An Example of Self-Neglect Due to Functional Barriers

Mrs. Jones is 68 year old widow. She lives by herself in her own home. The last time she saw her doctor was 3 years ago. She is on 3 medications. She has one daughter who lives a few miles away. They have a good relationship and socialize often. The daughter usually contributes to Mrs. Jones’s living costs because of her limited income.

About a year ago, the daughter’s work shift changed from day to night. It became difficult for both of them to connect as often as they used to. Mrs. Jones did not want to bother her daughter or be an “extra burden on her,” knowing how difficult night work is. Over the past year, Mrs. Jones has been calling her daughter less. Social activities have become infrequent. She no longer attends church services because her daughter also stopped going. Recently, Mrs. Jones has started to worry about being placed in a nursing home.

Mrs. Jones depends on her eye glasses, but has lost two pairs in the past. Since then, she has had difficulties getting around the house. She has had difficulties talking her medications because she cannot tell which medication is which. Her house has become progressively filthy. She has managed to make paths in the garbage that fills her house so that she can get from room to room.

Last month, Mrs. Jones fell in her yard after finally trying to take out the trash. A neighbor witnessed the fall and called 911. In the emergency room, no serious injuries were found. However, she was found to have high blood sugar and high blood pressure. She was also found to have ulcers on her feet and long toe nails. She was otherwise found to be in good health. No mental health problems were found. During her hospital stay, a staff member contacted Adult Protective Services (APS) to make sure that she would be safe living by herself at home. Daily home health was arranged for wound care, checking blood pressure, and monitoring blood sugar. Podiatry was also ordered. She was sent home after 3 days with her daughter.

APS visited Mrs. Jones the day she returned from the hospital. APS found Mrs. Jones to be competent and able to make appropriate decisions regarding her care. APS evaluated the house and found that it was dangerous because of clutter on the floor, making it hard for her to move around freely without falling. The clutter blocked some of the outside doors. All of her medicines had expired with empty bottles. The heater was dysfunctional and the plug of electric stove was burnt. There was no evidence of fire alarm in the house. There was evidence of leak in one corner of the house. When asked, Mrs. Jones confessed that she had not been to church for over a year.

When asked about these issues, she had reasonable explanations. She had lost both pairs of her eyeglasses. She no longer drives and depends on her daughter for transportation. Because her daughter works at night, she did not want to trouble her to get new eye glasses. Mrs. Jones was unaware that several of the doors were blocked because they were in rooms that she never visited. After losing her eye glasses she only stays in 2 rooms of the house. She avoids taking out the trash because she is afraid of falling, which in fact did happen. She stopped taking medications after mixing the bottles, and taking two of the same medication. This made her very dizzy. She did not know that the heater was not working. She does not cook and was unaware that the stove needed repairs. The house has never had a fire alarm. The water leak was in a room that she does not live in.

APS found her glasses under the clutter. The daughter and members of her church were able to clean the house and remove all trash. The daughter had professionals fix all home maintenance issues. Safety grab bars and an elevated toilet seat were added to the bathroom. Church members have volunteered to provide transportation for Sunday services. Meals-on-wheels was arranged to provide diabetes-friendly food. A neighbor agreed to check on Mrs. Jones and clean her yard once a week. A home care aide will visit three-times a week. The daughter is now looking for a daytime shift.

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Last updated: June 7, 2020 at 16:45 pm by
I. M. Abumaria, Doctor of Nursing Practice
Version 2.00