Self-Neglect – It Affects Vermonters Too

Did you know that over one million older adults are affected by self-neglect every year, and in the United States, it has been the primary type of elder abuse cases reported to Adult Protective Services? This rarely discussed issue affects Vermonters too. We spoke with Derek Souza, Specialized Care & Service Coordinator, to learn more about self-neglect and how Age Well helps those affected.


Self-Neglect is hard to define, can be difficult to recognize, and comes in a variety of different forms. However, the Vermont Department of Disabilities, Aging,  and Independent Living (DAIL) has come up with this definition of self-neglect:

“The term ‘self-neglect’ means an adults inability, due to physical or mental impairment or diminished capacity, to perform essential self-care tasks including:

(A) obtaining essential food, clothing, shelter, and medical care; (B) obtaining goods and services necessary to maintain physical health, mental health, or general safety; or (C) managing one’s own financial affairs.

This definition excludes people who make a conscious and voluntary choice not to provide for certain basic needs as a matter of lifestyle, personal preference, or religious belief and who understand the consequences of their decision.”

Age Well is the designated agency in Northwestern Vermont to receive referrals for self-neglect. To make a referral, call the Helpline at 1-800-642-5119.


  1. Sudden or recent behavioral changes 
  2. Poor hygiene
  3. Physical environment in poor condition
  4. Untreated wounds
  5. No recent medical appointments or visits
  6. Resistance to necessary care services
  7. Weight loss
  8. Poor safety awareness


Out of the 50 states, Vermont is the only one in which Area Agencies on Aging, like Age Well, are the organizations designated to investigate reports of self-neglect. In other states, the request goes through Adult Protective Services, but in Vermont those reports should go straight to one of the Area Agencies on Aging. 

Symptoms of self-neglect can be serious, so referrals for suspected self-neglect are prioritized and assigned within one business day. Typically, self-neglect referrals are assigned to a Specialized Care and Service Coordinator, who will attempt to contact the individual right away to schedule a visit.


Age Well employs two Specialized Care and Service Coordinators to respond to and follow up on reports of self-neglect. Derek Souza at Age Well has direct experience working with older Vermonters and the challenges involved in assessing and identifying self-neglect. Hear from Derek:

“We have a specific assessment for our clients that helps to identify risks and shared goals. Not all self-neglect reports are necessarily self-neglect. You have to determine if they are self-neglecting, or if it is a lifestyle choice that they’re consciously choosing to make. We want to be clear that we are always client-directed and to the best of our ability support what our clients choose. Self-neglect is a tough one because we are here to support our clients and we want to support their decisions, but some of those decisions are very harmful to them, so we have to try to work with each client and try to figure our strategies and goals that would be constructive to their well-being.”


Due to the COVID-19 pandemic, it can be even more difficult to determine if someone you know is self-neglecting, or choosing to self-isolate during these uncertain times. The potential depression and stress caused by COVID-19 may trigger symptoms of self-neglect. Some signs to watch out for in your neighbors and loved ones are garbage buildup, no longer getting their mail, not engaging with anyone, and stopping their normal routines altogether.


If you, a loved one, a patient, or someone you know is suffering from symptoms of self-neglect, call the Helpline at 1-800-642-5119 to make a referral. Age Well’s Specialized Care & Service Coordinators will make contact with the individual within two business days, unless determined that the situation requires a more rapid response.