When we read in the news about adult abuse or neglect it is usually a horrific story about a vulnerable senior who has been physically or financially injured by someone. Yet considerably more than half the cases investigated by state adult protective agencies involve elder self neglect with no involvement of another abusing person.

Although the "abuse" of self neglect may not be created by another person, the consequences can be just as damaging, even life threatening, as abuse caused by someone else. This is the dilemma facing many caregivers today.

We worry about older loved ones who insist they are "fine" at home, even though they don't eat well, fall frequently, neglect their hygiene, don't take prescribed medications properly if at all, write checks they can't afford to charities, and buy recklessly from shopping channels. We are stymied by their insistence that they have no intention of changing their personal habits or of moving somewhere safer.

We have trouble comprehending that they can't or won't see the risks.

The biggest reason for their disagreement with our assessment of their living situations usually revolves around our and our seniors' definitions of what is  acceptable. For us, it is their safety. For them, their independence and their ability to make their own choices, or in legal terms their "autonomy," is most often the biggest factor in defining their quality of life.

Recent surveys have shown that most seniors fear moving to a "facility" more than they fear death. They may even agree that they are living in an unsafe manner, yet they will still resist leaving for a "safer" living situation that in their eyes will take away both their privacy and their independence.

The fact that this may be taking a stupendous toll on their caring family members is irrelevant to their desire to stay right where they are and resist any services from "outsiders."

When we know that our senior is living in an unsafe situation our immediate response is usually to do our best to rescue the situation. If our parents are legally competent, however, we face legal limitations. Unless a court has declared someone to be incompetent, the law regards that person as perfectly capable of making independent decisions.

This puts us at a decided disadvantage when it comes to persuading a parent or other senior to make lifestyle changes when the senior is obviously making poor choices. According to the law, we all have the right to make poor choices unless our choices place us or others at "imminent" risk of harm. Unfortunately, "imminent" means "right now." A senior who is at risk of falling and breaking a hip some day, or becoming malnourished in time is not at "imminent" risk, so the law won't intervene. Nor will the law let us intervene.

Whatever the risks, the law doesn't permit us to take action to help a legally mentally competent adult without their approval. We can't legally "make" them accept changes.

Even the adult protective caseworkers face these challenges. They receive reports every day about seniors who are in dire straits, yet they can do little except offer alternatives to someone who is legally competent. If misery loves company, we have plenty of company from these overworked caseworkers.

So, what can you as a very concerned and tired person do about a senior who is neglecting his or her own personal safety and health?

You can continue to offer options and alternatives. Sometimes we have to measure success in the smallest baby steps.

Try to engage your elder in a conversation rather than a debate. When someone feels they are being "heard," rather than lectured at, they are more likely to truly listen and be a part of the conversation.

Busy body neighbors and other "concerned" citizens may intimate, or even outright accuse you, of being neglectful of your elder. Keep good notes, with dates, about what you have suggested, what you have tried, and the outcomes. Be sure that doctors and others who see them regularly know that you are trying. This is for your protection.

If you become seriously worried and you're not making any headway, make a report to your local Adult Protective Services agency yourself. Their number is in the blue pages of your telephone book and we have a link to an APS locator here: http://www.eldercareteam.com/public/404.cfm While their caseworkers may be unable to accomplish any more than you have, they will have a record of your report and their file will reflect that your elder refused their help. This will protect you in the event of unfounded allegations in the future.

If you and APS believe that your parent is perhaps no longer mentally competent, they can sometimes assist you to obtain a mental evaluation, which is the first step toward obtaining court-appointed guardianship.

Spend a little time putting together a "what if" list of resources. This way, should the worst occur, you will be more prepared to get help into the home or find alternative living quickly. If you think you might need legal or financial help, invest in a one hour consultation with an elder law attorney now, before the crisis.