In mid-size towns/cities in Mexico, two factors are crucial in determining the possible pathways to care: income and affiliation/insurance with a social security institution. We assume that Mrs Beatriz had little formal education and did not have formal employment, therefore, she does not have access to any social security institution that would provide her with access to health care services, a pension, or other benefits. For this reason, her options will be to use public health services from the Ministry of Health or to seek services within the private sector. Because the case mentions the son has a small business, we assume their income would not be enough for them to access private services as there are few available and these are usually highly expensive.

When symptoms get too worrying, Mrs Beatriz’s son and daughter-in-law will take her to a public health centre (Ministry of Health) where she will be seen by a GP. Because there are no national health programs for dementia, what she receives will depend on the GPs knowledge or willingness to act, given that it is unlikely that the GP has had any formal training on dementia (maybe not even on older adult care). Dementia will not be diagnosed, likely dismissed as “nothing to do about it”, but if lucky, Mrs Beatriz could get referred to a specialist for a consultation. However, given this is a mid-size town, this will most likely be in a larger town/city, imposing large financial and opportunity costs to the family, such as paying for the consultation, transportation to the clinic and either her son or daughter-in-law missing work, on top of her already limited free time to care for Mrs Beatriz. It is likely that they do not bother with this unless Mrs Beatriz starts having severe mood or behavioural problems that they do not longer feel capable of managing.

Care for Mrs Beatriz will likely be done 100% by her son and daughter-in-law. While Mexico had a tradition of family-based values and strong filial obligation, where daughters-in-law were a big pillar of support, cases like this are common and children’s own responsibilities. Financial commitments and time restrictions as more and more often they work outside the home and have no help to care for their own children, make these situations extremely hard to handle. Frustration, physical exhaustion, and feelings of being overwhelmed are frequent and in extreme situations lead to mistreatment.

After a while, Mrs Beatriz’s daughter-in-law has a serious talk with her husband as she feels the care situation becomes unbearable, and they could decide to hire someone to help them. As they only have little extra income for this they are likely to either get domestic help to take up some of the cooking and cleaning of the house and freeing some time for the daughter-in-law, or some other person to “watch” Mrs Beatriz and help her in personal care issues like getting dressed, minding her when the rest of the family is out, etc. Being a mid-size town, the cost of hiring these persons would not be high, but, they will NOT be trained in or have knowledge of taking care of older persons and even less, of managing a person with dementia. Therefore, Mrs Beatriz’s son and daughter-in-law will continue providing all care needed until the end of her life, with the support of a paid, but untrained carer when personal care becomes too difficult for them to manage.