Tuesday 19 November: Self-Neglect
The term “self-neglect” covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings.
Examples of self-neglect include:
- A refusal or inability to cater for basic needs, including personal hygiene and appropriate clothing.
- Neglecting to seek assistance for medical issues.
- Not attending to living conditions – letting rubbish accumulate in the garden, or dirt to accumulate in the house.
- Hoarding items or animals.
What causes self-neglect?
Self-neglect can result from any mental or physical illness that has an effect on the person’s physical abilities, energy levels, attention, organisational skills, or motivation.
There are two types of self-neglect:
Intentional, or Active Self-Neglect: When a person makes a conscious choice to engage in self-neglect. For example, they may actively refuse to visit a doctor when they’re feeling unwell.
Non-Intentional, or Passive Self-Neglect: When health-related conditions contribute to a risk of developing self-neglect. For example, a person with a learning disability may have lapses in concentration that may make them forget to attend to their personal hygiene.
How to respond to self-neglect cases
In most safeguarding issues, The Care Act 2014 (Section 42) requires that each local authority must make enquiries, or cause others to do so, if it believes an adult is experiencing, or is at risk of, abuse or neglect. This enquiry should establish whether any action needs to be taken to prevent or stop abuse or neglect. And if so, by whom.
Cases of self-neglect may not prompt a Section 42 enquiry. We invariably judge these cases on a case-by-case basis. Whether a response is required will depend on the adult’s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support.
Treatment for self-neglect can include addressing the underlying cause of the condition, whether this is depression or a more severe learning disability. Home care is another good solution for self-neglect cases. Carers can attend to cleaning, dressing, or feeding the individual in a way that does not interfere with their independence or autonomy.
It is key to establish a trusting relationship with a person who is engaging in self-neglect because. Restricting their autonomy can be harmful.
Good News Story
Phil is 65 years of age with a diagnosis of a Learning Disability and communication difficulties. He lives with his wife Pat who is 56 years of age, who also has a Learning Disability and presents with tendencies towards self neglect and hoarding. Both Phil and Pat have a history of limited engagement with professionals.
Historically, Phil attended and worked in a day centre, before securing a job packing boxes for some 18 years until he was made redundant. His mobility deteriorated in 2017 and he became wheelchair dependent. As a direct result, he had not left his flat for approximately 2 years as his wheelchair could not be pushed over the step and a ramp couldn’t be fitted due to the structure of the adjourning house. Until this time, Phil was the main carer for his wife, however, when his physical circumstances changed, Pat then became the primary carer.
Pat also struggles with her mobility as she has severe pain in her knee, and has been strongly advised by her GP not to push Phil in his wheelchair. In addition to the homes structural issues; Pat’s hoarding had become a significant concern for agencies providing them both with support and the property was deemed not only a fire risk but a risk to their general health and safety. It was concluded that the accommodation and Local Authority funded support plan was no longer suitable in meeting their needs.
The Social Care professional, Debbie from the Community learning Disability Team (CLDT), provided extensive intervention to Phil and Pat which enabled them to develop a trusting relationship together. Over time, both Phil and Pat were able to understand and weigh up the risks they were exposed to and the consequences of remaining in their current property. After months of engagement, Phil and Pat expressed their informed decision to move to a more suitable adapted property and were in agreement with the daily support of carers to support them in meeting their assessed needs and achieving their desired outcomes. The need for alternative accommodation was a high priority, due to the environmental risks, social isolation and self-neglect concerns. Debbie worked closely with HOST and Trafford Housing Trust (THT) to search for a suitably adapted property within the Borough of Trafford. After a number of viewings and regular liaison with Health colleagues and THT staff, a suitable Bungalow was found within Lostock Court, a Sheltered Housing Scheme in Stretford. Pat viewed the property in person whilst Phil viewed the photographs taken by his wife. Both Phil and Pat agreed to accept the housing offer.
As most of their existing furniture was not re-usable, Debbie sought support from local charities, internal & external agencies and a furniture bundle was arranged to support them in their new home. The housing scheme Manager, Elaine and the residents at Lostock Court were extremely helpful in assisting with supporting their move. This included physical support and donations of furniture and carpets. Additionally, a volunteer offered their support to support the removal process using his own van.
A package of care that could meet both of their needs was introduced and engagement continues to be really positive. Phil is now able to access the community daily and enjoy time with his peers.
Phil and Pat are extremely happy in their new home and very grateful from all the support they have received from everybody at Lostock Court, CLDT, THT, The Rainbow Trust and of course the volunteer who moved all their wanted belongings from their previous home to their new home.
Below are some photographs that Phil and Pat have agreed to be taken and issued. Phil did not wish to be in the photographs however was happy for the property to be shown. Pat wanted her photos to be taken and shared and both Phil and Pat are in support of their story being shared to help others with similar needs.
From their old home:
To their new: