Elder self-neglect is both a public health and human rights issue that hurts not only our loved one’s quality of life but their health and safety.

Self-neglect is often defined as a “refusal or failure” to care for one’s self. It involves areas like nutrition, hydration, hygiene, living environment, medication, and general safety.

Although researchers believe it’s common, elder self-neglect is poorly understood. Especially when it occurs in community-living facilities like assisted living and nursing homes. In some cases, self-neglect appears to be elder abuse but is wholly self-inflicted despite nursing staff’s best efforts.

Sometimes, self-neglect is a sign of elder abuse.

Elder abuse is considered to be a common state of existence in group living homes. So, it’s important to look carefully at your relative to distinguish between the two.

We try to break down the differences between self-neglect and elder abuse to help you keep your relative safe.

Prevalence and Risk Factors of Elder Self-Neglect

The official legal definition provided by the Elder Justice Act of 2010 is a person’s: “inability, due to physical or mental impairment or diminished capacity, to perform essential self-care.”

Researchers look at elder self-neglect as a standalone phenomenon, but studies produce inconsistent results. The inconsistencies extend to signs and risk factors.

Some studies show those most likely to experience self-neglect are those with the least economic resources. But, evidence suggests that anyone can experience self-neglect. Other risk factors include:

  • Psychological distress
  • Cognitive impairment
  • Physical disability

What are the signs of self-neglect? People who self-neglect might:

  • Fail to eat enough to get nourishment.
  • Decline to drink enough water to stay hydrated.
  • Wear dirty, torn, or weather-inappropriate clothing.
  • Live in unsanitary or hazardous conditions.
  • Avoiding the doctor or home visits.

Some of the most common signs include:

  • Poor hygiene
  • Skin rashes/bed sores
  • Smells of urine or feces
  • Social isolation
  • Increased symptoms of dementia
  • Hallucinations, disorientation, confusion or delusions
  • Skipping medications
  • Lack of interest in life
  • Unpaid bills and overdue accounts

It’s important to note that self-neglect does not equate to a desire to self-harm or suicide ideation or behaviors. If you suspect self-harm, address it immediately.

Self-neglect is better associated with changes that make it difficult to perform functions that were once easy. Those functions, like bathing, dressing, or cooking, may become neglected. This may not be due to the person wishing harm on themselves, but out of embarrassment, fear, or cognitive decline.

If your loved one begins experiencing these symptoms, and they live at home, it might be self-neglect. But, adults living in group settings or who have visiting health staff may also be experiencing elder abuse.

Elder Self-Neglect May Look Like Elder Abuse

Millions of older people in the United States experience self-neglect. It’s so common that self-neglect is the most commonly reported type of elder abuse.

Elder abuse may show some of the same signs as self-neglect. Common signs of elder abuse include:

  • Depression and confusion
  • Dramatic weight loss
  • Withdrawal from social life
  • Dirty hair or clothes or other poor hygiene
  • Skin rashes or pressure ulcers
  • A decline in cognitive faculties/rapid descent into dementia

Many of these signs match those of self-neglect.

It’s important to understand self-neglect and elder abuse may go hand-in-hand, particularly in a group living setting like a nursing home. Residents who experience elder abuse may react by engaging in self-neglect.

In this way, sometimes self-neglect is only a symptom of elder abuse.

In some cases, self-neglect is willful. Care teams know the signs and work to encourage the individual towards positive behaviors.

Unfortunately, researchers find that these two issues are often as entangled as they are separate. The best way to find out if self-neglect is self-inflicted or if it’s a symptom of elder abuse is to start a discussion with your relative and their care provider.

Any and All Signs Warrant a Discussion

Whether your relative lives at home or in a nursing home, any of the signs of self-neglect or elder abuse should prompt further discussion.

Start by discussing your loved one’s needs with their care providers. If they’re at home and receive visits from a home health aide or another member of staff, bring your concerns to them. In an ideal scenario, they should already be aware of what you’re seeing.

If your loved one lives in a nursing home or another group setting, do the same. Relate your concerns to the care team first, and then if necessary, to the shift leader or even director of nursing.

If the situation escalated to the point where you clearly see signs of neglect or abuse, then the staff should already know and be working on a solution.

Don’t forget to report your concerns to your loved one’s general physician. If they’re not already aware, they are a big help in reaching those engaging in self-neglect.

Additionally, if a physician suspects abuse, they have a direct avenue of reporting their suspicions to local agencies.

Escalate the Discussion

Remember that self-neglect is a hidden problem and it can be difficult to detect. Even if you suspect that the neglect is self-inflicted, it’s essential to escalate the discussion. This includes when abuse isn’t suspected.

If neglect continues in an institution, the organization may be in trouble. Even if there isn’t a recognized perpetrator, the 1987 Amendment to the Older Americans Act characterizes it as abuse.

Continue to report the behaviors you see, and if necessary, don’t be afraid to move your loved one to a safer place.

Self-Neglect is Still Abuse

It doesn’t matter whether your loved one willfully exhibits self-neglect at home or if they show signs in a nursing home. The law classifies self-neglect as abuse. If their caretakers are not managing the symptoms, then they aren’t doing their jobs.

Are you concerned about signs of self-neglect and don’t know where to turn? Click here to find a nursing home lawyer in your state.