A widower and his autistic adult son have been saved from years of "self neglect" after they were found with decade-old food in the fridge and bedding they had never changed. The bereaved pair’s desperate predicament followed the death of the man's wife, but authorities were unaware until he was taken to Southmead Hospital A&E in Bristol in a “significantly malnourished” state, having suffered a fall.
North Bristol NHS Trust’ s (NBT’s) safeguarding team raised the alarm and social services visited the pair’s home, to find what one experienced social worker described as the worst case of self neglect he had ever seen. Trust board members heard the house was “uninhabitable” with urine and faecal stained carpets and mattresses, a fire risk because of clutter and had mould on the walls and no working oven.
NBT mental health liaison specialist practitioner Gayna Scott-Angell told the meeting: “The son reported he had never eaten hot food in his life, he was living off cereal, milk and canned drinks. This wasn’t in connection to his diagnosis of autistic spectrum disorder.
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“Since the death of his mother, none of the bedding in the house had been changed. The son had not bathed or washed, none of his clothes had been washed, and his hair and nails had not been washed or cut.
“His clothes were all threadbare and his shoes all broken. The social worker stated that he had never seen such a level of self neglect in his career.”
But the case, which was told to the board on Thursday, May 26, as an example of the safeguarding team’s good practice and lessons learned, has a happy ending because of its intervention. Ms Scott-Angell said: “With assistance from family friends and social services, the house was cleared of all its clutter, it was cleaned and repaired, with new mattresses, bedding, washing machine and oven put in.
“The son was prompted to attend to his personal hygiene, he was taken to the barber’s and went shopping for new clothes and shoes.” She said the dad was diagnosed with cognitive impairment so could not give his son the prompting and support needed, but neither they nor a friend, who took a week off work to support the son when the father first went into hospital, realised they required help or knew how to ask for it.
Ms Scott-Angell said a local authority support worker was appointed and took the son out for lunch. “So he was trying new foods which he was really excited about – he really enjoyed a McDonald’s – and he has expressed an interest in going to college," she said.
“He was really excited about his opportunities. The son was really relieved and grateful to be getting support and help. The son had been wanting help but didn’t know how to access anything.”
She said it took some time for the team to realise just how urgently this was required because the father, who was taken by ambulance to the emergency department nine days after a fall left him with reduced mobility, had said his son would be fine at home alone. Members heard the dad had several pressure injuries and was “extremely frail for a man his age”, so paramedics and A&E staff raised concerns about self neglect.
“He reported that since his wife sadly passed several years ago, the two of them shared the household chores, with the son doing the grocery shopping while he did the cooking and cleaning,” Ms Scott-Angell said. But she said a needs assessment in hospital revealed he had struggled with mental health during the pandemic and was anxious and depressed, having lost a lot of weight and feeling physically sick at the thought of eating, and that he was using alcohol to cope.
It became clear the son, who was “very tearful and quite distressed” during visits, was also not doing well and both required support, she added. She said all three local authorities the hospital sent referrals to – Bristol, North Somerset and South Gloucestershire – were quick to respond.
NBT board chairwoman Michele Romaine said: “I’m just sitting here struck by what would have happened if he hadn’t come into hospital, which is what makes me feel sad, powerless, but at least when they do, we are doing the things that we need to do, which is really good to know.” Chief nursing officer Steve Hams said the two men’s outcomes were significantly better because of the team’s “professional curiosity” about how patients appear when they arrive at hospital.
