Mr Edi left his family many years ago to work in Jakarta as a street food vendor. He only visited his family once a year, and did not have a good relationship with his children. His children became increasingly estranged and he lost contact with his children after his wife passed away five years ago. He lives on his own in a small flat. Mr Edi finds it difficult to find his way to the shops and back, has difficulty remembering appointments and often forgets about eating.

Mr. Edi’s friends still check on him regularly. Mr. Edi is concerned about his health because he keeps forgetting his way to the shops and forgetting about his appointments with his friends. Some of his friends think it is a normal part of ageing but they ask him to go and get himself checked by the doctor. Mr. Edi had heard about Alzheimer’s Disease, so he decided to check himself to a Puskesmas near his house. Mr Edi had been screened in the Puskesmas and got a referral letter to the next healthcare facility (second level referral hospital), but he forgot the date of the appointment to the next healthcare facility, so he needs to make another appointment.

Mr. Edi’s friends volunteer to help Mr Edi get to the hospital, so that he can be tested and get a diagnosis by a neurologist/psychiatrist/geriatrician. Mr Edi receives Donepezil as a dementia medication. However, at this level of referral, any dementia medication will still have to be paid by Mr. Edi and because Mr Edi is retired he has difficulty paying for the medication. He also often forgets to take the medication.

Mr Edi’s friends try to contact his children because they see that his health is deteriorating. He is no longer able to go out and buy groceries, and sometimes soiled his pants. His friends or neighbours who visit him had to help him cleaning himself. However, as he lives alone, it might be a few days until someone visits him and finds out about his condition.

His oldest daughter came to visit Mr. Edi, but Mr Edi did not recognise her anymore. His daughter discusses with her other siblings and they decide to move their father into a nursing home.

Mr. Edi’s children find a nursing home operated by a religious organisation similar to Mr. Edi’s faith in the outskirts of Jakarta. They provide an array of activities such as music and art sessions. The fee is hardly manageable if all his 3 children chip in to pay for the nursing home.  However, upon learning that Mr. Edi has dementia and would gradually need support 24/7, the nursing home explained that they only accept residents with dementia or severe disability with the condition that the family will provide a carer themselves because they do not have enough staff to provide adequate care for highly-dependent residents. Adding the cost of a paid carer makes the cost absolutely unaffordable for the children.

The children have contacted several government-managed nursing homes, but all are full. Considering this, the children decided to ask Mr. Edi’s neighbours to continue looking after him and send a monthly payment as an incentive. However, after COVID-19, the payments stopped.

During the COVID-19 pandemic, Mr. Edi was infected from one of the neighbours who came and visited him. He was found to be infected through contact tracing done by the Puskesmas and was hospitalised due to moderate symptoms. During the hospitalisation, none of his children could be contacted.

Upon recovery, Mr. Edi still needs oxygen supply constantly and his ability to walk has decreased significantly. Considering his next of kin cannot be contacted and the neighbours’ inform they no longer can care for him with his current condition, the hospital contacted the Provincial Department of Social Affairs. Their staff came and assessed Mr. Edi, and decided that he could not live alone anymore. They arranged for him to be discharged to one of the government’s nursing homes in Jakarta.

Mr. Edi was placed in a ward for people who needs constant assistance. The ward consists of a large room with about a dozen residents, with three staff caring after them at a time. Despite trying as best as they can to provide care, the staff are overworked and sometimes cannot meet all the residents’ needs. Mr. Edi is now bed-ridden, and was given adult diapers due to his incontinence. The staff noticed that he is at risk of pressure ulcers, and try to move him every few hours. However, the staff struggled to make sure this can be done, in between giving medications, ensuring his oxygen cylinder is refilled on time, and caring for other residents. After a few months, Mr. Edi developed a pressure ulcer. He was referred to a GP from a nearby Puskesmas who came to the nursing home twice a week, and was given medications. However, this did not resolve, and resulting in recurrent infections.