Imagine your longtime neighbor is an elderly gentleman who lives alone. He’s been in and out of the hospital over the last few months. He rarely sees his only child, a son who lives on the other side of the country.

You pay your neighbor a social call upon his recent return from a hospital stay.

When he doesn’t answer the door, you peer into the window and are alarmed to see he’s on the floor and not responding to you as you call his name. You call 911.

Paramedics arrive. You stay to answer any questions you can. As you stand by, you hear that your neighbor hasn’t let the home health agency personnel in for their nursing care visits to monitor his health. And he hasn’t eaten the Meals on Wheels food that had been delivered.

It looks as though before he fell he hadn’t moved off the couch for days, soiling himself and the couch in the process.

Although your neighbor has fallen, he’s conscious. He’s annoyed that the paramedics were called. Upon standing, he refuses to get into the ambulance. He says nothing is wrong.

According to the paramedics, he appears to be alert and oriented to person, place and time (cognitively fit), just stubbornly refusing help of any kind.

Is your elderly neighbor exhibiting signs of self-neglect?

The National Adult Protective Services Association defines self-neglect as an adult’s inability, due to physical or mental impairment or diminished capacity, to perform essential self-care.

They make clear that lifestyle choices or living arrangements alone do not prove self-neglect.

For example, if a senior abuses drugs or alcohol, that may be a lifestyle choice. If a senior lives in only one room of his home with no heat or air conditioning and refuses to answer their phone, that may be a lifestyle choice.

According to a 2014 survey conducted by the National Association of Professional Geriatric Care Managers (now called Aging Life Care Association), self-neglect among seniors is the most common form of nonfinancial elderly abuse/neglect encountered by care managers.

Elder self-neglect is a largely hidden problem, with most cases going unreported.

The six warning signs of self-neglect most often cited by care managers are poor personal hygiene; poor medication management or refusal to take medications; possible dehydration, malnutrition or other unattended health conditions; unsanitary or very unclean living quarters; unpaid bills, bounced checks or utility shut-offs; and weight loss or lack of adequate food.

Some people who neglect themselves have insight into their behavior, while others do not. Some may have an underlying condition, such as dementia or depression. In many cases, people have suffered a major loss or trauma.

One major challenge in addressing self-neglect is knowing when to intervene, an action that usually involves making individual judgments about what is an acceptable way of living and at the same time assessing the degree of risk to a person.

Often people who self-neglect don’t want help to change, which puts themselves and others at risk—for vermin infestations due to unsanitary conditions or for fire due to hoarding, for example.

If the person is deemed to not have the mental capacity to make decisions about their own care, they may be involuntarily committed for observation or compelled to accept help. But if they are in possession of their mental faculties, they have a right to refuse treatment. This makes it difficult and sometimes heartbreaking for friends and family.

Adult Protective Services is duty-bound to investigate every claim of abuse and neglect reported to them. To make a report to Ventura County APS, call (805) 654-3200. The L.A. County APS number is (877) 4-R-SENIORS (477-3646).