The Increasing Problem of Self-Neglect and Seniors - A Complex and Challenging Issue
by Don Drake, Connelly Law Offices, Ltd. 7.24.24
"Elder self-neglect represents a substantial public health issue affecting numerous older individuals each year," stated professional fiduciary and certified elder law Attorney RJ Connelly III. "It manifests as the elderly person's inability or unwillingness to meet their essential needs, including adequate food, water, clothing, shelter, personal hygiene, medication, and safety precautions. A study published by the National Library of Medicine reveals that in this country, self-neglect constitutes the majority (41.9%) of reported elder abuse cases managed by Adult Protective Services (APS)."
With the aging population, the significant impact of self-neglect on the physical and mental well-being, mortality rates, and healthcare utilization of older individuals has become increasingly evident.
"This poses substantial implications for various organizations and professionals in the social and medical sectors, such as social service agencies, community organizations, healthcare providers, social workers, and legal professionals," said Attorney Connelly. "As the incidence of self-neglect cases is projected to rise, these entities must be equipped to address an expanding scope of the issue and effectively navigate the associated challenges, including educating family members on this issue."
Thelma's Story
Holly has always admired her mother for her resilience and determination, especially after her father passed away when she was in grade school. While her friends grappled with caring for their ailing parents, Holly's mother, Thelma, handled everything remarkably easily. Having raised Holly by herself since she was in the sixth grade, Thelma instilled a sense of self-sufficiency in her daughter. However, as time passed, Holly noticed changes in her mother's ability to look after herself and maintain her home.
Over time, Holly, who resided near her mother in Connecticut, had developed a habit of assisting her with household tasks. However, a noticeable change occurred in her mother's behavior over a few months. Despite Holly's unwavering offers of help, her mother, Thelma, continued to decline adamantly, growing increasingly irritable, and eventually expressing her frustration by telling Holly directly to leave her be.
Concurrently, Holly also noticed a concerning decline in her mother's physical and mental well-being and a deterioration in the condition of her home. Concerned that her presence might be causing her mother unnecessary distress, Holly decided to limit their interactions to phone calls rather than in-person visits. In hindsight, this turned out to be a significant misjudgment.
In the summer of 2023, Holly began to receive frequent calls from her mother's concerned neighbors. They expressed their worry about the accumulation of trash in the yard, which was attracting vermin. They also mentioned that the house windows were always shut despite the hot weather, and the lights remained off at night. Whenever they saw Thelma, she appeared disheveled and consistently wore the same pajamas.
When Holly showed up unannounced at her mother's house one hot and humid August morning, she was taken aback to find that the power had been shut off due to non-payment, even though she knew her mother, Thelma, had a significant amount of money in her checking account. Even more alarming was seeing disconnection notices from the gas company and the cable provider, but thankfully both services were still active.
Thelma appeared unable to explain the situation coherently, leaving Holly concerned about her mother's ability to care for herself. The kitchen table was cluttered with spilled medication, and the sink was piled high with unwashed dishes. A foul stench wafted from the refrigerator, where food had spoiled due to the lack of electricity. Despite Holly's worries, Thelma staunchly refused any assistance, insisting that she was an independent adult with the right to live life on her own terms.
After exhausting all available resources, including reaching out to multiple social service agencies and seeking assistance from the local police, Holly came to the distressing realization that her elderly mother, Thelma, was a victim of self-neglect.
Despite Holly's best efforts, Thelma adamantly refused any support from the local social service agency or home health care services. It became evident that helping her mother would not be a simple task but would entail navigating a complex and prolonged legal battle to ensure Thelma's well-being.
Attorney Connelly pointed out that seniors like Thelma and people with disabilities who are struggling with self-neglect often display specific characteristics. They are more likely to be living alone and have a higher risk of facing mental or physical health challenges like Alzheimer's disease, declining physical abilities, and issues related to alcohol or drug abuse. The statistics show that more women than men are impacted by self-neglect, which might be because a larger number of women live independently compared to men.
Is Self-Neglect a Form of Suicidal Behavior?
While we have discussed suicidal behaviors in seniors in previous blogs, it is important to recognize that self-neglect differs from this behavior in that it does not indicate an active desire to take one's life. Self-neglect is a passive and frequently involuntary state that can impact older individuals. It arises when an individual can no longer take care of themselves but is unaware or unwilling to acknowledge their incapacity to do so. Persistent self-neglect may be evidenced by:
Utility Shutoffs/Financial Issues - When someone who has always been diligent about paying their bills on time suddenly begins to neglect this responsibility or their utilities are disconnected due to non-payment, it could be a sign of a serious issue. This behavior change might indicate that the person is being financially exploited, particularly if they are older and vulnerable. Financial exploitation involves taking advantage of someone and preventing them from managing their money. Alternatively, if there is no evidence of exploitation, the situation may be due to the individual experiencing difficulties such as forgetfulness or struggling to handle paperwork and financial tasks.
Medication Mistakes - The failure of an elderly individual to adhere to their prescribed medication regimen, whether through discontinuation, incorrect dosage, or lack of understanding about the quality of certain medicines, can gravely jeopardize their health and, in some cases, lead to fatal consequences. Even if they have access to medication management technology, neglecting to utilize it may signify a deficiency in self-care or an inability to attend to their own needs. Consequently, it is important to ensure that older adults receive the necessary support and resources to handle their medications effectively.
Home Neglect - When you observe a sudden and noticeable decrease in the overall tidiness and cleanliness of a typically well-kept living environment, for example, noticing an increase in unwashed dishes accumulating in the sink, the build-up of grime in the bathroom, and a general increase in clutter throughout the entire home, it might be a sign that an older adult is struggling to maintain their living space and is potentially starting to neglect their care and well-being.
Neglecting Basic Health - It's important not to underestimate the importance of maintaining proper hydration and nutrition. When individuals either forget to consume water and food or are unable to do so, it can indicate a serious case of self-neglect. Family members and caregivers must remain attentive and take proactive steps to ensure their loved ones receive the necessary sustenance to stay healthy and secure. This obligation also includes ensuring that there is an ample supply of nourishing food available in the household.
Mental Health issues - Conditions such as schizophrenia, dementia, alcohol or substance abuse, and psychosis are mental illnesses that have the potential to contribute to the emergence or worsening of self-neglect. Recognizing these signs of self-neglect can provide valuable insights into the mental well-being or potential illness of individuals within the community, allowing for timely interventions and support.
Poor hygiene - If an older family member or loved one starts to overlook personal hygiene tasks such as taking regular showers, brushing their teeth, washing their hands, or presenting a well-groomed appearance, it could be an indication that they are encountering difficulties in carrying out these activities due to physical or cognitive limitations. This may include struggles with remembering to perform these tasks or encountering physical impediments to self-care.
The Cause of Self Neglect
The root cause of self-neglecting behaviors can be complex and multifaceted. It may stem from a range of factors. Conditions such as traumatic or acquired brain injury, Alzheimer's disease, or other mental health conditions that affect cognitive functioning and decision-making abilities can lead to difficulties in maintaining personal hygiene and overall well-being. Similarly, individuals with obsessive-compulsive disorder or hoarding disorder may struggle with neglecting self-care due to their conditions.
Additionally, physical illnesses such as chronic fatigue syndrome, fibromyalgia, or other debilitating conditions can significantly impact one's ability to attend to personal hygiene, maintain energy levels, and stay organized. Further, the side effects of certain medications or medical treatments may lead to reduced motivation, affecting an individual's ability to care for themselves properly.
Addictions to substances or behaviors, such as alcoholism, drug dependency, or compulsive gambling, can also contribute to the neglect of basic needs. Traumatic life changes, such as the loss of a loved one, displacement due to natural disasters, or major life transitions, can result in self-neglect as individuals struggle to cope with overwhelming emotional upheaval.
Legal Response to Older Adult Self-Neglect
Several actions can be taken to address the issue when dealing with situations that do not involve wrongdoing by caregivers or elder exploitation. These actions may include but are not limited to, seeking assistance from elder law practitioners who may recommend:
Seeking a Power of Attorney (POA) - As an older adult's ability to care for themselves declines, they may reach a point where they need to designate someone to make important decisions on their behalf. In such cases, they may sign a power of attorney, giving a trusted individual or professional fiduciary the authority to act as their agent. It's important to note that this can only happen if the older adult still has the mental capacity to make their own decisions. Once a power of attorney is established, the designated agent will have the legal authority to make financial or healthcare decisions for the older adult.
Filing for a Conservatorship or Guardianship - In situations where an older adult cannot take care of themselves and refuse outside help, a conservatorship or guardianship may be necessary. This is particularly common when the individual is experiencing mental decline and is unwilling to grant power of attorney, and, according to Attorney Connelly, should be a last resort. In such cases, a court will appoint a conservator or guardian to oversee and make decisions regarding the incapacitated adult's personal, financial, and healthcare matters.
Other Options for Family
Family members must understand that elder self-neglect is a complex issue that presents challenges in terms of providing appropriate support. This difficulty arises from seniors having the right to refuse care, particularly those with higher cognitive and physical functioning levels. Additionally, elders may be in denial about their living conditions and genuinely believe that they do not require assistance.
If you notice that your aging loved one is displaying any of the signs mentioned above, there are several actions you can take to aid and support:
Encourage social engagement and prevent isolation by making regular in-person visits, organizing social gatherings, having phone conversations to check in regularly, and providing transportation assistance when needed. These actions can help individuals stay connected with their community and maintain their well-being.
Take responsibility for cleaning their living space to ensure a safe and healthy environment.
Accompany them to their medical appointments and assist them in following their healthcare routine to ensure they receive the appropriate care and support.
Reach out to other family members, local charitable organizations, or agencies like Adult Protective Services to explore additional options for comprehensive care and support for your loved one. Seek assistance from these resources to ensure your loved one receives the help they need.
A Final Thought
"If you observe that a family member is finding it challenging to handle everyday activities like keeping track of medications, cooking meals, or taking care of personal hygiene, it might be time to start looking into assisted living and memory care options," said Attorney Connelly. "Being able to recognize the signs of self-neglect and staying attentive is crucial in ensuring that elderly individuals receive the support they need to enhance their quality of life. It's common for seniors to feel hesitant about seeking assistance due to concerns about losing their independence. However, by offering them high-quality care, we can help them maintain their independence for a longer time, ultimately leading to a happier, healthier, and more secure life."
Please note that the information provided in this blog is not intended to and should not be construed as legal, financial, or medical advice. The content, materials, and information presented in this blog are solely for general informational purposes and may not be the most up-to-date information available regarding legal, financial, or medical matters. This blog may also contain links to other third-party websites that are included for the convenience of the reader or user. Please note that Connelly Law Offices, Ltd. does not necessarily recommend or endorse the contents of such third-party sites. If you have any particular legal matters, financial concerns, or medical issues, we strongly advise you to consult your attorney, professional fiduciary advisor, or medical provider.
Comments