Mr Eduardo is in what we could consider and extreme or critical case as daily support and care is unavailable. This is a large and densely populated area, where it is not common for people to know or look after their neighbours. He is estranged from his children and at this point it is unlikely that they will be in contact soon, after five years of not talking to any of them.

Mr Eduardo receives an unexpected visit one day from volunteer case workers from DIF (system for the integral development of the family, a public institution). Using administrative records to identify households with older adults who could need support as part of their social assistance reach out program, DIF identified and visited Mr. Eduardo’s household. On arrival, they conduct a rapid assessment on his living conditions and decide to sign him into their novel strategy on supporting older adults with cognitive impairment that provides them with a bracelet which containing a personal identification code and a telephone number for reporting, hoping to address Mr Eduardo’s concern with his increasing difficulty to return home. In addition, the volunteer makes a note to find out if Mr Eduardo could be a beneficiary of additional DIF programs, such as meals at community centres, because it seems he does not have much food in the home and when questioned, he says he has little resources and often goes without basic staple foods. He does not have a pension, nor any other income, so he is worried that with the little money he has, he can get by for many years more.

A few months later, coming back from doing some shopping, Mr Eduardo falls and is not able to stand up. He is assisted by someone passing who decides to call an ambulance as Mr Eduardo not only is not able to get up, but seems disoriented and is unable to give any references as to his name, where he lives, etc. He is taken to a public (state-level Ministry of Health services) hospital where he is diagnosed with hip fracture. Because Mr Eduardo cannot provide any details, the hospital contacts DIF and with his ID they identify him as someone in their registry and open a case with the social worker based at the hospital. After consultation with other specialists, they decide surgery has too many risk factors and stays for weeks in hospital for observation.

After 3 weeks, Mr Eduardo is discharged, after considering his socioeconomic condition and the fact that DIF employees were not able to contact any of Mr Eduardo’s children or any other family members, they arrange to send him in to the only care home available in the city of Toluca belonging to the DIF system.  The care home will assure Mr Eduardo has a place to live and his basic social and health care needs taken care of. However, these facilities are not equipped to care for people with dementia, care workers are not trained or have the basic competencies to care for people with dementia and in consequence, his dementia-specific care needs will likely go untreated/will not be managed.   Given Mr. Eduardo has no other place to go, DIF will make sure he stays in the care home until the end of his life.