Self-Neglect and Hoarding: A Safeguarding Guide for Care Providers

Self-neglect is when a person does not care for their own health, hygiene or surroundings in a way that puts their wellbeing at risk. Hoarding can be part of self-neglect. The Care Act 2014 statutory guidance recognises self-neglect as a category of adult safeguarding concern, and it is one of the most complex areas of practice because it sits between respecting a person's choices and protecting them from harm.

What does self-neglect include?

• neglecting personal hygiene, health or nutrition
• living in unsafe or unsanitary conditions
• refusing help or services that are needed
• hoarding belongings or animals to a level that creates risk

When is self-neglect a safeguarding concern?

Not every unusual lifestyle is a safeguarding matter. A concern arises when a person's choices or circumstances put them at risk of significant harm and they may be unable to protect themselves. Key questions include:

• Does the person have capacity to make decisions about their care and surroundings?
• How serious is the risk, and is it increasing?
• Is anyone else at risk, such as other residents, neighbours or family?

Balancing autonomy and risk

Adults with capacity have the right to make choices others disagree with. Good practice respects that right while making sure the person understands the risks and knows support is available. Making Safeguarding Personal puts the person's own views and wishes at the centre of decisions.

Where there is doubt about capacity, a decision-specific capacity assessment is needed. Where a person lacks capacity, decisions must be made in their best interests and in the least restrictive way.

What good practice looks like

• Build a relationship. Trust is often the first step to change.
• Be professionally curious. Look for the reasons behind the self-neglect, such as bereavement, trauma, mental health or physical illness. Read more on professional curiosity.
• Assess capacity properly and record it.
• Work with partner agencies. Self-neglect often needs a coordinated, multi-agency approach.
• Keep reviewing. Risk can change quickly.
• Record decisions and the reasons for them.

Common challenges

Staff can find self-neglect difficult because there is rarely a quick fix, people may refuse help, and agencies may disagree about what to do. These are exactly the situations where confident, proportionate decision-making matters most.

Training and support

PMH's safeguarding adults training builds the judgement staff need for complex situations, including self-neglect, coercion, capacity and multi-agency disagreement. For organisation-level support, see our safeguarding consultancy.

Frequently asked questions

Is hoarding a safeguarding issue? Hoarding can be part of self-neglect and becomes a safeguarding concern when it puts the person or others at significant risk.

Can a person with capacity refuse help? Yes. Adults with capacity can refuse support, but practitioners should make sure they understand the risks, keep offering help and review the situation.