Social care responses to self-neglect and hoarding among older people

The 2014 Care Act recognised self-neglect and hoarding behaviour as possible safeguarding concerns, requiring local authorities to respond.

Older people showing self-neglect and/or hoarding behaviour are often reluctant to accept treatment, services, or support, if they recognise the existence of a problem at all. When behaviour changes, this often only happens over a long period of time, and outcomes can be minimal and uncertain.

Working with individuals needs patience and mutual trust. However, provision of continuous support is hard for busy operational teams, and it can be difficult to justify the commitment of staff long-term. 

• Aims

  This study explored safeguarding and social care responses to self-neglect and/or hoarding behaviour among older people to answer the question ‘what works in practice?’

   

• Methods

  The study used a mixed method approach consisting of literature and document reviews, interviews with 31 safeguarding adults leads and managers and 13 practitioners in 31 areas, and case studies in six SAB areas which involved interviews with 33 senior managers and 60 frontline practitioners from agencies and organisations represented on the SABs. Eight older people with lived experience, and 9 relatives and carers were also interviewed. Another arm comprised the economic analysis of service provision. 

• Findings

  Social care responses to self-neglect and hoarding among older people – project findings report

  The main recommendation is the establishment of specialist multi-agency teams comprising professionals from at least social care/social work, mental health, housing, fire and rescue, environmental health, and voluntary community services. These would enable professionals to react to the complexity of individuals’ needs. These teams need enough resources to allow engagement with individuals (and their relatives and/or carers) long-term, and to be able to follow-up and monitor.

  Where specialist services cannot be established, multi-agency working can be improved by continuous conversations about cases, increased participation by agencies, and better integration of third sector organisations. If external providers are commissioned, it is important that their services are based on a therapeutic approach, and that they can work with individuals long-term.

  Another recommendation is for improving access to (community) mental health services for this group. The implications of this would need to be explored further.

  We recommend that assessments, especially mental capacity assessments, need to be undertaken with great sensitivity so as not to threaten individuals (or their relatives/carers) and discourage engagement with services.

  We heard that some professionals were still perceiving self-neglect and/or hoarding behaviour as a choice. More awareness is needed, including in relation to mental capacity. For professionals directly working with individuals, specialist training and supervision focussing on ways to directly treat and support could improve outcomes long-term.

  Finally, preventative approaches need to anticipate potential future needs. Anticipation may be possible at certain points in a person’s life such as a bereavement or moving house, or through a shared multi-agency register flagging potential points of concern that should be monitored.

  We have provided some economic evidence that investing in services can improve outcomes for individuals and reduce the risk of harm. 

• Resources and publications

  Manthorpe, J., Woolham, J., Steils, N., Stevens, M., Martineau, S., Owen, J., & Tinelli, M. (2022). Experiences of adult social work addressing self-neglect during the Covid-19 pandemic. Journal of Social Work. https://doi.org/10.1177/14680173221083446

  Owen, J., Woolham, J., Manthorpe, J., Steils, N., Martineau, S., Stevens, M., & Tinelli, M. (2022) Adult safeguarding managers’ understandings of self-neglect and hoarding. Health & Social Care in the Community. https://doi.org/10.1111/hsc.13841

  Martineau, S., Manthorpe, J., Woolham, J., Steils, N., Stevens, M., Owen, J., & Tinelli, M. (2021) Social care responses to self-neglect among older people: an evidence review of what works in practice, London: NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King’s College London. https://doi.org/10.18742/pub01-047

  Steils, N., Woolham, J., Manthorpe, J., Martineau, S., Owen, J., Stevens, M., & Tinelli, M. (2022) What do we know about hoarding behaviour and treatment approaches for older people? A thematic review, London: NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King’s College London. https://doi.org/10.18742/pub01-083

  Further study and contact information can be found on the project website.

  Please also see the connected School for Social Care Research projects: 

  • Decluttering the homes of people with hoarding behaviours: Local authority commissioning, professional practices, and user experiences
  • Understanding and improving training offers for professionals working with people with hoarding behaviours