What is self-neglect?
- a lack of self-care to an extent that it threatens personal health and safety
- neglecting to care for one's personal hygiene, health or surroundings
- the inability to avoid harm as a result of self-neglect
- failure to seek help or access services to meet health and social care needs
- the inability or unwillingness to manage one's personal affairs
What causes self-neglect?
It is not always possible to establish a root cause for self-neglecting behaviours. Self-neglect can be a result of:
- a person's brain injury, dementia or other mental disorder
- obsessive compulsive disorder or hoarding disorder
- physical illness which has an effect on abilities, energy levels, attention span, organisational skills or motivation
- reduced motivation as a side effect of medication
- addictions
- traumatic life change.
Supporting adults who are, or at risk of, self-neglecting
The Care Act 2014 recognises self-neglect as a category or abuse and neglect which means that safeguarding duties apply where the adult has care and support needs and is at risk of self-neglect which they are unable to protect themselves from (due to their care and support needs).
The adult often struggles to recognise the risks they are living with. They may lack mental capacity in relation to the care needs and in some more complex and high risk circumstances it may be necessary to consider using the Mental Capacity Act 2005 and Best Interests frameworks to provide vital care and support.
When developing an approach it is important to try and understand the individual and what may be driving their behaviour. There are some general pointers for an effective approach:
- Multi-agency – work with partners to ensure the right approach for each individual
- Person centred – respect the views and the perspective of the individual, listen to them and work towards the outcomes they want
- Acceptance – good risk management may be the best achievable outcome, it may not be possible to change the person’s lifestyle or behaviour
- Analytical – it may be possible to identify underlying causes that help to address the issue
- Non-judgemental – it isn’t helpful for practitioners to make judgements about cleanliness or lifestyle; everyone is different
- Empathy – it is difficult to empathise with behaviours we cannot understand, but it is helpful to try
- Patience and time – short interventions are unlikely to be successful, practitioners should be enabled to take a long-term approach
- Trust – try to build trust and agree small steps
- Reassurance – the person may fear losing control, it is important to allay such fears
- Bargaining – making agreements to achieve progress can be helpful but it is important that this approach remains respectful
- Exploring alternatives – fear of change may be an issue so explaining that there are alternative ways forward may encourage the person to engage
- Always go back – regular, encouraging engagement and gentle persistence may help with progress and risk management
Practical tasks
- Risk assessment – have effective, multi-agency approaches to assessing and monitoring risk
- Assess capacity – ensure staff are competent in applying the Mental Capacity Act in cases of self-neglect
- Mental health assessment – it may, in a minority of cases, be appropriate to refer an individual for Mental Health Assessment
- Signpost – with a multi-agency approach people can be signposted to effective sources of support
- Contact family – with the person’s consent, try to engage family or friends to provide additional support
- Decluttering and cleaning services – where a person cannot face the scale of the task but is willing to make progress, offer to provide practical help
- Utilise local partners – those who may be able to help include the RSPCA, the fire service, environmental health, housing, voluntary organisations
- Occupational therapy assessment – physical limitations that result in self-neglect can be addressed
- Help with property management and repairs – people may benefit from help to arrange much needed maintenance to their home
- Peer support – others who self-neglect may be able to assist with advice, understanding and insight
- Counselling and therapies – some individuals may be helped by counselling or other therapies. Cognitive behaviour therapy, for example, may help people with obsessive compulsive disorder, hoarding disorder or addictions
Resources
Avon Fire & Rescue have produced a clutter image rating scale to identify cases of hoarding and self-neglect.
Anyone can fall victim to rogue traders scammers - from doorstep sellers to cyber criminals - all of whom have the single aim of stealing your money.
Scams are becoming ever more sophisticated and elaborate. For example:
- internet scammers can build very convincing websites
- people can be referred to a website to check the caller’s legitimacy but this may be a copy of a legitimate website
- postal scams are massed-produced letters which are made to look like personal letters or important documents
- doorstep criminals call unannounced at the adult’s home under the guise of legitimate business and offering to fix an often non-existent problem with their property, sometimes they pose as police officers or someone in a position of authority.
All of the above cases are financial abuse and the adult at risk can be persuaded to part with large sums of money and in some cases their life savings. These instances should always be reported to the local police service and local authority Trading Standards Services for investigation.
Resources
The best way to protect yourself from scams and rogue traders is to learn how to spot them and what to do if you come across them. A good place to start is the Little Book of Scams from Avon & Somerset Police.
You can check if something might be a scam via Citizen's Advice.
Trading Standards offer a lot of information and advice on dealing with doorstep, internet, mail and telephone scams.
The Buy With Confidence scheme features businesses that have been vetted and approved by Trading Standards to ensure that they operate in a legal, honest and fair way.
Action Fraud is the UK’s national police fraud and cyber crime reporting centre.
Care homes
If you can no longer live independently in your own home, you may consider going into a care home.
Different types of care homes
There are various types of care homes, which fall into the following broad categories.
Residential care homes
Provide personal care and general help with things like washing, dressing, bathing and going to the toilet, if required - they do not offer nursing care. If you have a health problem that needs a registered nurse, this care will be provided by the District Nursing Service who will visit your care home in the same way as if you were living in your own home.
Care homes with nursing
Provide nursing care 24 hours a day. People living in these homes will have health care needs that can only be met by a registered nurse. Some offer general nursing care for older people, while others specialise in mental health or physical disability. Care homes with nursing are often dual registered to provide both ‘residential’ and ‘nursing’ care. If you choose one of these homes you may not need to move if your condition changes. This type of home also helps couples who may have different needs to live together in the same home.
Specialised care homes
Residential homes that specialise in caring for people with a long term mental health need or a high level of dementia who do not need nursing. A social care and support assessment will determine whether this type of home is suitable for you or not.
Care homes for people with severe physical or learning disabilities, or autism
These care homes specialise in supporting people who have severe physical or learning disabilities or autism. They may or may not provide nursing care and will have a particular focus on the specialised needs of individual residents.
Find a care home or care support yourself
If you're considering moving into a care home or you need care and support at home, you can find this yourself, or ask a friend or family member to do this for you.
The Live Well B&NES website allows you to search for care services in Bath and North East Somerset.
Look under 'Care Homes in Bath and North East Somerset' for local care homes, or 'Care at home' for organisations that can help you live independently at home.
Search for a care home or support online here.
Ask an agency
You can ask an external agency to find a care home or care provider for you and there may be a charge for this.
Ask Bath and North East Somerset Council
Bath and North East Somerset (B&NES) Council can find a home or care provider for you, for an administration fee of £250 plus VAT.
If you ask B&NES Council to help you find a care home or care provider, one of their social workers will carry out a social care and support assessment to make sure the care provided is right for you. For example, a residential care home is not suitable if you need regular nursing care and they will advise you about this.
B&NES Council will find homes or care agencies that are suitable for you, and you will then choose which one you prefer. Let the social worker or the brokerage team know if there is anything you would like them to look for, for example the location of the home, or being accompanied to a specific hobby.
If a place is not available in your chosen home, B&NES Council may be able to arrange for you to move to another home while you wait for the place to become available. If you are in hospital and are ready to be discharged, you may be asked to move to another home until a place becomes available in the home of your choice. This is because the hospital bed will be needed by another person.
Download and complete B&NES' Council's self-funder agreement, if you would like them to find a care home or support for you. Send your completed form to Client Finance Team, Bath and North East Somerset Council, Lewis House, Manvers St, Bath BA1 1JG.
Paying for a care home
If you've had a social care and support assessment, and you've been found to have eligible needs, B&NES Council will then carry out a financial assessment to work out what (if anything) you have to pay.
If you have savings of over the 'upper capital limit’ (£23,250) you will have to pay the full cost of the care. You can pay this yourself or a friend or family member can pay this on your behalf. The invoice will be issued once the placement at the home has been confirmed or care agency has been set up.
Unhappy about a care home?
If you're unhappy about a care home, speak to the manager of the care home first. If you're still unhappy after speaking to the care home manager, speak to your social worker, or the team supporting you.
You can also let the CQC know online, or Healthwatch, by telephone 01225 23 24 01, or email info@healthwatchbathnes.co.uk.
Care at home
If you are having difficulty with everyday tasks around the home, such as preparing meals, housework or personal care, there are services available to help you.
What is care at home
Care at home services, sometimes known as homecare or domiciliary care, is support provided in the home by care workers to help you to look after yourself and your home, so that you can stay independent for longer.
Care at home can be flexible, with just the right amount of assistance given at any one time. You may need a small amount of support with everyday tasks while you're recovering from an illness, or extended visiting homecare over a longer period, or live-in care around the clock.
The kind of services available to help you in your own home can include:
- Getting in and out of bed
- Washing and dressing
- Preparing meals
- Cleaning
- Shopping
- Going out and about
- Companionship
It’s important to remember that as well as care at home, there are other options available to help you to continue to live independently in your own home. Explore
Live Well B&NES Adults or use the search bar at the top of the pages to find a range of services including services supporting independent living, meals for adults, home adaptations, assistive technology and much more.
Choosing a care at home service
Some care at home providers are locally based while other agencies will provide services across the whole country.
Find providers offering services in our area via our
Find care at home directory, which gives key information about each service including whether they are Care Quality Commission (CQC) registered.
Most care at home providers offering personal care (such as washing, dressing and toileting) must be registered with the Care Quality Commission (CQC), who monitor, inspect and regulate services and publish what they find. Search
CQC homecare for providers and compare ratings and services.
Individuals or small enterprises who provide care at home, have eight or fewer workers and are independent of any larger organisation, are sometimes called
Personal Assistants or micro-providers. If they are contracted directly by the person receiving care (or related third party) and are working wholly under their direction, they are exempt from Care Quality Commission (CQC) regulation, even if providing personal care.
The
Homecare Association can give you details of care at home providers that follow its code of practice.
When choosing a care at home provider, think about what things you need support with, when you’d like help and what’s most important to you. Ask friends or relatives for recommendations of providers that they've used. Contact several providers, so you have a choice. Write a list of questions you have or use a prepared list such as this
Care Choices Homecare Agency checklist.Instead of using a care at home service, you might consider employing a
personal assistant who provides support to someone who needs assistance with daily tasks.
The
Reablement service provides short-term therapy and support by working with you to prevent hospital admission, this can take place in your own home, or a care home. This service is free and accessed via your GP, paramedic or Health Care Professional.
Age UK’s Getting help at home, offers comprehensive guidance on what to do if you need care and support at home.
Paying for care at home
You may wish to buy your support yourself from a provider. If you’re not sure what your needs are, or if you think you need help arranging your support, you can
request a social care and support assessment, regardless of your financial situation. You might be asked to contribute to the cost of some of the services recommended, but this will depend on your situation and the type of service. A financial assessment will work out what you need to pay towards the cost of your care or support (if anything).
See
Financial support for adults for how charges for social care support services are calculated, information about Personal Budgets and Direct Payments, plus other support available with managing money.
Attendance Allowance is a benefit that you might be able to claim if you’re over State Pension age, need help with care or have an illness or disability.
Getting help with housework, gardening and other tasks
There are agencies and companies who provide home maintenance, housework, gardening, mobile hairdressing and other services.
A good way to find reputable providers is to ask friends, family or neighbours. Or you can search the internet for services, via a
Google search or using an online directory such as
Dentons. Your local library membership gives you free computer and internet access, or you can ask a member of staff to help you with an internet search, at one of the
Libraries and Information & Advice Services.
Age UK B&NES Helping You: At Home service helps with practical day-to-day tasks in and outside the home. There is an hourly charge for this service which is available in the Bath catchment area only.
Curo’s Independent Living Service can help with a variety of tasks to support you to live independently at home, offering flexible packages with different levels of support to suit all budgets and needs.
We Care Home Improvements provide help to improve the homes of older people and those with disabilities.
Community Catalysts work locally helping people to start and run small enterprises or businesses that offer care and support to older and disabled people in their homes or in the community. If you or someone you know needs care or support you can search Community Catalysts B&NES
Small Good Stuff directory which will link you with local people who might help.
The Gardeners Guild is a national trade network for professionally qualified gardeners.
All the businesses on the
Buy with Confidence scheme have been stringently vetted and are monitored by Trading Standards. In the unlikely event of something going wrong with a business based in B&NES, our Trading Standards Team can offer support to help put things right.
Citizens Advice offer useful
consumer advice including how to find a trader and check you can trust them and what to do if you’re unhappy about poor service, as well as a consumer helpline.
Mate Crime is a term used where people within communities, particularly people with learning disabilities or mental health issues are befriended with the intention of them being exploited and abused financially, physically, emotionally or otherwise. Mate Crime is also a form of Disability Hate Crime. The perpetrator is likely to be perceived as a friend who will use this relationship for exploitation.
Mate crimes are likely to happen in private, often in the victim’s own accommodation. They can also happen via social media, where victims are financially or sexually exploited after being befriended online. Frequently the person at the centre of the abuse will consider the person using harmful behaviour to be a friend, and not recognise that they are being abused and exploited.
Tricky Friends is a short animation developed by Norfolk SAB to help people to understand what good friendships are, when they might be harmful, and what they can do.
If you have experienced a mate crime, you probably feel very upset, confused and scared.
Tell someone that you feel comfortable talking to and they will support you to report it to the police. It might sound scary reporting it to the police, but by doing this, you might help stop these incidents from happening to someone else. Reporting to the police also helps them to know the scale of hate and mate crime in your area, and deal with it better.
How to report a crime
You can report a crime by: