Some Seniors Neglect Themselves: What You Can Do

By San Diego County Aging & Independence Services

The outside of the house hardly hints to the filth inside. But neighbors report seeing rodents enjoying cat food the woman leaves out. Papers and garbage litter the home, and the owner looks pale and dirty. It's hard to imagine this former librarian used to be so organized.

Neighbors call Adult Protective Services. The woman refuses help, but after a couple of visits, the APS worker gets the name and number of the woman's son, who lives away. The woman has not been eating well. She agrees to see a doctor for a sore ankle, and physician sees that the woman is confused. There is enough evidence of the woman neglecting herself that her son should be able to become her conservator.

This woman is not unusual. Almost 40 percent of the reports to APS involve self-neglect.

"Depression is a major element (of self-neglect)," says an APS social worker who did not want to be identified. "They have little interest in health, hygiene, in life."

These seniors isolate themselves. Sometimes a mental illness develops or has progressed. They may be suffering unresolved grief from the death of a spouse or child. They might have a form of dementia. Often poor nutrition and hydration, plus poor medication management, creates confusion. A downward spiral overtakes them. It becomes too much effort to shower, to pay bills, to care about such things.

"Sometimes they see they have a problem," the APS social worker says, "but they don't have the wherewithal to do anything about it. They can't make a plan."

APS workers can assess the situation and help clients get emergency food, medical care, transportation, housekeeping or money management. But often seniors refuse help, fearing a loss of independence.

If clients insist they like how they're living and are not gravely disabled (unable to provide their own food, clothing and shelter), "then there's not a lot we can do to straighten up the situation," says the social worker.

"It is not our place to force our lifestyle choices on others," says an APS supervisor in San Diego County. "Our place is to keep them safe."

Often it's a crisis that makes change happen. One woman was referred to APS after a new landlord was ready to serve an eviction notice for failure to pay rent. He didn't feel she was capable of finding a new place to live. The only halfway decent clothing the woman had was what she was wearing. She never left her apartment except to walk to the grocery store once a month. She was 20 pounds underweight. She had no friends or family.

The eviction crisis allowed social workers to help the woman move into a nice board and care facility out in the country, which she appears to enjoy. They also bought her new clothing. She had her hair cut and is wearing makeup again.

Elder abuse reports have been rising steadily. APS in San Diego County receives an average of 1,000 each month. The growth in reports is related to increased awareness of elder abuse and self-neglect, but also to the increase in vulnerable, frail, older adults as people live longer.

APS workers want to encourage neighbors and others to continue to make referrals if they suspect someone in their community might be endangering himself/herself with self-neglect. Any calls they make to APS or the local Elder Abuse Reporting Line will be confidential. These calls can save lives.