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Abstract: 

The visible, as well as the more prevalent invisible, elders who are isolated from an effective support system, with their inappropriate clothing, often preceded by the odor of the unwashed, are labeled self-neglect clients in reports to APS. Community awareness of their apparent deteriorated condition and high-risk circumstances often leads to strident demands on APS staff. “Do something! You have to get her out of there! She’s too old to live like that!” APS investigation outcomes that reference autonomy and the right to self-determination of a mentally competent adult are often met by hostility and disbelief. Self-neglect is outside the conceptualization used for adult maltreatment: harm inflicted by others on community dwelling vulnerable adults, with the perpetrator of the harm often identified as family, hired caregiver, perhaps a newfound “best friend.” Placing neglect of self within the same paradigm as adult maltreatment sharpens the ethical dilemmas regarding self-determination that exist throughout the provision of APS investigations and services. This paper examines the legal, definitional, ethical, and practice problems posed by self-neglect cases through the lens of self-awareness: Just when should the government intervene to check on how well an older adult—or any of us— is taking care of him or herself? The article includes a self-care chart (checklist) and a sample document,”A Statement Regarding the Possibility of Future Neglect of Self”, which, when filled in, can facilitate monitoring and possible intervention.

Keywords: self-neglect within paradigm of adult maltreatment; problems posed by self-neglect cases; self-care chart; statement regarding possibility of future neglect of self

Affiliations:  1:  Cuyahoga County Department of Senior and Adult Services.