She had drifted into a hellish life.

By the age of 62, the Dane County woman was firmly in the grip of alcohol abuse and her condition was deteriorating.

She was picked up by police many times, sometimes landing in the hospital. One time, her hair was so filthy and matted that hospital staff had to cut it off. Her problems had grown worse with age as she refused help from a brother and from county social workers.

Dane County elder abuse investigator Brenda Ziegler started visiting her, not pushing her to accept help, but simply to talk on the porch.

After six visits, the woman let social services providers inside.

Ziegler withheld her client's name to protect her confidentiality. Her story shows how much time and effort it can take to rescue a troubled elderly person from self-destructive behavior.

That's time that many social services providers seldom have in a system that isn't keeping pace with the rise in elder abuse, the Wisconsin State Journal found in an eight-month investigation.

What experts call "self-neglect" is the most common type of elderly abuse in Wisconsin, and the State Journal found gaps in what government is doing to save the elderly from themselves:

• Wisconsin lacks the resources to consistently find, track and follow up with those elderly who neglect themselves.

• Gaps in state law make it harder to detect and respond to elder abuse. Reporting elder abuse is mandated only in narrow circumstances, and laws protecting personal freedoms can get in the way of efforts to intervene.

The state recorded 2,367 reports of self-neglect last year, accounting for more than half of all elder abuse cases. Seventeen of the reports involved deaths, according to the Department of Health and Family Services. Self-neglect reports nearly doubled in the last 10 years.

Neglectful behavior includes failure to take medication, alcohol abuse, hoarding or living in unsafe environments.

Investigators and social services workers can share many startling stories of harmful behavior: A senior uses an oxygen tank yet smokes. Another amasses tens of thousands of dollars in credit card debt and falls to invitations to borrow more. A woman with 40 cats is overcome by fumes from feces in her "cat room" and found by a grocery delivery man lying on the floor, the ammonia stinging her eyes, skin and lungs.

Typically, the elderly person's judgment has been clouded by dementia, substance abuse or other forms of mental illness, from mild depression to obsessive-compulsive disorder.

There are no simple solutions, experts said. It takes patience, time, understanding and resources for aggressive, sustained outreach, mental health treatment, home cleaning and maintenance, and repeat visits.

'A fine line'

Case study

When social workers got inside the home of Ziegler's troubled client, they found it in poor condition, with no running water. She slept on a urine-soaked mattress on the floor and revealed she was incontinent. Although she had scant income, she was a compulsive shopper, filling the home with her purchases. Because the elderly woman was considered mentally competent, Ziegler and others could do little until she let them in and they saw her living conditions.

Helping the infirm elderly can be complicated because the law gives people the right to refuse help if they are legally competent and it can't be proved that they pose a threat to themselves or others.

Dr. Michael J. Siebers, associate professor at the department of medicine at UW-Madison who has practiced geriatric medicine for two decades, said perhaps 10 percent of his patients neglect themselves.

"They don't recognize there's an issue," he said. "They don't think they need help."

In some cases, when problems are severe, authorities must decide if they should intervene by documenting problems and seeking a court order to declare an elder legally incompetent.

Elder advocates say they are cautious about pursuing that course, and many defend competency laws as an important safeguard of independence for senior citizens.

"It's a fine line," Ziegler said, adding that advocates use a combination of instinct, information and what's been witnessed to make decisions.

Leaving a vulnerable senior citizen without needed help, however, can have serious consequences.

Those with deteriorated mental faculties can neglect eating until they starve. Some can't or won't take medicine. They live in inadequate shelter. They accumulate debt or neglect bills. They hoard possessions, junk or animals, sometimes making homes hazardous.

Some seniors understand their circumstances but decline help because they fear intervention will rob them of their independence and force them into long-term care, said attorney Betsy Abramson, a leading authority in the state on elder abuse issues.

"They see no middle ground," she said.

Persistence pays off

Case study

About two years ago, Ziegler's client agreed to accept professional services, help dealing with her incontinence and medication for depression and alcoholism. A nonprofit group fixed her home's plumbing and other problems. A case manager helped her return unneeded purchases. She was sober, Ziegler said. She had a small dog for company and worked part time as a personal aide to a developmentally disabled woman. She died of cancer earlier this year, but she had lived in her own home and handled her own care and housekeeping for many months.

With today's resources and demands, it would be hard for an elder abuse investigator or social worker to devote the time it can take to win trust and get in the front door. It will be harder in the coming years, as more baby boomers join the ranks of the elderly, and experts say the system isn't ready.

"I had time to create relationships when I was first hired," said Ziegler, who was named Dane County's second elder-abuse investigator in 1999. A third was added in 2005 to erase a waiting list. Ziegler said demands keep rising. "We don't have that kind of time now."

Dane County's response system of helping self-neglecters has funding gaps and remains informal, said Tommye Schneider, director of environmental health for the Madison-Dane County Health Department, and others in the field.

In fact, agencies in this area are taking budget cuts, advocates said.

The $400,000 in state money for emergencies — funds for treatment, in-home services, temporary shelter — provided to 25 counties in south-central Wisconsin hasn't increased since 2003. State assistance for related emergencies — temporary shelter, cleaning a clutter-filled home — is limited.

One way to uncover more self-neglect while respecting the state's competency laws would be to invest in more outreach to legally competent elders who neglect themselves, and develop more methodical ways to find them. For now, investigators rely on tips — from utility and delivery workers, neighbors, family, police and senior services providers.

But few communities have attacked the problem with aggressive, sustained outreach, mental health treatment, home maintenance efforts and follow up.

"It's really frustrating," said a Dane County woman whose 85-year-old relative has so filled her condominium with old newspapers and other things that she can't use rooms or her stove and has no hot water. The woman, who asked to withhold her relative's name to protect her privacy, said she sees a system full of good intentions but with little coordination.

"It's like nobody knows what the other person is doing," she said.

Madison Assistant Fire Chief Paul Bloom, who has made countless emergency medical runs, agrees: "I've been to homes and seen the same people many, many times. We go back 10 times. That shows nobody's taking care of the problem. There just needs to be repeated follow-up."