Mr D’Souza lives by himself in a mid-size town in India since his wife passed away last year. He used to work as an assistant at a local pharmacy near his house, but retired over 13 years ago. His children have moved to the bigger city to work and can only visit once a month. His sons send Mr D’Souza  money every month in order for him to meet his living expenses. Over the last few months Mr D’Souza  has found it difficult to look after the house and himself. His son has noticed that his father does not seem like himself and is worried about him and what people may think if they see his father. He has observed that his father—who used to be very socially active in the community— has become very withdrawn.

On his next visit, the son takes his father to see a general physician at a private clinic nearby, who suggests that this could just be old age problems and prescribes some medication. The elder son pays the physician directly for the service. A few days later, his father’s neighbour calls him and informs him that his father has fallen and fractured his hip. The neighbour had already taken him to the nearest hospital to be treated by a medical physician, but Mr D’Souza would now require help around the house until his hip heals, as he is currently bedridden due to his injury. The next day, the elder son travels to his hometown in order to bring his father back with him to the city. As Mr D’Souza stays with his elder son in the city for a few days, the son notices that his father seems to be very confused and is having difficulty communicating his needs. Over the weekend, the elder son (after researching his father’s symptoms online) takes his father to the neurology out patient department (OPD) of a public hospital nearby. The waiting time at the hospital is long, and they only see a neurologist almost 3 hours after their arrival. During the appointment, the neurologist assesses Mr D’Souza  and recommends an MRI and a few blood tests. The waiting time for the scan is almost a month. The elder son pays for the consult and tests out-of-pocket, both of which are subsidized (assessment made by public hospital and is based on the family’s socioeconomic status). The father continues to stay with his son and more than a month later, they go back to the hospital with the reports for a follow-up. The neurologist diagnoses Mr D’Souza with dementia and prescribes medication. He advises the elder son that the disease would continue to progress and that Mr D’Souza would require someone to provide constant care for him. The elder son decides to move Mr D’Souza permanently to his apartment in the city, but struggles to provide the required care (helping his father with ADLs) for his father and also manage his own job responsibilities. As Mr D’Souza’s symptoms progress to a stage where he can no longer eat, dress or bathe himself without assistance, the elder son makes a decision to hire a full time attender from a private company that provides elder home care services. The attender is male and untrained (will be unable to do therapies targeted towards persons with dementia (e.g. cognitive stimulation)) and the service is highly expensive. The younger son also contributes towards the cost of keeping the full-time attender (out-of-pocket costs), but it is draining the savings of both brothers. This has impacted their future plans to get married and invest in houses of their own.