New Self Neglect Guidance

Self-neglect and hoarding frequently feature in national and local Safeguarding Adult Reviews (SARs) and as a Board we are determined to embed the learning.

For further information regarding Salford Safeguarding Adult Reviews, please visit the SSAB webpage Published SARs and other reviews | Salford Safeguarding Adults Board

We know that crucially to have any effective intervention with adults who self-neglect or those who have hoarding behaviour, it’s the ability to engage and build a rapport with people, explore their lived experience and build relationships of trust. This is very much in tune with the ethos and principles of making safeguarding personal and our duty to promote the individual’s wellbeing.

We would strongly encourage all agencies and professionals, along with the wider voluntary and community sector, to be familiar with this guidance and actively contribute to its implementation.

It is important to understand that this guidance should be read in conjunction with Salford SSAB Multi Agency Safeguarding Policy and Procedures

The aim of this guidance is to support practitioners working across all services to recognise self-neglect and hoarding, to better understand potential underlying reasons why people may self-neglect and / or hoard, as well as the impact of these behaviours.

It aims to provide practical guidance and useful tools to support practitioners to engage and support people who are self-neglecting and/or hoarding by ensuring their approach and any interventions are person centred, trauma informed, responsive, sensitive and proportionate to the presenting risks. It also aims to promote the importance of effective multi agency working to ensure that individual and organisations uphold their duty of care.

Professionals should work in partnership with the adult, local communities and other organisations to raise awareness of self neglect and hoarding by sharing information appropriately, providing advice and support as required and empower individuals as far as possible, to understand the implications of their actions.

The Care Act 2014 statutory guidance, paragraph 14.17, defines self-neglect as: "A wide range of behaviour neglecting to care for one's personal hygiene, health or surroundings and includes behaviour such as hoarding."

Managing the balance between protecting adults at risk of self-neglect against their right to self-determination can be challenging. There will be occasions where people who are not looking after themselves, whether they have mental capacity or not, could have a serious impact on their health and well-being and the wider family, friends and community.

The Care Act 2014, sets out the local authority’s responsibility for protecting adults with care and support needs from abuse or neglect which includes self-neglect being included in the required arrangements for adult safeguarding . See Chapter 14 of the Care and support statutory guidance accompanying the Care Act 2014 (Department of Health and Social Care).

Section 1 of the Care Act provides particular focus on well-being in relation to an individual, and requires that organisations should always promote the adult’s well-being in their safeguarding arrangements, which is also in line with Making Safeguarding Personal (MSP).

There are various reasons why people self-neglect such as loss / bereavement, trauma (e.g. experiencing or witnessing previous abuse), physical or mental health conditions or substance addiction / misuse.  Some people have insight into their behaviour, while others do not. It can often be very complex. 

It is important to understand that poor environmental and personal hygiene may not necessarily always be as a result of self-neglect. It could arise as a result of cognitive impairment, being physically unwell or impaired, poor eyesight, functional and financial constraints. In addition, many people, particularly older people, who self-neglect may lack the ability and/or confidence to come forward to ask for help, and may also lack others who can advocate or speak for them.  If once you speak to a person and they are willing to accept help, they can be referred for a Social Care Assessment.

There is a number of different ways a person can be self neglecting, for further potential characteristics relating to self neglecting behaviour please refer to Appendix 1 – Possible characteristics of a person who may be self neglecting 

The World Health Organisation Family of International Classifications Network (WHO-FIC) defines Hoarding disorder as:

‘Hoarding disorder is characterised by accumulation of possessions that results in living spaces becoming cluttered to the point that their use or safety is compromised. Accumulation occurs due to both repetitive urges or behaviours related to amassing items and difficulty discarding possessions due to a perceived need to save items and distress associated with discarding them. If living areas are uncluttered this is only due to the intervention of third parties (e.g., family members, cleaners, authorities). Amassment may be passive (e.g. accumulation of incoming flyers or mail) or active (e.g. excessive acquisition of free, purchased, or stolen items). The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.’

Why might someone hoard belongings?

There are different reasons why someone may hoard.  It could be due to a physical disability or health problem that means they have difficulties managing and can’t clear things they have accumulated.  It could be due to a cognitive impairment or learning disability that means they don’t know who to dispose of items.  There can also be other underlying factors such as recent or past trauma, mental health problems such as depression, schizophrenia or obsessive compulsive disorder. Hoarding can be, but isn’t always, linked to self-neglect.

Signs of hoarding behaviours

• May keep or collect things that have little or no monetary value

• May find it hard to organise items

• May struggle to manage everyday tasks such as cooking / cleaning and paying bills

• Property is very ‘cluttered’ and rooms cannot be used for intended purpose

• Person is extremely attached to items

When hoarding becomes a problem

According to the NHS, Hoarding is considered to be a significant problem if:

• The amount of clutter interferes with everyday living – for example, the person is unable to use their kitchen or bathroom and cannot access rooms;

• The clutter is causing significant distress or negatively affecting the person's quality of life or their family's – for example, they become upset if someone tries to clear the clutter and their relationships with others suffer

A hoarding disorder can make it difficult for someone to get around their home and use rooms for their intended purpose such as sleeping, personal hygiene and food storage / preparation. People who hoard can often be reluctant to allow people into their homes whether it be family / friends or people who may be needed to carry out work or repairs.  This mean that the property condition can deteriorate and become a health hazard.

In some circumstances, hoarding can create risk to the person hoarding and others as it can lead to:

• Rodent or insect infestations

• Fire risk due to flammability of the hoard or blocking of exit routes

• Increased risk of trips and falls

• Items causing harm by falling on the person

For further support when working with someone that may have hoarding behaviours, please refer to the Hoarder Insight Tool - Appendix 2 – Hoarder Insight Tool - this guide should be used to assess the person’s view towards their individual circumstances.

Clutter Scale

The clutter scale is a national tool that can be used as a guide and to assess the person’s living conditions and the scale of the hoarding. 

The clutter scale should be used with caution and only as a guide because it’s not always considered to be the most person-centred approach because the circumstances of each person is different, perspectives can differ and it doesn’t consider other factors such as hygiene, smells and infestations.

Please click the link for a copy of the Clutter Image Rating 

Safeguarding Principles

When working with anyone who is self-neglecting or hoarding, it’s important to always remember the safeguarding principles:

Empowerment – People being supported and encouraged to make their own decisions and informed consent

Prevention – It is better to take action before the harm occurs

Proportionality – The least intrusive response appropriate to the risk presented

Protection – Support and representation for those in greatest need

Partnership – Local solutions through services working with their communities. Communities have a part to play in preventing detecting and reporting neglect and abuse.
Accountability – Accountability and transparency in delivering safeguarding

Making Safeguarding Personal (MSP)

Making Safeguarding Personal (MSP) recognises that adopting a ‘one size fits all’ approach to safeguarding will not work.

We are all different, we have different backgrounds, cultures, lifestyles, interests, likes / dislikes. Our life experiences can have a huge influence on how we interpret and interact with the world around us.

The Care and Support Statutory Guidance states that:
‘Making safeguarding personal means it should be person-led and outcome focused. It engages the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety.’

Equality and Diversity 

Every person has the right to be their true self and to live a full life without prejudice, fear or barriers and there also needs to be a mutual respect that everyone’s lifestyle choice might not be the same.

The SSAB has some resources available on the website which will raise awareness which include:

A 7-minute briefing on d/Deaf awareness.

A 7-minute briefing on the Equality Act 2010

For more information on Equality, Diversity and Inclusion, please see Equality, Diversity and Inclusion | Partners in Salford.

You can also consider looking at the learning from SAR Kannu 2021 who had long term health condition, concerns were raised regarding Kannu not accepting care and support in the Nursing Home which led to a decline in her mental and physical health. Kannu then started to withdraw from acceptance support and this was related to her culture and her wish to purify her body to prepare for her passing. 

There was also a Joint SAR/CSPR where there was concern about a person self-neglecting; the review highlighted learning around cultural awareness including understand protected characteristics under the Equality Act 2010 and the importance of Think Family and working together.

Professionals from across a wide range of agencies are well placed to identify concerns about self-neglect and/or hoarding, especially those that visit people in their own homes such as housing providers, health services and sometimes emergency services.
All services need to familiarise themselves with potential indicators of self-neglect and hoarding, and also the underlying reasons why people may self-neglect or hoard.

Indicators of self-neglect may include:

• Living in squalor / unclean property
• Living in hazardous property
• Missing medical appointments
• Poor personal hygiene
• Not eating properly
• Lack of food / mouldy / food that’s gone off
• Infestations

Indicators of hoarding may include:

• May keep or collect things that have little or no monetary value
• May find it hard to organise items
• May struggle to manager everyday tasks such as cooking/cleaning and paying bills
• Property is very ‘cluttered’ and rooms cannot be used for intended purpose
• Person is extremely attached to items

Please click the link for a copy of the Clutter Image Rating 

A conversation will need to take place with the person who is self-neglecting or hoarding.  If you already have a relationship with the person, then you may be best placed to do this. If you don’t then you may need to consider whether there is someone who has a relationship with the person (this could be a housing officer, a district nurse, therapist, GP) and would be better placed to have a conversation with them regarding your concerns.

It is important not to judge the person, but to build a relationship and engage with them to try and understand if there are any underlying cause for their behaviours i.e. bereavement, trauma, significant events in their life or a physical reason. 

Five top tips to support you to have difficult conversations

1. Preparation – jot down key points in priority order in advance as this will act as a prompt when you are with the person. 
2. Specifics are important – have one to two detailed examples of how support can be provided to mitigate risk(s) or support available, take different formats of information which are accessible to support conversations.
3.  Environment is important – the type of space you use to engage with the person can have an impact on how the conversation goes, consider alternative environments to have a good conversation i.e. ask they person where they feel most comfortable meeting with you or if they don’t want you to visit their home suggest alternatives likes local coffee shop or walk and talk.
4.  Silence is golden – when you have provided the information then stop and allow the person to reflect and take it in. Don’t rush the conversation, take time to listen to what they are saying.
5. Put yourself in their shoes – how would you feel to hear the information you have provided to the person and more importantly remember what language you use, don’t use jargon.

Trauma informed and Professional Curiosity

Salford is committed to becoming a trauma responsive city, for more information about being trauma responsive, see Trauma Responsive | Salford Safeguarding Adults Board.

You will need to show an interest in them, asking them about their background, their culture, their life. It is important to demonstrate professional curiosity and cultural awareness. 

Remember – professional curiosity is a professional term/act, but the real meaning to remember is about talking to a person to understand what is happening within their life rather than making assumptions or taking a single source of information and accepting it as face value. 

It is important to be aware of the possible impact of trauma on the person.  For example, they may find it difficult to trust professionals, or be hypervigilant and very easily distracted or upset. But practitioners should also remember that people with trauma also have strengths and can develop resilience.

Once you’ve built a relationship with the person, then you will be able to move on to sensitively asking them about their lifestyle. You need to establish the person’s understanding of their hoarding / self-neglect, for example:

• What is the person’s views of their lifestyle
• Do they have insight?
• Have they shared any information that might indicate why they self-neglect and/or hoard?
• Do they appear to have mental capacity? Do they understand what they are doing and the risks?
• Do they understand the risks and why you / other professionals may be concerned?
• Do they want / need help?
• What help do they need?
• Do they need a social care assessment?

If the person acknowledges that they would benefit from support, depending on your role and the support required, you may be able to provide support yourself, or refer them to support services - see the links below for local resources of support available in Salford.

Other forms of support available in Salford

Salford City Council

Health and social care•Salford City Council

Quick help – get the right care from the right person•Salford City Council

mycity Directory

Consider whether you need to refer the person for a social care assessment

However, if the person is putting themselves or others at risk due to their self-neglect and/or hoarding, then you may need to refer the person to Adult Social Care for a Safeguarding Enquiry (under Section 42 of the Care Act).

For further information and guidance which can help to get engagement with adult who may be self neglecting, see Appendix 3 – Actions which can support practitioner to engage with adults 

Professionals from a number of agencies may have contact with the person and it’s important that information is shared so that any risks can be properly assessed, and because different agencies can have different powers to intervene in different situations, particularly where adults may be vulnerable or at risk of harm. 

For further information visit the SSAB webpage - Working with partners | Salford Safeguarding Adults Board

Multi-agency meetings to share information should be considered at the earliest opportunity to ensure a preventative approach is taken. However, where there are significant risks, this should be managed under Salford Safeguarding Process.

Information sharing across all relevant agencies is crucial so that all agencies involved can have a better understanding to the extent and impact of the self-neglect and to work together to support the individual in a co-ordinated way. This should be done with the person’s consent where possible.

Wherever possible the person themselves should be included in the meeting along with significant others and an independent advocate where appropriate.

Consent from the person is not always needed to share information. For further information, visit the SSAB website - Information Sharing and Confidentiality.

There will be circumstances where a person who is self-neglecting may be cared for by a family member, friend or neighbour and you may need to explore whether they may need to be included in any conversations, assessments or support plans.

If the person does have someone who provides care, they may be entitled to receive support and can have a carer’s assessment to determine any additional support they may need to support them in their caring role.

If the adult has 'substantial difficulty' in understanding and engaging with any social care process, including a Care Act Section 42 Enquiry, arrangements must be made to ensure there is an appropriate person to help them, and if there isn't, arrange an independent advocate.

The person may be able to access the support of an advocate who can help to explain things they may not understand and support them to express their wishes and feelings.

For more information about Advocacy in Salford please visit Mind in Salford. Advocacy - Mind In Salford 

It is important to consider how to engage the person at the beginning of any assessment. Careful consideration should be given to the method of making contact to ensure it is not perceived as impersonal or authoritative. Home visits are important, and practitioners should be mindful to whether third party information or a telephone conversation is sufficient to make an informed assessment/decision. Every attempt should be made to obtain information directly from the adult that the concerns are relating to. 

Refer to Appendix 4 - Guidance Questions for Practitioners when engaging with a person who maybe self neglecting (word doc)

It is important that the practitioner uses their professional skills to be invited into the person's house and observe for themselves the conditions of the person and their home environment. Practitioners should discuss with the person any causes for concern over the person's health and wellbeing and obtain the person’s views and understanding of their situation and the concerns of others.

It is also important to be mindful that the person may give superficial responses initially. The practitioner will slowly need to build a relationship to explore more deeply into how a person understands and could act on their situation. Information sharing across all relevant agencies (subject to appropriate information-sharing protocols) is crucial so that all agencies involved better understand the extent and impact of the self-neglect, including hoarding, and work together to support the individual and assist them in reducing the impact on their wellbeing and on others.

Communication and engagement is key when working with people who have hoarding behaviours, the diagrams below are some simple actions to promote engagement. 

Risk enablement provides real choice and control which means to take the risks that they choose and incorporating safeguarding and risk enablement into relationship-based, person centred working.

Always make judgements about ‘likely risk’ based on evidence and not based on assumptions, emotion or anxiety.

There is a need to be mindful that organisational and professional risk aversion and defensive practice can hinder choice, control and independent living. This poses real challenges for practitioners/professionals in balancing risk enablement with their professional duty of care to keep people safe. 

Risk enablement therefore should always be a core part of placing people at the centre of their own care and support.

Adopting a positive approach to risk means recognising the positive benefits that risk taking can have and taking steps to:

1. Actively encourage and support a person to take a risk; when
2. Taking the risk is likely to achieve personal change, growth and promote individual wellbeing.

Wherever possible you should take a positive approach to risk assessment unless taking the risk will increase the risk of abuse or neglect of the person (or another vulnerable adult or child).

Risk assessments - Safeguarding Adult Reviews (SARs) emphasises the importance of risk assessments and they should be robust and holistic, with risks being considered individually and collectively. Risks to other people should not be under-estimated. Assessments should be evidence-based and not reply solely on an individual’s self-reporting. The approach should be multi-agency, culminating in risk management plans that include consideration of all possible legal options. Decisions, and the reasons behind them, should be clearly documented, with multi-agency meetings reconvening to consider progress and to review the plan. If someone chooses not to engage, agencies should not withdraw from supporting the adult without a formal multi-agency discussion and completing a risk assessment.

This has been learning taken from SAR Francis - Francis was in his 50’s at the time of his death, lived alone and there were concerns about Francis’ vulnerability and risk of exploitation and there were missed opportunities for a multi-agency approach to safeguard him. 

For further tools and templates to understand risk management, please refer to 

Appendix 5 – Salford Single Agency Assessment/Risk Assessment
Appendix 7 - Key Principles of Risk Assessment
Appendix 8 - Examples of Risk that may be identified
Appendix 9 - Salford Multi Agency Risk Assessment 

Sometimes, people who are self-neglecting or hoarding may experience problems with their mental capacity or with their executive functioning.

It is important that conversations with the person explore their understanding of the situation, following the principles of the Mental Capacity Act 2005.

If there is reason to doubt a person’s mental capacity to make a particular decision, and all practicable steps (for example, using visual images, simplify language or using different communication methods) have been taken to help them make the decision without success, then an assessment of their capacity should be conducted. The assessment should explore whether the person can do the following:

-    Understand the information needed to help make the decision
-    Retain the information
-    Weigh up the information
-    Communicate their decision to others

A person lacks mental capacity under the Mental Capacity Act if they are unable to do one or more of these things.

The assessment must be accessible, and every attempt should be made to engage with the person taking into consideration any disabilities or impairment they may have i.e., hard of hearing, speech impairments etc. This may require support from specialist team like the Speech and Language Service, Occupational Therapists and Learning Disability Services.

This is learning that has been taken from SAR Irene who was an older adult who had communication needs and experienced domestic abuse within her marriage.

The assessment should also take into account the person’s social history and their current relationships. Assessment should not rely just on the individual’s self-report but triangulate this with other available information. It can be helpful to seek the views of other people who know the person such as professionals, family members, friends or neighbours as appropriate.

Unwise Decisions

A person is not to be treated as unable to make decisions/lack capacity merely because they make an unwise decision. Every attempt should be made to maximise capacity using practicable and reasonable steps to help them.

Executive Functioning

Assessing mental capacity and trying to understand what lies behind self-neglect and hoarding can often be complex. Mental capacity assessments must be kept under review, especially where a person’s mental capacity appears to fluctuate. Practitioners with specialist expertise should be involved in particularly complex assessments.
To assess ‘executive functional capacity’ (which is the ability to make a particular decision). In these situations, there seems to be a disconnect between what people say and what they can or actually do. A thorough mental capacity assessment must be completed, with records clearly documenting the basis on which decisions about capacity were reached.

Executive function should considered as part of the mental capacity assessment. This can be done by using “show me” or “demonstrate” approaches.

For information and helpful tips please refer to an article produced by Community Care - Executive functioning and the Mental Capacity Act 2005: points for practice - Community Care

The Mental Capacity Act Code of Practice states that one of the reasons why people may question a person’s capacity to make a specific decision is “the person’s behaviour or circumstances cause doubt as to whether they have capacity to make a decision” (4.35, MCA code of practice, page 52). Arguably, extreme hoarding or self-neglect behaviour meets this standard and an assessment of capacity should take place.

Executive incapacity must be a direct result of a permanent or temporary impairment or disturbance of the mind. As executive capacity is not explicitly referred to in the Mental Capacity Act 2005 it must be considered as part of the functional tests, particularly whether a person can understand relevant information about a decision to be made and use or weigh that information as part of the decision-making process.

Practitioners should be aware that people who are autistic can often have difficulties with planning and initiating tasks. This may not mean that they lack the mental capacity to make the relevant decision(s) but they may need support (see principle 2 of the Mental Capacity Act).

For more information, please refer to the Mental Capacity Act 2005 Resource and Practice Toolkit (proceduresonline.com)

Also, consider looking at the learning from SAR Eric who lived a full and active life, but experienced depression as he got older. He took to his bed and started to refuse food, water, care or treatment.

The most frequent concern raised by professionals when working with adults who may self-neglect or hoard is that they can’t or don’t recognise their behaviour to be a concern and don’t feel that they need the support of services.

Self-neglect or hoarding needs to be understood in the context of each individual’s life experience; there is no one overarching explanatory model for why people self-neglect or hoard. It is a complex interplay of association with physical, mental, social, personal and environmental factors. A starting point is trying to understand why the person is disengaging and the context for why they may mistrust service.

Accepting self-neglect as a "lifestyle" choice and ending involvement without having assessed the risk and attempting to engage with the adult in a meaningful way is not acceptable as this exposes the adult at risk to ongoing or increased harm or abuse, every organisation has a duty of care.

Practitioners should be prepared to say “I’m worried about you. I’m concerned that you don’t understand the risks in your situation, and I may have to make decisions for you.  Please help me to help you.”

We all have a role to play

Part of the challenge is knowing when and how far to intervene where there are concerns about self-neglect and hoarding, and the person appears to have mental capacity. This may involve making professional judgements about what is an acceptable way of living for the person, balanced against the degree of risk to them and/or others.

Before ending involvement with a person, best practice suggests that there should be a multi-agency meeting to discuss the implications of withdrawing and a multi-agency risk assessment should be completed to evidence the rationale for withdrawing and how the identified risks can be managed or monitored. Where possible, there should be agreement within the meeting which organisation is best placed to have oversight of the person and will maintain contact in an effort to engage the person and to monitor/reduce the risks.

If the risk have been identified as low or moderate risk(s), a multi agency meeting should be considered – this should be arranged by the agency/professional that knows the person the best (this may not be or does not need to be Adult Social Care) 

Refer to Appendix 6 – Proposed Agenda for Multi Agency Professionals Meeting – suggested format of the multi-agency professional meeting relating to self-neglect and hoarding.

When there is adult living with moderate or high risk(s), simply ending involvement because an individual refuses to engage is not seen to be good practice. This may require agencies to be flexible in their approach when they are best placed to lead and coordinate the offer of care and support.

If risk(s) are high, these should be managed under Salford Safeguarding Policy and Procedures.

If they risk remains significantly high and the person remains in the safeguarding process, then it may be appropriate to refer the person to the High Risk Advisory Panel. This is an advisory panel that may be able to offer professionals additional advice and support to reduce any immediate risk of death.

For further information about working with partners and understand what legal options could be explored please visit the SSAB webpage for  - Working with partners | Salford Safeguarding Adults Board. 

It is important to record assessments, decision making, rationale for intervention and withdrawal, in detail to demonstrate that statutory duties, legal framework and processes have been followed, and that practitioners and managers have acted reasonably and proportionately.   

• There should be a clear record of what options were considered and why certain actions were or were not taken including the person’s wishes and feelings.
• At every step and stage in the process record any interactions that were considered, who has been consulted and what decision have been reached.

Domestic Abuse

Being in an abusive relationship could be a factor that causes someone to self-neglect.

Controlling or coercive behaviour does not relate to a single incident, it is a purposeful pattern of behaviour which takes place over time in order for one individual to exert power, control or coercion over another. Such behaviours might include:

• Isolating a person from their friends and family;
• Depriving them of access to support services, such as specialist support or medical services;
• Depriving them of their basic needs;
• Taking control over aspects of their everyday life, such as where they can go, who they can see, what to wear and when they can sleep;
• Repeatedly putting them down such as telling them they are worthless;
• Enforcing rules and activity which humiliate, degrade or dehumanise the victim;

There may be situation where an informal carer is very involved in the person's care, can involve a complex mix of elements including controlling and coercive behaviour, dependency and self-neglect.  In these circumstances it is important to:

• Have discussions with the person who is self-neglecting separately in order to discuss any aspects of coercion
• Establish with the informal carer, how they perceive their caring role, what care and support they provide, what care and support they believe the person requires and if they need any support in their role as an informal carer - a carer's assessment should be offered.
• If you are concerned that a person is experiencing domestic abuse or coercive / controlling behaviours, you should complete the referral to the Safe in Salford Domestic Abuse Service (or other specialist service if more appropriate) and/or MARAC (multi-agency risk assessment conference).  

The referral form incorporates the DASH (Domestic Abuse, Stalking and Honour based violence) Risk Indicator Checklist which will help to assess the risks to the person and the support required.  

MARAC is a multi-agency forum for sharing information and jointly planning responses where the person is considered to be at high risk of death or serious injury.  If the adult meets the criteria for MARAC (either due to the DASH score or because of professional judgement), the referral form should also be uploaded to Sharepoint by a designated representative within the service, in line with local processes.

For further information regarding Domestic Abuse and the Toolkit, please visit the SSAB website, Domestic Abuse webpages which also include definition, local support and referral form including the DASH Risk Assessment.

Children (Think Family)

If you are supporting an adult and there are any children or young people, you must consider the impact of the adult’s self-neglect on them. If an adult is neglecting themself, they could also be putting their child/children at risk of harm or neglect.  

Please see the Safeguarding Children Partnership for guidance on neglect of a child. 

Please also refer to the Think Child – Think Adult – Think Family Guidance.   

If the child or young person under 18 provides regular and ongoing care and emotional support to a family member who has care and support needs. A referral to Salford Carers Centre should be considered for additional support to be provided. (Care Act 2014, S61)

For more information on Young Carers, see Young Carers•Salford City Council

Housing/Homelessness

Though homelessness is traditionally associated with rough sleeping, it is now accepted to be broader than that. The term covers a spectrum of living situations notable by the absence of safety, security and stability, including:

People residing in temporary accommodation: night or winter shelters, hostels, B&Bs, women’s refuges 

‘Statutory homeless’: people who local authorities have a legal duty to secure a home for 

People sleeping rough: sleeping in the open air, or in places not designed for human occupancy 

Hidden homeless: staying with friends/ family/acquaintances, ‘couch-surfing’ or ‘squatting’

Response 

Duty To Refer – The Homelessness Reduction Act 2017 ‘Duty to Refer’ means that partner agencies must consider the housing circumstances of any person who has engaged with them. If any housing issues are identified, partner agencies must make a referral to the local authority homelessness/housing options team, with the person’s consent 
For further information, see Public duty to refer homelessness•Salford City Council

Consider raising a statutory safeguarding adults concern - When there is evidence that a homeless adult with care and support needs is at risk of abuse or neglect, a safeguarding concern should be raised in line with multi-agency safeguarding adults’ procedures. Even if the harm is believed to be caused by self-neglect, and the adult is assumed to have mental capacity to make the decisions resulting in self-neglect, safeguarding adults’ policies and procedures should still be applied.

Safeguarding adults•Salford City Council

Multi-Agency Working - If the statutory Safeguarding duty is not met, then consider initiating collaborative working supported by existing legislation to support the adult’s wellbeing i.e. Care Act 2014, Equality Act 2010, Human Rights Act 1998, Housing Act 1996, Mental Capacity Act 2005, Mental Health Act 1983 and Homelessness Reduction Act 2017.

Adult safeguarding and homelessness: experience informed practice | Local Government Association

Safeguarding in Housing - Salford City Council

There is concern about an adult who has care and support needs who maybe self neglecting or displaying hoarding behaviour

In all circumstances: Engagement with the adult will be needed.

• Attempt to reduce any immediate risks

• Where appropriate consider and assess mental capacity

• Identify key individuals and agencies involved

• Multi Agency Approach and working together is essential – do not work in silo

• Share information and work together - Consent is preferable, but not always needed for Information Sharing

• Record risks and actions taken

• Be flexible, persistent and trauma responsive

• Relationship building with the individual is key

• Be professionally curious, listen and find out more from the person.

• Where possible, ensure the adult has continuity so they can start to trust the professional

• Work at the pace of the individual

Remember the importance of building trust and rapport, rather than having an over reliance on assessments

If the risk(s) continue or escalate - Always Remember 

If the adult does not want to engage – do not walk away! Remember to have Professional Curiosity 

• Seek advice and guidance if you are unsure.

• Discuss with line manager or specialist safeguarding lead/team within your organisation

• Always complete a single agency or multi agency assessment is there are identified risks or the risk are increasing.

• If you don’t get a response you feel should be happening from agencies, consider if escalation is required - SSAB Multi Agency Escalation Policy and Procedure

• Consider the safety of other adults and children – Think Family

If you are Worried About An Adult, consider whether the adult would benefit from a Social Care Assessment

If risks remain concerning, consider reporting a Safeguarding Concern to Adult Social Care 

If you have concern about a child(ren), report you concerns - Worried about a child•Salford City Council

Appendix 1 - Possible characteristics of a person who may be self-neglecting

Appendix 2 - Hoarder Insight Tool

Appendix 3 - Actions which can support practitioners to engage with adults

Appendix 4 - Guidance Questions for Practitioners

Appendix 5 - Salford Single Agency Self Neglect Assessment / Risk Assessment (word doc.)

Appendix 6 - Proposed agenda for Multi-agency Professionals Meeting

Appendix 7 - Key Principles of Risk Assessment

Appendix 8 - Examples of Risk that may be identified

Appendix 9 - Salford Multi-Agency Risk Assessment

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