Silver Linings: Officials walk thin line to help vulnerable, elderlyBy SHAWNE K. WICKHAM
New Hampshire Sunday News
April 09. 2017 12:50PM
SALEM - Nearly every community has one: That house where trash, old vehicles and debris accumulate into an eyesore, aggravating neighbors who demand that officials do something about it.
Last week, 55-year-old Charles Hill barricaded himself inside his condemned house at 20 Irving St., started a fire and then fatally shot himself in the basement as the home burned. He owed more than $15,000 in back property taxes.
The case raises an uncomfortable question: How do we balance the right to be left alone with the obligation to be our brother's keeper?
New Hampshire law actually addresses that balance, according to Rachel Lakin, administrator of the state Bureau of Elderly and Adult Services.
The state's adult protection law applies to "vulnerable" adults 18 or older who suffer abuse, exploitation or neglect - including self-neglect. What most folks may not know is that every one of us has an obligation to report such cases - the same mandatory reporting requirement that applies to suspected child abuse, Lakin said.
But RSA 161-F also states that it is "implicit" that "whenever possible an adult's right to self-determination should be preserved, and that each adult should live in safe conditions and should live his own life without interruption from state government."
When someone reports a possible case of abuse or self-neglect, the state is obligated to investigate, Lakin said. Her bureau's social workers will do a safety assessment, making sure the person has enough food, medication and heat.
Help is available, if the individual is determined to be "vulnerable," meaning unable to manage personal, home or financial affairs in his or her own best interest. The state can offer assistance with housing or Medicaid; there's even a small amount of emergency funding available for cleaning in some cases.
But Lakin said an individual also has the right to refuse such services.
"If someone doesn't want help, and they're adamant about that, there's not much we can do," she said. "We do try to persuade, and cajole, and use all the skills we have, to try to convince them to let us help them.
"But again, if they're not hurting anybody else, and they're not putting anybody else at risk, people have the right to live their lives the way they want to. And people have the right to make bad decisions."
In the last fiscal year, BEAS got more than 6,000 calls reporting possible abuse or neglect and investigated more than 3,700 cases. Lakin said 2,420 of those were for self-neglect, 1,825 involving individuals over age 60.
Lakin said her office is getting more calls about hoarding situations; she wonders if it's because more people are staying in their homes longer.
Often, a town or city health officer gets involved.
That's what happened in Salem, where Bill Lockard is the town health officer. He said neighbors had been calling him for years to complain about Hill's property.
When Lockard first visited the property in 2015, it was filled with debris: abandoned cars, a box truck, metal, wood, plastic, broken shards of mirror, swimming pool filters. "He had no swimming pool," Lockard said.
When he learned the home had no electricity or running water and there was human waste and rotting food inside, Lockard declared it unfit for human habitation.
By law, a situation has to present an "imminent health hazard" for such an action, he said. "I get calls many, many times that people feel it's unsanitary and unhealthy, and you go there and it isn't clean, but it's not an imminent health hazard."
Lockard said he gave Hill information about places to go for help, including financial assistance. He knew Hill went to live with his brother after the house was condemned.
There's only so much town officials can do, he said. "The individual has to afford himself of assistance if they want to seek help."
Lockard had planned to bring in a contractor to clean up Hill's property this spring, after a court ruled the town could do so.
"I was just waiting for good weather, for all the snow to melt so we could get a good idea what's on the property," he said.
Then came the news that Hill's home had exploded and burned and Hill was found dead inside.
"It was a total shock," he said.
Lockard said the Hill property wasn't even the worst he's seen in his 30 years as a health officer. He remembers a home where a woman was living with the bodies of her dead pets. "Some people get attached, and even after they pass, they can't bear to get rid of them," he said.
The worst case involved a family living in squalor, he said. "It was a split level and it looked like the parents were just on the first floor and let the kids do whatever they wanted on the second floor, including running around in their own filth."
The case came to officials' attention one night when neighbors found a little girl running naked in the street. The state Division of Children, Youth and Families was called in, Lockard said.
Lockard figures he's had to condemn about two dozen homes in Salem in the past 15 years. More often, he said, homeowners work with local officials to clean up their property.
Timothy Soucy, Manchester's public health director, said he's has seen "some pretty horrific situations" in his 27 years with the health department.
"And we always ask ourselves what's our primary role: are we regulators or are we social workers?" he said. "And I think the answer is always a little bit of both."
When a building becomes a source of danger to the health of occupants, the city can order the property to be cleaned, Soucy said. But that doesn't mean clutter or dirty laundry lying around.
"It's if there's something there that can make somebody sick," he said, such as animal waste, non-working toilets, or rotting garbage.
Sometimes, he said, that order "prompts people to get help not only for the cleaning but whatever other help they may need."
Manchester has a hoarding task force, bringing together resources from state, mental health, health and elderly services agencies. Soucy said the approach is to try to get to the underlying causes of a bad situation.
"If someone has a mental health issue or they're elderly and they just can't physically do it anymore, then I think we have a responsibility to stand in," he said.
William Rider, president and chief executive officer at the Mental Health Center of Greater Manchester, said the center's outreach workers will try to establish a relationship in such situations.
Sometimes, he said, that means engaging the individual to talk about items that may seem like clutter to outsiders but that have real meaning to the owner. The idea is to make a connection before the situation gets to a point where police have to get involved, he said.
"That gets to be like trying to pick up a scared cat," he said. "Somebody's going to get clawed."
The town of Barnstead recently withdrew a residency permit for a home where a man, his adult son and his son's friend were living with 30 cats.
Police Chief Paul Poirier said conditions inside the home were "deplorable."
"There were cat feces everywhere, and urine," he said. There were tarps over holes in the roof and buckets catching the water coming in. "There was mold on the walls, floor, ceilings; there were sticky fly traps ... throughout the home that looked like they had been there for years."
In the basement, water was dripping into the electrical box, the chief said. "They were very lucky that that place didn't go up."
It wasn't a situation that developed overnight, Poirier said. "I don't know how you get to that point as an individual but ... they've been living this way for years," he said.
Town health and welfare officials have worked together on the case, connecting the family with mental health and other services. The cats were placed at a local animal shelter, and the town brought in a company to clean up the home.
Poirier said the residents were cooperative. "Maybe it was a relief to them," he said.
"Maybe they're deep down inside glad that it happened so that they could get some assistance."
Salem's Lockard said town officials will be meeting to discuss last week's tragedy, "to see what we could be doing better."
But he said, "Sometimes no matter what you try to do right, it doesn't always work out."
Silver Linings is a continuing Union Leader/Sunday news report focusing on the issues of New Hampshire's aging population and seeking out solutions. We would like to hear from readers about issues related to aging. Please contact reporter Gretchen Grosky at email@example.com and 603-206-7739 or reporter Shawne K. Wickham at firstname.lastname@example.org. See more at www.unionleader.com/aging.