The Helpful Neighbor: How Did I Get Involved?
By Pamela D. Wilson, MS, BS/BA, CSA, NCG
I recently received a telephone call from the housekeeper of an elderly woman named Shirley who was concerned that her client was alone and had serious health concerns. She called, frantic because Shirley was starving herself. The housekeeper reported that Shirley told her that she wanted to die. Concerns existed about self-abuse, Shirley’s right to decide that she wanted to die, and reporting the concerns to the police or adult protective services for further investigation. After speaking with the housekeeper, I learned that there was a neighbor who had taken on the task of helping Shirley on a regular basis because there was no immediate family in town.
I called Mike, the neighbor, and made arrangements to meet him at Shirley’s home to assess the situation and to determine what support might be provided. Upon meeting Shirley, I discovered a small woman of 5 feet who weighed 80 lbs. according to the scale in her home. She was very polite, willing to engage in conversation, and admitted that she was starving herself because “the angel of death had visited” and she no longer wanted to live. Shirley was physically weak and needed to hold onto furniture to walk. By the appearance of her hair and a noticeable body odor it was apparent that she had not bathed in some time. Her clothing was dirty. Her ability to recall events was very poor. Her only means of nutrition was juice that she drank during the day. She was determined about the right to die in her own home
Mike was concerned about his personal responsibility in having knowledge of the situation. He wanted to support Shirley’s wishes. He was also concerned about the potential liability of not reporting concerns to medical or other professionals. I was concerned about Shirley falling in the home or being too weak to call for help, even though I knew she would likely not call for help because of her wish to die. We asked Shirley about a visit to her doctor. She refused and said she had not seen a doctor in over five years because she just didn’t trust them.
Shirley agreed to allow an in home caregiver come into the home to help her bathe and to check on her on a daily basis. This would provide Mike and the housekeeper with some comfort that she was being seen daily. Mike was emotionally torn between his personal desire to help Shirley and his desire to do the right thing for her physical well-being. As a friend, and not a family member, he felt helpless to change the situation.
In a situation like this, where there are no clear guidelines, where does one go for help or advice if a person refuses to seek medical care? What about individuals living alone who experience memory loss? What about individuals like Shirley who may not possess the insight to realize that self-neglect is occurring? Neighbors and friends, because of a desire to help others become involved in situations for which we are unprepared. Does having knowledge that a frail, older adult may be unsafe or neglecting their own care have legal ramifications? Is it possible for a neighbor or friend to be held legally responsible for not reporting a concern?
Depending on the state in which you live, yes. Many states have mandatory reporting requirements for adults over a certain age. This means that there is a requirement to contact the police to report concerns. This reporting extends to healthcare professionals, care agencies visiting the home to provide services, care managers, and anyone who has a concern that an older adult may not be able to care for him or herself. Since my work in this industry in 1999, I have reported issues to the police and to adult protective services. While even I felt uncomfortable in making the call, I realized that it was an ethical responsibility to make the report and request an investigation.
If you are concerned about making a report, and the individual about whom you are concerned agrees, contact a caregiving advocate to request an independent evaluation of the situation and to discuss of options. It is common for an individual who may have lived at home alone for some time to see how much a situation has declined. If there is no family visiting, there is no one to raise concerns. Neighbors may not feel that it is their responsibility to express concerns to another neighbor. Unless one has experience, a lack of awareness about available options and community support exists. There are many options for older adults who wish to remain at home to receive assistance.
Another consideration in these situations is locating family members to discuss the concern if possible. It is important for all persons to have a medical and financial power of attorney who can step in to assist at the time of need. Not having a legally responsible person to assist in making medical decisions or to pay bills can place the care and well-being of an individual at risk if a serious health concern were to occur.
In the situation of Shirley, Mike and I were eventually able to convince her to agree to go to the hospital for an evaluation. She agreed after discussions about the ability to be made comfortable and to receive care in her home that supported her desire to die at home The result of the hospitalization was that she was diagnosed with cancer and was placed immediately on hospice care. She was supported by hospice until she passed away without worry, pain or discomfort. Mike and the housekeeper were relieved that Shirley was able to receive needed care and passed away peacefully.
If you find yourself in a situation where you are uncertain about the ability of a non-family member to care for him or himself, seek assistance. It is common for fear or indecision to delay decision making especially if one is not a family member. Those of us who are more able have a responsibility to assist others who might be struggling to care for themselves. Help and support exist.
© 2012, 2013, 2018 Pamela D. Wilson, All Rights Reserved
Pamela D. Wilson, MS, BS/BA, CG, CSA, a National Certified Guardian and Certified Senior Advisor, is a caregiving and elder care expert, advocate, and speaker. Pamela offers family caregivers programming and support to navigate the challenges of providing, navigating, and planning for care. She guides professionals practicing in estate planning, elder and probate law, and financial planning to create plans to address unexpected concerns identified in her past role as a professional fiduciary. Healthcare professionals are supported by Pamela’s expertise to increase responsiveness and sensitivity to the extensive range of care challenges faced by care recipients and caregivers.