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CMAJ - November 16, 1999JAMC - le 16 novembre 1999

Task force seeks solutions for "senior squalor"

Lynne Swanson

CMAJ 1999;161:1307

Although London, Ont., is known as a wealthy university town, local public health staff and other service providers were so disturbed to find some seniors living in filth that the municipality allocated $25 000 for a 2-year Task Force on Senior Squalor.

Many isolated seniors refuse to seek or accept help

Public health staff have found reclusive seniors living in homes overflowing with garbage amid huge stacks of debris and papers, surrounded by human and animal feces, urine on the floor, soiled bedding and decomposing waste.

Although their condition represents a health risk to themselves or others, these seniors are usually unwilling to accept help. "If ever there was a frustrating condition to deal with, it's senior squalor," says Dr. Graham Pollett, medical officer of health for the Middlesex-London Health Unit. A major issue is that "no one community agency has a legislated mandate to deal with the problem."

Pollett says social breakdown of the elderly has 3 chronic characteristics: profound social isolation, extreme neglect of self-care and refusal of help.

Senior squalor is not always a condition of poverty. Pollett says people have been discovered living in squalor who have significant financial resources or own their home. In fact, when a person lives in an apartment or a multiunit building, it is frequently brought to the health unit's attention by neighbours complaining of odour or pests. The health unit has a better chance to intervene in these cases than in an owner-occupied house.

Although senior squalor is not well documented in North America, Pollett says British studies indicate that about 50% of people living this way have an underlying psychiatric illness, such as schizophrenia, chronic depression or dementia. In those situations, legislation is available to assist.

Pollett says the other half come through a capacity assessment "with flying colours. That's an especially difficult group to deal with. What do you do as a physician, as a public health unit, as a housing authority, as a public trustee?

"This is where you realize in many instances you are powerless to help. People fall through the cracks and you come smack up against individual rights versus societal rights or responsibilities to care for people who can't care for themselves."

When attempts are made to help, people are often bounced between agencies. If people are evicted from housing because they are placing others at risk, the problem moves elsewhere — sometimes to shelters or the street — with them.

Since 1988, London has had an At Risk Registry of people identified as being unable to care for themselves, living in deplorable conditions and who are not being cared for by any organization or will not accept care. There are usually 15 to 25 people on the registry at one time, but others may be living in squalor without social welfare agencies knowing it.

Although numbers are small, Pollett expects them to grow because of Canada's aging population. He also points to a study that indicated seniors living in squalor face a 50% mortality rate within a year. "Knowing the high mortality rate, it just adds to the concern and frustration. Are people making an informed decision to live in this state? To me, the answer is not clear cut."

Mary Huffman, a public health nurse, says seniors living in squalor usually live alone and have no family support or reject such efforts. Many don't have health coverage. "But it's not just a medical issue," says Huffman.

She says the role of the task force will be to look at "how the community is going to address this so these people get the help they need in the most efficient and unobtrusive manner. We really need to look at some type of community system so needs are addressed in the least intrusive but most beneficial way for the community, but also for that individual to maintain their rights and dignity."

Pollett expects the task force to look at ways to improve the coordination of services, identify gaps and recommend strategies for addressing needs. The group will also examine various legislation. Pollett is unaware of similar Canadian initiatives and hopes other communities learn from London's experience. He is particularly pleased the group is chaired by Rev. Susan Eagle, an ordained minister who also serves on city council and is a social activist.

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Lynne Swanson is a journalist in London, Ont.

© 1999 Canadian Medical Association or its licensors