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Self-Neglect: A Form of Elder Abuse

In Pennsylvania, reports of suspected elder abuse have been rising steadily for several years.  During the fiscal year 2016-2017, Adult Protective Services (APS) across the Commonwealth received a total of 28,633 reports of suspected elder abuse. Of these reports, 20,494 (71.6 percent) were deemed appropriate for investigation, and of the cases investigated, 6,899 were substantiated and required action by APS.

The term “elder abuse” often invokes thoughts of financial exploitation, caregiver neglect, psychological abuse, physical abuse and/or sexual abuse. However, the majority of substantiated cases of elder abuse in each of the last three years were for actions of self-neglect (38-45%). Self-neglect is defined as “the failure to provide for oneself … goods or services essential to avoid a clear and serious threat to physical or mental health” (PA statute).

Cases of self-neglect are tricky to manage due to principles of autonomy and self-determination. The ability of a local Aging and Community Services office to take action without an individual’s consent is limited. Individuals have the right of self-determination, or the ability to live the way they choose, even if those choices are not the norm for the rest of society.

Sometimes, these choices may place an individual at risk for a catastrophic event, regular hospital admissions or visits to the emergency room, and an earlier death. But if individuals have capacity, they are allowed to take these risks as long as there is no immediate threat to themselves or others.

The Pennsylvania Code defines an older adult in need of protective services as “an incapacitated older adult who is unable to perform or obtain services that are necessary to maintain physical or mental health, for whom there is no responsible caretaker and who is at imminent risk of danger to his person or property.”

The conditions of incapacity, inability and imminent danger must occur together for protective services to take action and override an individual’s autonomy. An unwillingness to consider safer and healthier alternatives is not enough of a reason. For individuals with dementia, who may have an inability to recognize their limitations and the potential negative consequences of certain choices, the question becomes, “At what point are they considered incapacitated?”

Self-neglect is a complicated issue which can create heightened emotions both within a family and within larger society. It raises moral questions about personal autonomy and social responsibility that have no clear-cut answers. The legal liability of family members and health care professionals in self-neglect situations will vary from state to state.

While many people may believe that children have a moral obligation to care for their aging parents, a legal duty to do so is a separate issue. In Pennsylvania, the designation as an agent under a power of attorney does not in itself necessitate that action be taken on behalf of an older adult, but if an agent chooses to act, then the action taken must be in the best interest of the older adult.

Goals for the optimal health and safety of an older person who is demonstrating self-neglect may not always be achievable. But as individuals and as a society, we must maintain an awareness of self-neglect and demonstrate efforts to handle each situation with appropriate attention and sensitivity.

Pennsylvania maintains a statewide hotline to report suspected cases of all forms of elder abuse (800-490-8505) or the local Area Agency on Aging may be called.  If an individual is facing immediate risk, local law enforcement should be notified. 

Employees of care providers are required to report suspected elder abuse, while the general public is encouraged to do so.  If someone is reluctant to get involved in a potential abuse situation, it is important to note that laws are in place to protect those who report their suspicions from retaliation and civil or criminal liability.  Abuse reports are confidential and the suspected abusers and/or their victims are not informed as to who reported the situation.  A reporter is not required to provide proof of abuse either. 

Elder abuse occurs across social, racial, and family boundaries.  For additional information about elder abuse including risk factors and warning signs, visit the U.S. Department of Health and Human Services website at

Karen Kaslow, RN, BSN