Talking to someone with self-neglect requires patience and understanding. Remember, always start by contacting Adult Protective Services (APS) and/or the health care provider if you think there is self-neglect. Do not intervene by yourself. Intervening without help can lead to dangerous behaviors; Self-neglect requires APS and other professionals (Clark County Hoarding Task Force [CCHTF], 2006).
Tips for talking to an individual with self-neglect:
- Be Gentle. Let the person tell his/her story.
- Respect the person and the items that may be hoarded.
- Remain calm, caring, and supportive.
- Use facts, not emotions.
- Point out items, conditions, or situations that are unsafe.
- Check if the pets have been neglected.
- DO NOT be critical or judgmental.
- DO NOT make negative comments.
- DO NOT force the individual to do something.
- DO NOT force the person to talk about something that makes them uncomfortable.
- DO NOT talk about the person as if they are not there (CCHTF, 2006).
Talking about Self-Neglect
The individual is more likely to talk if they feel that you are being supportive. Consider starting a conversation about self-neglect by talking about common interests or general topics to help make the person more comfortable (Braye, Orr, & Preston-Shoot, 2011). Showing that you understand and care builds trust For example, you may say “I agree that it’s really important for you to stay at your home” or “I understand that you do not like being in the hospital. Can we talk about the best ways to get you back home safely?” (Smith, Lo, & Aronson, 2013). Ask the person how he/she sees their situation now and how it was in the past. Try to get a sense of when things began to change, bereavement, reduced function. Ask them how they are coping with a their situation.
Often they do not see or view their situation as one of self-neglect (M. Day, Selfneglect.org PDSA cycle, 2017, February 5).
Maintaining the relationship is important. While emails, texting, and calling by phone are good ways to stay in contact, visiting the individual in person is the best (Washington State Department of Social and Health Services, n.d.). Building good relationships is key to maintaining the kind of contact that can enable interventions to be accepted as time passes (Braye et al., 2011).
Family and Friends may be able to persuade individuals with self-neglect by sharing a common goal (Smith et al., 2013). For example, a shared goal may be for the individual to stay in their home safely with with adequate resources. This goal may persuade the individual to allow neighbors or home care to to visit for welfare checks or services. The individual may be willing to accept help in exchange for independence.
It is important to try to understand the concerns of individuals with self-neglect. For example, if the individual is refusing to let strangers come inside their home, ask “can you tell me what concerns you have about letting someone come into your home to help you?” or “Is there anything that would make someone coming into your home acceptable to you?” (Smith et al., 2013).
Family and friends must find solutions that still respect the individual’s preferences (Smith et al., 2013). For example, if the individual declines Meals On Wheels because he or she does not want the delivery person to enter their home, the food can be left on the the door instead. The best-practice approach is not to force services on individuals with self-neglect (Ridings, 2008).References
Day, M. R. (2017, February 5). Selfneglect.org PDSA cycle.
Braye, S., Orr, D., & Preston-Shoot, M. (2011). Self-neglect and adult safeguarding: Findings from research.
Clark County Hoarding Task Force. (2006, December). Guidelines for the investigation of hoarding Behavior and Issues with elder, child, and animal abuse or neglect caused by hoarding behavior. Retrieved January 7, 2017, from http://vet.tufts.edu/wp-content/uploads/TFGuidelines.pdf
Ridings, J. (2008). Using concept mapping to identify elder self-neglect program evaluation information for Metro Chicago. ProQuest.
Smith, A. K., Lo, B., & Aronson, L. (2013). Elder self-neglect—How can a physician help?. New England Journal of Medicine, 369(26), 2476-2479.
Washington State Department of Social and Health Services. (n.d.). Self-neglect. Retrieved from https://www.dshs.wa.gov/altsa/home-and-community-services/self-neglect
Last updated: June 7, 2020 at 16:43 pm by
I. M. Abumaria, Doctor of Nursing Practice