Self-neglect: when elder abuse gets really complicated

Friday, June 13, 2014

Suzanne Burke

 Suzanne Burke

CEO, Council on Aging

By Suzanne Burke
CEO, Council on Aging

Many neighborhoods have at least one – a rundown house where dirty curtains are always tightly drawn and no one ever seems to be around. Maybe an old woman lives there alone and has become reclusive.  When she does appear, she is disheveled and talks to no one.

She may be merely poor and a bit eccentric. Or these could be signs of the more serious problem of self-neglect.

Self-neglect is a common form of elder abuse. According to the AARP Public Policy Institute, self-neglect represents 40 to 50 percent of cases reported to adult protective services agencies. And yet – with the exception of extreme cases of hoarding – it seems to get even less public attention than other forms of elder abuse, such as physical abuse or financial exploitation.

That may be because there is no perpetrator – the individual either will not or cannot care for herself – and so the situations are often complex and difficult to improve. Contributing factors may be lifelong patterns of self-neglect, dementia, illness, malnutrition, overmedication, poverty, substance abuse, depression and isolation.

To complicate matters further, we all have a right to live as we please. If a person chooses to neglect his or her own health or safety, is it abuse? Is it right to intervene, especially if the person demands to be left alone?

There are no easy answers. But it’s important to address the questions.  For professionals in the field of service to older adults, the month of June (including World Elder Abuse Awareness Day on June 15) is a time in which advocates, victims, and service providers bring attention to the problem through rallies, memorial services, conferences, or by wearing purple.  Greater awareness raises more voices to help those who have no voice.

Greater public understanding of self-neglect is important because it is common and affects many people besides the individuals at risk. Sons and daughters may be at wit’s end trying to help an older parent. Adult Protective Service workers are often stymied when they try to help. Fire departments and paramedics are called again and again to the home. Hospital emergency departments provide costly care that could have been avoided.  Community health departments and legal services are sometimes involved.

Kevin Kurpieski, supervisor of Butler County Adult Protective Services and a member of the county’s Elderly Services Program Advisory Council, says that his workers have more self-neglect cases than all other types of abuse combined.  They often call for a multi-disciplinary approach from professionals in several different fields, but that can take more time than anyone has and often, Kurpieski says, “the person keeps turning you away at the door. We can’t just load people into a vehicle and take them to a facility.” 

As intractable as the problem may seem, we do need to find better ways to address it. A formally-structured multi-disciplinary team involving Council on Aging, fire department/paramedic teams, Adult Protective Services, mental health professionals, and the court system, is one strategy we’re contemplating.

A major sign of hope came earlier this month when the Ohio House and Senate passed House Bill 483, a budget bill that includes new investments in Ohio’s children, seniors and families.  The bill includes $10 million to strengthen Adult Protective Services across Ohio, which have long been gravely underfunded with some counties having as few as one worker for the entire county. 

On an individual level, is there anything we can do ourselves to help a neighbor who refuses the care that they need? Call Adult Protective Services, yes. And when you do, please leave your name and phone number, so the investigators can get more information. But don’t stop there. Reach out, as hard as that may be.  Don’t confront about the un-mown grass and the falling down house. Try to build some trust.  You never know. It may finally open the path to help.