National Senior Independence Month: A Spotlight on Self-Neglect

February is National Senior Independence Month. According to the American Health Care Association and the National Center for Assisted Living  -

This celebration was established to help seniors remain in control of their daily lives.This month encourages seniors to take the opportunity to evaluate their current living situation, and determine whether or not adjustments could be made to create a better lifestyle. This is the opportunity to notice strengths and weaknesses in daily routines and make minor adjustments with potentially huge improvements.

Many seniors strive to live as independently as possible for as long as possible. Seniors can access services and supports, such as Home- and Community-Based Services and assistive technology, to help them in age sagely in their own homes. Unfortunately, changes to physical or mental health may contribute to a senior no longer managing themselves and their homes safely. These changes may lead to self-neglect, which the National Adult Protective Services Association defines as

“…seniors or adults with disabilities who fail to meet their own essential physical, psychological or social needs, which threatens their health, safety and well-being. This includes failure to provide adequate food, clothing, shelter and health care for one’s own needs.”

According to the 2020 National Adult Maltreatment Reporting System  Adult Maltreatment Data Report, state adult protection systems (APS) received over 1,327,019 referrals of alleged maltreatment in 2020. More than 380,000 of the allegations accepted for investigation included concerns of self-neglect[1].

In 2018, the Administration for Community Living (ACL) contracted with New Editions Consulting, Inc. to create an Adult Maltreatment Screening and Assessment Tools Inventory (Inventory) to provide a directory of evidence-supported screening and assessment tools related to adult maltreatment. New Editions designed the Inventory for use by professionals in the field who interact directly with clients and aid in the investigation and substantiation (i.e., evidence is found to support the allegation) of abuse or neglect. ACL’s Office of Elder Justice and Adult Protective Services (OEJAPS) has observed that APS practitioners often use screening and assessment tools developed “in-house.” Though these tools may be useful, without thorough testing and evaluation it is unknown whether they effectively identify individuals experiencing maltreatment. Using screening and assessment tools with established evidence, such as those described in the Inventory, provides practitioners with a level of confidence that aninstrument will be effective for their purposes.

The Inventory includes tools designed to screen for or assess general adult maltreatment or specific subtypes of maltreatment (e.g., self-neglect) based on peer-reviewed research, published between 1980 and 2018. For each tool, the Inventory lists the domain(s), number of items, and amount of training required for use. New Editions methodologists also reviewed and assessed the level of evidence supporting each tool and provided suggestions to further strengthen the level of evidence for each instrument. The Inventory contains three tools that can support APS investigations and facilitate access to services and supports for seniors experiencing self-neglect.

  1. EDMA (Detection Scales for the risk of domestic abuse and self-negligent behavior in elderly persons) Escalas de Detección de Riesgo de Malos Tratos Domésticos y Comportamientos Autonegligentes (EDMA): This tool was originally created in Spanish and is designed for use by social service professionals to help them identify situations involving domestic abuse towards seniors and self-neglecting behavior. Information is collected by observation and through a questionnaire.
  2. Elder Self-Neglect Assessment (ESNA): The ESNA measures both environmental and behavioral aspects of elder self-neglect, including ratings of living conditions, physical and mental health, social connectedness, and financial issues. Information is collected by observation.
  3. Self-Neglect Severity Scale (SSS): Researchers designed the Self-Neglect Severity Scale (SSS) based on interviews with APS workers and a national expert panel. The SSS is based on observation and interview and is administered in the home to allow for an environmental assessment.

OEJAPS has placed Version 1.0 of the Adult Maltreatment Screening and Assessment Tools Inventory on the National Center on Elder Abuse website for download, along with instructions for navigating the inventory. A planned future update will adapt the inventory to a web-based, searchable format.


[1] McGee, L. & Urban, K. (2021). Adult Maltreatment Data Report 2020. Submitted to the Administration for Community Living, U.S. Department of Health and Human Services.

Focus or Topic