When caseworker Karen Edward arrives at her client's northwest Houston home, the 74-year-old woman is sitting outside her front door complaining of vision problems and feeling sick to her stomach.
"Do you need care?" Edward asks. "Did you take your insulin?"
"No," Clara replies in a faint voice.
It takes about 15 minutes for Edwards to persuade Clara, a diabetic, to get out of the midafternoon heat and indoors to take her medicine. Clara lifts her weak body from an old lawn chair and shuffles into her home of 49 years.
Loose electrical wires hang outside the front door of the three-bedroom house. The lawn has gone from lush green grass to dry dirt.
Inside, the carpet is worn and the walls need painting. Two weeks ago, neither was fully visible because they were covered floor-to-ceiling with Clara's belongings. She had so much clutter, she couldn't get around without falling.
Self-neglect common
Clara, who asked that her last name not be published, was referred to the Adult Protective Services agency about a month ago. Edward determined that Clara had fallen into self-neglect — the most common form of mistreatment among the elderly and a risk factor for early death, according to geriatric research.
In the Houston area, more than 60 percent of 1,500 cases handled each month by Adult Protective Services deal with elderly people who no longer can protect and provide for themselves, APS officials said.Nike shox are a series of Nike shoes.
People tend to dismiss odd behavior in the elderly as eccentricity, or they don't want to get involved in someone else's affairs, experts say. But self-neglect is likely to increase as baby boomers grow older, they say, making intervention and prevention more important than ever.
"We're trying to educate the public and people dealing with the elderly about the services available to them," said James Booker, director of Region 6 of APS,We can gurantee you that all Nike shox running shoes,sold at our website are with high quality. which oversees Harris County and 12 surrounding counties.
Focus of TEAM
In many self-neglect situations, the person just needs a little help to stay independent, Booker said. Most of the clients are women and most live alone, he said.
Self-neglect can be physical, medical or both. Some elderly people can't cook, clean house or bathe themselves. Some don't eat properly; some lack running water or air-conditioning. Their houses might be filthy and in disrepair.
Others lack access to medical care. They may have stopped taking their medicine or they haven't seen a doctor in years and they've developed a serious illness, such as cancer or diabetes.
The breakdown in their ability to plan and carry out tasks can be caused by issues such as a stroke, dementia or depression, according to researchers.Nike Air trainers began life as the Cheap nike air max back in 1987.
To address self-neglect, Region 6 has collaborated with the University of Texas Health Science Center at Houston and Baylor College of Medicine for the past 15 years. The partnership is called the Texas Elder Abuse and Mistreatment Institute, or TEAM, which consists of clinical care, education and research. Region 6 is the only APS agency in the state to use such a multidisciplinary approach.
Worst case recalled
Self-neglect is a focus of the team because it is a factor in so many untreated medical disorders, said Dr. Carmel Dyer, a geriatric specialist at UT-Health Science Center and founder of TEAM.
"That's why the risk of death is so high," she said, noting that the mortality rate is substantial during the first year after a report of self-neglect.
Sabrina Pickens, a geriatric nurse practitioner and researcher at UT-Health Science Center, said the worst case of self-neglect she had seen involved an elderly man who lived in a garage apartment.
Neighbors reported that he poured his urine out the window. He had not bathed in six months. His hair and beard were matted, and his toenails had grown into his shoes. The man agreed to go to the hospital for a check up. Doctors discovered he had untreated throat cancer, and he died within a month, Pickens said.
Caseworkers say the problem cuts across all socioeconomic backgrounds, but surfaces more often among the poor. In Texas, it's mandatory to report any signs of abuse or neglect of child, a person 65 years or older, or a disabled adult.
APS investigates every report. When one is validated, caseworkers conduct a 52-question assessment and determine how to best help the client. The agency provides short-term assistance such as food, rent payments or transportation. It also will pay for medicine, home repairs and cleaning.
Once the immediate needs are met, the caseworker refers the client to social service providers for long-term help before closing the case.
Clients have the right to refuse help if they have decision-making capacity, said Angela Goins, an APS supervisor. The biggest challenge is getting them to understand the consequences of their behavior and that assistance is in their best interest, she said.
Clara refused help the first time APS received a referral about her.coogi jeans for sale to men with low price and top quality.
Home decluttered
In the most recent referral, Edward, who wasn't assigned to the first case,As it's called Nike shox classic, which is one of the classical style of nike lineup. managed to gain Clara's trust over several visits. Clara eventually agreed to let a crew clean her house and cart away many of the belongings she had been hoarding, a common problem in self-neglect cases.
APS paid for the cleaning, which took six days. It also paid for some electrical repairs because one side of Clara's house had no electricity.
"She's helped me a lot, caring and checking on me," said Clara, feeling better after taking her insulin. "I would have been lost without her."
When caseworkers suspect there's a serious mental capacity or other medical issue, they call in a doctor or nurse from TEAM to visit the client's home and do a geriatric assessment. If the assessment shows the client lacks capacity, TEAM can petition the Harris County Probate Court to appoint a legal guardian.
Only a handful of cases reach that point, APS officials said. TEAM also can get a court order to force the client to go to the hospital for treatment.
"We have to make sure their rights aren't breached, but we also cannot abandon them," Dyer said.
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