Self-Neglect and Hoarding

“A wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding”.  Care Act (2014) statutory guidance (updated 2023) 

 

This strategy is designed for all agencies, to support best practice in working together with someone who may be self-neglecting and / or hoarding. It describes how agencies and practitioners should be working together to offer support and find solutions to identified needs.

All partners are encouraged to download the strategy and cascade within their organisations.

Other resources to download (as referred to on page 10 of Strategy & Toolkit):

• • • Self Neglect Pathway Checklist Aide Memoire
    • Referral to Self-neglect panel template
    • Multi-agency risk conversation tool
    • Clutter rating tool

• • Please also refer to the Regional Self Neglect Guidance web pages.

 

See WSP series of Videos below on Self-Neglect & Hoarding

 

 

Self-neglect, hoarding and safeguarding adults

Self-neglect covers a wide range of behaviour which in general means someone is not caring for their own personal hygiene, health, safety or surroundings. It can also include hoarding behaviour, although not always. Hoarding can involve specific things, very general items, or animals – even data can be hoarded!

The reasons for self-neglect are often complicated, although sometimes there may be a simpler reason for a change in circumstance. Someone who develops dementia, for example, may forget how to do certain household tasks, or someone with a new disability may not be able to maintain their personal hygiene in the same way as they had before.

Self-neglect will not often be taken forward as a s42 (safeguarding adults) enquiry – however supporting someone who self-neglects or hoards will usually need agencies to work together closely, in line with safeguarding adult processes.

Chronic self-neglect and/or hoarding is likely to have developed over many years, and it may be considered a safeguarding concern at the point:

• where the person with care and support needs can no longer control their behaviour, so they cannot protect themselves;
• where there is a defined high risk of harm to the individual;
• or the physical / environmental risk to others is significant.

“Safeguarding duties will apply where the adult has care and support needs (many people who self-neglect do not), and they are at risk of self-neglect and they are unable to protect themselves because of their care and support needs. In most cases, the intervention should seek to minimise the risk while respecting the individual’s choices. It is rare that a total transformation will take place and positive change should be seen as a long-term, incremental process.” Self-neglect: At a glance | SCIE

Mental Capacity

Where there is a concern that a person may be unable to make decisions in relation to self-neglect and / or hoarding, as a result of a cognitive impairment of some kind, a mental capacity assessment should be completed in relation to each specific decision.

As part of any MCA assessment, you need to think about what the ‘relevant information’ might be – this is the information the person making the decision needs to be able to understand / retain / use / weigh in making a decision.

For hoarding, there is some case law which sets some examples – from AC and GC (Capacity: Hoarding: Best Interests) [2022] EWCOP 39 (section 14 of the judgement):

(1) Volume of belongings and impact on use of rooms: the relative volume of belongings in relation to the degree to which they impair the usual function of the important rooms in the property for you (and other residents in the property) (e.g. whether the bedroom is available for sleeping, the kitchen for the preparation of food etc). Rooms used for storage (box rooms) would not be relevant, although may be relevant to issues of (3) and (4).

(2) Safe access and use: the extent to which you (and other residents in the property) are able or not to safely access and use the living areas.

(3) Creation of hazards: the extent to which the accumulated belongings create actual or potential hazards in terms of the health and safety of those resident in the property. This would include the impact of the accumulated belongings on the functioning, maintenance and safety of utilities (heating, lighting, water, washing facilities for both residents and their clothing). In terms of direct hazards this would include key areas of hygiene (toilets, food storage and preparation), the potential for or actual vermin infestation and risk of fire to the extent that the accumulated possessions would provide fuel for an outbreak of fire, and that escape and rescue routes were inaccessible or hazardous through accumulated clutter.

(4) Safety of building: the extent to which accumulated clutter and inaccessibility could compromise the structural integrity and therefore safety of the building.

(5) Removal/disposal of hazardous levels of belongings: that safe and effective removal and/or disposal of hazardous levels of accumulated possessions is possible and desirable on the basis of a “normal” evaluation of utility.

For more information on mental capacity see our dedicated pages on mental capacity and safeguarding.