Signs of Self Neglect

A person who cannot do those things for essential selfcare due to physical or mental deficiencies is what the Public Policy Institute of AARP calls self-neglect. Some of the signs of elder self-neglect are poor personal hygiene, bedsores or skin rashes, untreated injuries or infections, weight loss and dehydration or malnutrition. Still other signs are unpaid bills, unsanitary or unsafe living conditions, poor personal hygiene, lack of food in the home, and improper or dirty clothing. None of this is caused by a third party, but the bad effects on an elder can still be considered elder abuse, even though not caused by anyone else. A daughter in California recently called my firm with great concern about her mother in Connecticut. The mother’s small circle of friends had called the daughter about unsafe conditions, poor food, and obvious falls the mother had taken. The pattern of mother’s behavior and was a classic case of self-neglect.

The first thing the daughter did was get a good idea from her mother’s friends about food, clothing, and hygiene. She decided to talk about these things in a gentle way, but mother was very defensive and took the questions as an intrusion on her independence. The very “stubbornness” which allows many people to carry on, despite infirmities, is a double-edged sword, as sometimes it results in rejecting reasonable suggestions or direct help. The daughter was aware of her mother’s stubbornness and did not push too hard. She just made a few suggestions for letting the friends check on mother more frequently. She also got permission to talk to mother’s doctor. After many such telephone conversations from California, she made a trip to Connecticut for a visit that allowed her to compare what mother was saying to the real-life conditions that were obvious. Hygiene, nutrition and safety were all being neglected to one degree or another. During that trip she also looked at mother’s years old documents such as power of attorney, living will and HIPAA form.

Since my firm had done those years ago, it was time for an update, and mother was
receptive to having us do that. Daughter was back in California but sometimes it’s easier for a non-family member to talk about self-neglect (not in those terms) and how much it would mean to the daughter if some steps were taken to be safe and nourished and clean. Because of our legal services many years ago, the mother let me bring updated documents for signature. The witnesses that came from my office were two of our elder care coordinators one of whom used to work for the State of Connecticut doing Medicaid and the other who had worked for one of the companies hired by Connecticut that evaluates people for homecare. They did a friendly and quick assessment and made suggestions to both the mother and daughter, such as having at least weekly calls, and letting friends in more often and leaving more food in the refrigerator. This was not a cure all or permanent, but it at least got the camel’s nose under the tent to encourage family communication. Although mother would not take our suggestion to hire a home care agency to make regular checks, at least the seed was planted. Self-neglect is often caused by diminished capacity, which is difficult to deal with, especially if the person is extremely strong willed. It is even more difficult if the children live far away and cannot easily visit. Recognizing the signs before it is two late is a key to minimizing self-neglect.