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Promoting good practice in self-neglect

Publish on Category: Birds 0

Mr Bs Life
Early 60s; mild learning disability; living in family home; parents death left him isolatedBefriended; Friend moved in as a ‘carer’; concerns about home conditions/hygiene; serious hoarding/fire risksSuffered a Stroke; impaired mobility & speech; difficulties securing adaptations;Further decline in personal care & state of house; episodic involvement with agencies; assumptions of mental capacityReluctance to accept help and support at home;Safeguarding concerns: neglect; financial exploitationInteragency work to secure change in hygiene and conditions; hostility and aggression from carer; gradual development of relationship; mental capacity assessmentsCompliance with health and personal care intervention; referral to mental health services; refusal to change home conditionsDied with his fiend in accidental fire June 2017
Emergent learning themes
Assessment of need and risk
Early missed opportunities to conduct care & support needs assessment: “no identified needs”Outcomes of OT assessment frustrated by absence of home ownership proofSafeguarding concerns identified but:Difficulty engaging with AM – relationship with friend /carerNo evidence of care & support needs assessmentNo comprehensive risk assessment – fire / willful neglectDelicate balance of negotiated vs imposed solutionsTrust-building interventions pursued without appropriate risk-management strategiesLack of momentum in the safeguarding plan
Mental capacity
Reliance on assumption of capacity rather than formal process of assessmentMental capacity assessments(i) finding of capacity not evidenced(ii) examples of excellent practiceSignificance of absence of capacityNo explicit best interests decision-making process
Mental health
Mental health needs recognized late in the process
Approaches to service refusal
AM’s assurances taken at face valueAbsence of professional curiosityFailure to pursue proactive engagement warranted by level of riskCulture of case closure resulting from resource and caseload pressuresLoss of momentum in response to continued refusal to deal with the state of the property
Relationships with significant others
Friend/carer’sneeds not fully recognizedCoercion and control of AM recognized but not addressedIntermittent contact with AM’s family - missed opportunities
Interagency collaboration & coordination
Some good practiceEffective communication over specific mattersSafeguarding meetings provided effective forum for some agencies to coordinate their involvement, strong legal presenceEffective communication between ACS and NSFTBut - missed opportunities; disagreements about responsibilitiesSignificant gaps in communication/coordinationFire ServicePoliceGPHow effective was the safeguarding process? – delay in moving forward
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Promoting good practice in self-neglect