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What to do if you think your parent is self-neglecting

Self-neglect can include hoarding of rubbish

Signs of some degree of self-neglect is common amongst older people. Sometimes there’s a simple explanation that can be addressed through practical help.

Perhaps a friend or relative that’s not visited for a while notices that your relative has lost weight. That could be a health issue, which needs checking out sooner rather than later.  Alternatively it could be that they’ve lost interest in food because age tends to dull sense of smell and taste. Maybe they’re depressed. Or they may just not have the energy to buy ingredients and cook a meal. It becomes a more worrying situation if it seems they don’t remember whether they’ve eaten or not.

Another possible sign of self-neglect is a lack of cleanliness. There could be good reasons for this too. Older people often find it harder to take care of their personal hygiene, while washing clothes and bedding can be heavy work. Again, it becomes more of an issue if your relative simply doesn’t notice their condition, or refuses to do anything about it.

Self-neglect can extend to the house as well. Dust piles up, stains go unchallenged – and perhaps even unnoticed. In some cases people begin to hoard, collecting useless stuff and refusing to let go of anything. There’s a particular health concern if they’re not even agreeing to putting the kitchen waste out.

What to do first?

Having a chat with your loved one may reveal that they know things aren’t right but they’re struggling to manage on their own. In that case, it could be that arranging for carers and/or cleaners to help out in the home could solve much of the problem.

If having food to eat is an issue, then there are numerous companies who are willing to deliver ready meals to the housebound. An even better idea is to encourage your relative to visit a local community centre that offers hot lunches and a chance to spend time with others. Quite often they’ll be able to arrange transport too. If remembering to eat is a problem, there are plenty of ways to set up reminders at meal times.

Determining self -neglect

If simply not being able to cope well any more isn’t the answer, you may have to look more closely at whether your relative is actually neglecting themselves. They could potentially be causing themselves and others harm as a result. Living surrounded by rubbish, for example, can invite vermin and be a fire risk. Not eating and drinking properly can land a person in hospital and cause mental as well as physical problems.

The Care Act 2014 talks about self-neglect and social services agencies publish useful information and advice about identifying the problem.

This is a very clear list of indicators from Rochdale Borough’s Safeguarding Adults Board:

  • Very poor personal hygiene
  • Unkempt appearance
  • Lack of essential food, clothing or shelter
  • Malnutrition and/or dehydration
  • Living in squalid or unsanitary conditions
  • Neglecting household maintenance
  • Hoarding
  • Collecting a large number of animals in inappropriate conditions
  • Non-compliance with health or care services
  • Inability or unwillingness to take medication or treat illness or injury

If you feel this is happening to your relative but they refuse to accept that they have any sort of problem, it may be time to call in professional help. Start with the website of their local authority, which is likely to offer information about self-neglect. And there should be a number for you to call to find out more.

It’s useful to know that the Care Act 2014 puts a requirement on local authorities to enquire further and assess the needs of an adult whenever a notification of harm caused by self-neglect is made. The assessment should be made even if it’s unlikely that the person concerned is eligible for local authority support. The aim is to paint a full picture of the person’s needs, to understand what sort of help and support they need.

This process gets trickier if your relative refuses to take part in the assessment. In this case the local authority is expected to try persuasion before resorting to legal intervention.

It may be that your relative has reached the point of not having the mental capacity to make the decision to get help. In that case the local authority should carry out ‘supported decision-making’, aiming to involve the older person as much as possible in the process.

The authority will need to carry out a capacity assessment and take ‘best interests’ decisions on behalf of your relative if they’re found not to have capacity themselves. If there are people with power of attorney, this will be a time to be involved.

You can find out more about the Care Act, mental capacity and the role of professionals in the Safeguarding Adults in Bexley toolkit. It includes a useful section on hoarding. Or look on any local authority web site.

It’s a difficult road to travel, but remember that the abiding principle is to be acting in your relative’s best interests.

You may find more help in our other articles:

Photo by Michael Jin on Unsplash

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