State and federal data suggests there's a growing threat to the nation's senior population that experts warn can lead to poor health outcomes or death—and that threat is self-neglect, Yuka Hayashi reports for the Wall Street Journal.

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The problem of self-neglect

Self-neglect occurs when someone loses the ability to perform essential self-care, such as keeping up with personal hygiene, taking proper medications, or providing him- or herself with food and shelter. 

When left unaddressed self-neglect can lead to poor physical and mental health outcomes, Hayashi reports. XinQi Dong, director of the Institute for Health, Health Care Policy and Aging Research at Rutgers University, said the risk of premature death is 15 times higher for people experiencing self-neglect than for other adults.

And the issue is particularly prevalent among seniors, as they are more likely to suffer from illness, dementia, poverty, depression, or the loss of a caregiver.

In 2018, more than half of reported cases of alleged elder abuse or neglect investigated by adult protective services actually involved self-neglect, according to a new HHS report. Overall, those 144,296 cases accounted for more elder abuse cases than neglect, financial exploitation, physical abuse, emotional abuse, and sexual abuse combined.

And a look at state-level data suggests the problem has gotten worse in recent years, Hayashi reports. Virginia's local service providers investigated 18% more self-neglect cases in 2019 when compared with 2015, while Iowa reported a 55% increase in self-neglect cases between fiscal years 2017 and 2019.

Self-neglect, particularly in seniors, can stem from various situations, Hayashi reports. For instance, a senior who falls and fractures a hip could become bedridden and become unable to care for themselves. On the other hand, seniors who struggle to pay bills might have their utilities cut off or, in extreme cases, could lose their homes.

Lori Delagrammatikas, executive director of the National Adult Protective Services Association, said the increase in self-neglect cases can also be partly attributed to an increase in the number of seniors who live alone.

According to government data, about 25% of seniors ages 65 and older, or 14.3 million, lived alone in 2017, up 31% from 10.9 million in 2007. As a result, on average, seniors age 60 and over spend more than 10 hours of their daily measured time alone, according to the Pew Research Center. 

"A lot of people end up getting very isolated in their homes," Delagrammatikas said. "That can cause a downward spiral."

How state governments are addressing self-neglect

Some experts say the key to curbing self-neglect cases is to make it easier for seniors to live in their homes. For instance, services like medical transportation services, grocery delivery, and home help with chores could make living alone safer for seniors and reduce cases of neglect.

Paige McCleary, director of Virginia's Adult Protective Services Division, said agencies in Virginia work with seniors to arrange house cleanups or Medicaid-covered home care. In other states, agencies try to move seniors into assisted-living facilities.

In extreme cases, when self-neglect is apparent but the individual refuses help, agencies turn to the courts and law enforcement to relocate individuals or place them in short-term guardianship.

But, according to Hayashi, such extreme measures are needed on rare occasions. The ultimate goal, according to McCleary, is to help people live safe and healthy lives.

"It's not uncommon that our workers face individuals who clearly can't manage themselves in their own homes but absolutely refuse to go to assisted living facilities or nursing homes," McCleary said. "We try to support them in making their own decisions about how they choose to live their lives" (Hayashi, Wall Street Journal, 2/11).