Recently a
friend told me she had lost sleep trying to help an elderly friend who was
being “stubborn:” - living conditions were not good and she was refusing help.
Their unwillingness to take advantage of various programs was frustrating. However,
as my friend noted, “they haven’t hit rock bottom yet, but they’re awfully
close.”
“What’s to be
done?” People genuinely care but aren’t sure how to go about helping in
situations like this.
In order to
answer that question, ask yourself three questions:
1. Are they a
danger to themselves/others?
2. Why might
they be reluctant to seek help?
3. What is your
relationship to this person?
Those with health, disability or aging issues
are very concerned about loss of independence, freedom and control of their own
life. This easily translates to fear and can keep them from taking advantage of
what could actually make things easier and even improve their independence.
Regardless of
motivating factors, does the current situation pose an immediate threat to health
and safety of the individual and are you in a position to do something about
it?
The first step
then is to realistically assess the situation. Below are risk factors to
consider:
• Lack of
current support structure
at home/lack of family, friends, community
• Suffering
from self-neglect home:
Insufficient food, water, heat; filth or bad odors, hazardous, unsafe or
unclean living space; major repairs are needed and not done; human or animal
feces; hoarding (nothing is thrown away); animal or insect infestation
• Suffering
from self-neglect personally:
Poor hygiene (dirty hair, nails, skin); smells of feces or urine; unclothed or
improperly dressed for weather; skin rashes or bed sores; dehydrated,
malnourished or weight loss; absence of needed dentures, eyeglasses, hearing
aides and assistive devices; increased dementia, confusion, disorientation;
unexpected or unexplained worsening of health; spending too much time alone;
stopped engaging in activities; lack of interest or concern about life;
untreated medical conditions; hallucinations, delusions, self-destructive
behaviors or significant behavior changes.
• Lack of
financial resources to
remain in current living situation
• Unable
to get to care: Can’t
drive, no public transportation
• In an
abusive situation: 1 in
6 people over the age of 59 suffer some form of abuse while living in community
settings. There is a growing body of literature that links violence and chronic illness.
Abuse in these situations can be physical, inappropriate use of drugs,
restraints or confinement; emotional (intimidation, humiliation, blaming);
sexual; neglect; financial (stealing, misusing funds, forgery, identity theft);
withholding medication and/or limiting access to care.
• Highly
anxious
• Recent
loss: Break up; death;
employment; significant health status change
• Exhibits Violent
behavior (hurting
animals or other people)
• Substance
abuse-the person or
those caring for them.
If you find
yourself saying yes to these risk factors, what is your relationship and how
might that impact your ability to help?
Do you connect
with this person as a volunteer (e.g. deliver Meals on Wheels) or in a
professional capacity (e.g. personal care attendant)? In such cases, the
organization you work or volunteer for is most likely covered by “duty to
report.” If that is the case, talk to your immediate supervisor about how to
proceed.
Friends and
neighbors can try offering help and assistance to the person and/or the
caregivers. Be concrete about what you can do and don’t just say, “if you need
anything call me.” It’s also important to let family/caregivers know if there
are issues taking place when they are not around. That noted, if you think the
person is being abused, or the situation is dire, contact Adult Protective Services(APS) in your area.
Family and
those closest to the person will do best with understanding their fears-loss of
control; change; impoverishment; being perceived as “less than” or “incapable”-
and developing a plan accordingly. The more they are presented with options and
involved in creating a plan, the more likely they will respond.
If you are not
having success, consider enlisting another family member, clergy, doctor, close
friend etc. However, if you find the person is at high risk, and unwilling to
consider changes, you can contact your local police force and request a
“welfare check” or call APS.
Sometimes
letting a caregiver or the person themselves know that if conditions remain
unchanged APS may need to be contacted, is enough for changes to take place.
However, this can also back fire, and they can withdrawal even more.
Over the years,
I’ve had various people insist they didn’t need help, Life Alerts etc. They
were fiercely independent and assured me that even if they fell and I found
them dead on the floor, “It’s my choice!” The reality is often very different
than what one imagines. More than one of these individuals has fallen and they
were far from content to just lie there. In fact, when people give me the “my
choice” line, I relay some of the stories I’ve seen. Further, it’s appropriate
to talk to them about the impact of family, neighbor kids etc., finding them in
an extremely compromised state or worse. More often than not, after such
conversations, they’ll be a bit more willing to consider options.
Note that APS can’t remove a person from their home against
their will or force them to accept help. However, they can intervene without
the consent of the vulnerable adult only if all other avenues have been
exhausted, the person is found incompetent by the courts, and a court order has
been granted to appoint a legal guardian to make decisions on his or her
behalf.
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