reports. The physician reviews the reports and diagnoses Mrs Bhatt with hypertension and dementia. He prescribes some medication. The daughter-in-law and son continue to make repeated visits to the physician in the city, as Mrs Bhatt begins to have other medical issues and severe behavioural problems. Mrs Bhatt’s son worries about costs, as he has already spent some of his savings on the tests and consultations. As Mrs Bhatt’s symptoms began to progress, she becomes unable to do basic activities such as eating, bathing, dressing, and using the bathroom. Mrs Bhatt develops pneumonia and is admitted to the hospital and then temporarily to a local private nursing home (smaller hospital). The daughter-in-law assumes the primary responsibility of caring for Mrs Bhatt. The son will be responsible for hospital visits, communication with medical professionals and taking medical decisions regarding care. Whereas, care with BADLs and IADLs is provided by the daughter-in-law. As a result, she has to step down from her role in the family business and spends around 12-14 hours per day providing care to her mother-in-law. She struggles to manage her other household responsibilities and give time to her children.