<p>This article situates perspectives of South African social service and health care providers on older adults who live with dementia and Alzheimer’s disease in ethnographic context. A review of findings from multi-year field research on long-term care and service provision for older adults in peri-urban Mpumalanga shows: racial disparities in accessing formal dementia diagnoses; aggression, forgetfulness, and wandering as the most reported symptoms of presumed dementia; and provider-reported ethno-racial differences in families’ diagnostic- and care-seeking practices. Findings corroborate evaluative research showing structural barriers to diagnosis and care. Hansen’s concept of diagnostic apartheid is expanded to explain how making sense of dementia is a sometimes partial, unequal, and racializing process; how older adulthood is reproduced as a structurally vulnerable position; and how historical consciousness of violence informs understandings and non-integration of neuropsychiatric and other models of dementia.</p>