Professionals Checklist For establishing if a concern meets the criteria of self-neglect/hoarding Person causing concerns: Address : Personal Identifier NHS Number or IT number if D.O.B: known: Person Completing Checklist: Date Completed: *Please add any comments/justification/evidence in the box on the rear of this form Issues for consideration when deciding if an individual is seriously self- YES NO neglecting /Hoarding. Is physically frail or has a physical disability, learning disability, mental health needs, long term condition or misuses substances or alcohol? 1 ☐ ☐ Does the person have capacity to make decisions about their health, care and 2a ☐ ☐ support needs? Has a formal mental capacity assessment been undertaken? 2b ☐ ☐ If the person lacks capacity to understand they are has a best ☐ ☐ 2c interest meeting taken place? 3 Is the person unwilling or failing to perform essential self-care tasks? ☐ ☐ 4 Is the person living in unsanitary accommodation possibly squalor? ☐ ☐ Is the person unwilling or failing to provide essential clothing, medical care for 5 themselves necessary to maintain physical health, mental health and general ☐ ☐ safety? Is the person neglecting household maintenance to a degree that it creates 6 ☐ ☐ risks and hazards? Does the person present with some eccentric behaviour and do they 7 ☐ ☐ obsessively hoard and is this contributing to the concerns of self-neglect? Is there evidence to suggest poor diet or nutrition e.g. very little fresh food in 8 ☐ ☐ their accommodation/mouldy food identified? Is the person declining prescribed medication or health treatment and/or social 9 care staff in relation to their personal hygiene and having a significant impact ☐ ☐ on their wellbeing? Is the person declining or refusing to allow access to healthcare and/or social 10 ☐ ☐ care staff in relation to their personal hygiene? Is the person refusing to allow access to other agencies or organisations such 11 ☐ ☐ as utility companies, fire and rescue, ambulance staff, housing or landlord? Is the person unwilling to attend appointments with relevant health or social 12 ☐ ☐ care staff? 13 Have interventions been tried in the past and not been successful? ☐ ☐ Has the person any family , partners or friends that may be able to assist with 14 ☐ ☐ any interventions? Is the perceived self-neglect impacting on anyone else? e.g. family members, 15 ☐ ☐ partners, neighbours, etc. 16. Are their dependent children living in the accommodation? ☐ ☐
Professionals Checklist For establishing if a concern meets the criteria of self-neglect/hoarding Person causing concerns: Address : Personal Identifier NHS Number or IT number if known: D.O.B: Person Completing Checklist: Date Completed: *Please add any comments/justification/evidence in the box on the rear of this form Issues for consideration when deciding if an individual is seriously /Hoarding. YES NO 1 Is physically frail or has a physical disability, learning disability, mental health needs, long term condition or misuses substances or alcohol? ☐ ☐ 2a Does the person have capacity to make decisions about their health, care and support needs? Has a formal mental capacity assessment been undertaken? If the person lacks capacity to understand they are self- neglecting has a best interest meeting taken place? ☐ ☐ 2b ☐ ☐ 2c ☐ ☐ 3 Is the person unwilling or failing to perform essential self-care tasks? ☐ ☐ 4 Is the person living in unsanitary accommodation possibly squalor? ☐ ☐ 5 Is the person unwilling or failing to provide essential clothing, medical care for themselves necessary to maintain physical health, mental health and general safety? ☐ ☐ 6 Is the person neglecting household maintenance to a degree that it creates risks and hazards? ☐ ☐ 7 Does the person present with some eccentric behaviour and do they obsessively hoard and is this contributing to the concerns of self-neglect? ☐ ☐ 8 Is there evidence to suggest poor diet or nutrition e.g. very little fresh food in their accommodation/mouldy food identified? ☐ ☐ 9 Is the person declining prescribed medication or health treatment and/or social care staff in relation to their personal hygiene and having a significant impact on their wellbeing? ☐ ☐ 10 Is the person declining or refusing to allow access to healthcare and/or social care staff in relation to their personal hygiene? ☐ ☐ 11 Is the person refusing to allow access to other agencies or organisations such as utility companies, fire and rescue, ambulance staff, housing or landlord? ☐ ☐ 12 Is the person unwilling to attend appointments with relevant health or social care staff? ☐ ☐ 13 Have interventions been tried in the past and not been successful? ☐ ☐ 14 Has the person any family , partners or friends that may be able to assist with any interventions? ☐ ☐ 15 Is the perceived self-neglect impacting on anyone else? e.g. family members, partners, neighbours, etc. ☐ ☐ 16. Are their dependent children living in the accommodation? ☐ ☐
professionals-checklist-for-self-neglect-and-hoarding.docx