Director's blog: Lesley Carcary

I recently attended a workshop on self-neglect at AEA’s English conference, and it got me thinking about the way in which we ‘support’ those who self-neglect.  There will always be cases where older people would clearly benefit from support and intervention if they are unable to care for themselves properly, but should we be intervening in cases where someone chooses to hoard, for example, or live in squalor?  How far should state intervention go without interfering with the individual’s right to a private life?

While AEA’s definition of elder abuse focuses on harm caused by another person within a relationship of trust, adult safeguarding frameworks across the UK include reference to neglect and self-harm as types of harm. Although there’s no definition of ‘harm’ or ‘abuse’ within the legislation, many practitioners consider some instances of self-neglect as an adult safeguarding concern.  But if it is, who is it actually benefiting? 

Elaine Aspinwall-Roberts at Liverpool John Moores University (the workshop presenter) posed a number of questions around whether social work intervention is benefiting the social worker or the adult ‘at risk’.  It’s important to consider and respect an individual’s lifestyle choices and their right to refuse services, which raises the issue of whether intervention in some cases may only be benefiting practitioners in terms of improved outcomes, or even simply covering their backs. From the service user’s point of view, unwanted and unnecessary intervention may only lead to loss of trust, reduced control over their own lives, or damage to self-esteem.

"Anyone who rejects the hygiene consensus and does not wholeheartedly join the coalition of the willing  and rejects convention by adopting a lifestyle characterised by dirt and squalor, might find themselves labelled diseased and disordered" (Lauder, 2005).

While AEA’s primary concern is to support and speak up for those who are being harmed by other people, I think there’s still a need to pick up on possible indicators of genuine self-neglect to ensure support is available for those for need it. My view would be that it is appropriate for self-neglect to be considered an adult safeguarding issue in some cases, but it is vitally important that a person-centred approach is taken to ensure that we are not imposing our own standards and lifestyle choices on others.

AEA Scotland’s national conference next month picks up on some of these issues, focusing on tensions between individual autonomy and state protection. Is it possible to support and protect older people at risk of harm, while ensuring real choice and empowerment for the individual? Come along to join the discussion on 27th October in Glasgow. Find out more here