Can We Help The Self-Neglecting Senior?

Guest Blog Post by Jennifer FitzPatrick, MSW, LCSW-C

Attorneys, because of the doctrine of attorney-client privilege, are generally forbidden from reporting any private or confidential information about a client, including reporting suspected self-neglect to Adult Protective Services. However, many other senior-serving professionals are classified as “mandated reporters,” meaning they are required to report suspected abuse, exploitation or neglect (including self-neglect). If, in the course of his or her professional duties, a mandated reporter is made aware of neglect or abuse, he or she is required to report these concerns to APS.  According to the National Adult Protective Services Association, some of the most common mandated reporters include:

 • Social Service Agencies
 • Law Enforcement Personnel
 • Emergency Response Service Providers
 • Healthcare, Medical or Dental Service Providers
 • Mental Health Providers
 • Financial Services Providers
 • Clergy

When these professionals who are mandated reporters make a referral to their local Adult Protective Services (APS), often they are frustrated with the results.  They may see a problem such as a client hoarding, a patient neglecting a serious health condition, or an 86-year old man financially supporting a malingering 62-year old daughter instead of paying his own bills. When these professionals report these matters as they are required to, the assumption is that APS will go in and resolve the situation.  These professionals tend to see APS as the police for older adults not following societal rules.  Of course the client should stop supporting his drug addicted daughter and pay his electric bill thinks the financial services provider.  Certainly the patient should take his insulin and lose some weight thinks the healthcare provider.  The wealthy patient living in squalor should clean up and live “normally” thinks the Emergency Response Service Provider.

There is no doubt that self-neglect in older adults is a serious issue; in fact, several studies suggest that it is highly associated with increased mortality. The larger problem that some professionals grapple with is that older patients who refuse to follow their recommendations usually have every right to refuse to do so.  In most jurisdictions, APS can only investigate if an older adult is categorized as vulnerable.  According to the Administration on Aging’s National Center on Elder Abuse, “a vulnerable adult is defined as a person who is being mistreated or is in danger of mistreatment and who, due to age and/or disability, is unable to protect himself or herself.” 
Professionals often have to balance their belief about what’s best for the older adult clinically, financially, or legally while also respecting the older adult’s right to make his or her own decisions, even if those decisions demonstrate egregiously poor judgment.  Referring to APS may be appropriate at times, but we need to keep our expectations in check.  APS has a mandate to investigate self-neglect, but APS does not possess a magic wand.  Sometimes APS won’t investigate because the referral does not fall under its mandate.  Other times APS will investigate but be legally unable to take much more action than the professional who initially referred because the older adult is competent to make his or her own decisions.

So how do mandated reporters ultimately help the self-neglecting older adult?

1.    Show respect for the older adult and his decisions, no matter how much you disagree with them.  During the aging process, so much can feel out of a person’s control.  An older adult can be more open to hearing what a professional says when there’s acknowledgement that the older adult is still an adult.  Many tend to infantilize older adults, but when they are treated with dignity there is a better chance for your message to be heard.

2.    Encourage and persuade.  Give the older adult examples of when others in similar situations did not change and what the consequences were.  For example, if an older woman does not use her prescribed walker and is hoarding, she is at additional risk for falls.  The professional might consider sharing a story of when a patient in similar circumstances did this and it led to a broken hip and a long term stay in a nursing home.  These types of stories can sometimes motivate clients to at least consider changing or accepting more help.

3.    Keep referring to APS.  Although APS are not the “fixers” many mandated reporters hope them to be, APS does typically keep good records of referrals.  Even if APS may be unable to investigate today, or even though the investigation may not lead to immediate improvement, a referral begins a file. Perhaps APS cannot investigate today because the client doesn’t meet the required criteria. But what if three more people refer that client to APS in the next six months?  This may give APS the information it needs to open an investigation and help improve the client’s situation.

When APS workers are unable to investigate a case because it does not meet their criteria, they often are able to give helpful suggestions and ideas on other ways the professional could help the client.  The APS worker may recommend a service or strategy the referring professional had not considered.
Self-neglect in older adults is one of the most challenging and common situations that many senior-serving professionals encounter; we must remember that older adults are still adults who are allowed to make poor decisions.  There are very few circumstances in which it is legal or ethical for a professional to force an older client to change.  Dedicated senior-serving professionals must sometimes simply accept that only a serious crisis will lead to a real change.  Professionals should treat the self-neglecting senior with empathy and respect, and remain open to helping the client when he or she is ready to accept the help.
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About the author:

Jennifer FitzPatrick, MSW, LCSW-C is a speaker, author and consultant on aging & caregiving.  For more information, please see www.jenerationshealth.com.


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