From the outside, the house appears vacant, with trees and untrimmed bushes shielding it from the road. Inside, photographs show, knee-high trash covers the floor and black mold clings to the walls and cabinets. Cobwebs hang from the ceiling. Rats and snakes move across the floor. The toilet is backed up with waste, and rotting food fills the freezer. 

But this house in Woodford County isn't empty. Two women call it home and have done so for nearly 70 years, their nearest relative an 85-year-old brother living in another state. And despite offers of assistance, they choose to live amid the squalor. 

So far, five or more agencies involved with the case have been unable to reach a viable solution to the problem, frustrating officials as they search for a way to help the residents. "These are human beings, not animals," Sheriff James Pierceall said. "People shouldn't live like that." 

A sheriff's deputy took photographs of the home after police were contacted by a plumber who was upset by what he found when called to work there. Because the women were not breaking any laws and declined medical treatment, there was little authorities could do. 

The case - with its painful questions and lack of clear, easy answers sheds light on the little-discussed category of elder self-neglect, which some say is already the most common form of elder abuse and will only become more prevalent in the coming years. As baby boomers hit 60 and beyond, the demographic shift will make it more costly and difficult to care for and manage their needs. That, experts say, will mean some slip through the cracks. 

"Elder abuse in any form is bad, but it becomes more problematic when it's self-neglect," said Dr. Robert Roush, associate professor of geriatrics medicine at Baylor College of Medicine in Houston, Texas. "It's a growing problem." 
Research about self-neglect is limited, and there is no agreed-upon, universal definition for the condition. Roush said more often than not, symptoms of self-neglect start small, then snowball as mobility and mental sharpness drop off with age. People may begin saving magazines, cleaning less or becoming more withdrawn. Over time, the neglected clutter can engulf a home or apartment. Eventually, grooming habits fall off, too, and homes can become unsafe. 

"It has not to date been funded to the level we can do that," she said, noting that in some states self-neglect can make up about 40 percent of their elder abuse case load. "It's kind of a wait-and-see game with fiscal year 2009." 

The causes of self-neglect vary from person to person. Sometimes the condition is associated with undiagnosed or untreated mental illness, such as dementia, depression or obsessive-compulsive disorder. Sometimes it's rooted in family history or the childhood of those who lived during the Great Depression. More often than not, their lifestyle is a choice, and individuals see nothing wrong with the way they live and act. 

That, researchers say, is what makes the situation so tricky and controversial to treat. If adults choose to neglect their personal health or safety and don't ask for help, what can be done to stop them? Personal rights and freedoms often clash with the need to intervene, especially when it's against the individual's will. 
"These people are generally reluctant to accept assistance and need a lot of relationship building," Moorman said. "There's just not a quick fix." 

For example, agencies in Woodford County have known about the women for nearly two years and have seen their conditions deteriorate over that time. Officials there, most of whom spoke on the condition of anonymity because they were not at liberty to publicly discuss the case, said the lack of change is not from a lack of trying. 

"It can overwhelm these social services," Roush said of self-neglect cases. "Where are they going to go and on whose nickel?" Authorities essentially have two options. They could have the women declared incompetent in court but then would be responsible for finding a new home, dealing with the old one, caring for the women and managing any legal or emotional fallout. 
Their second option is finding a violation with the home and having it condemned. But if the residents continue to refuse help, they're homeless. 
Compounding the problem is that self-neglects are usually fearful of strangers. DeRenzy said it may take months before a social worker can get a resident to even open the door and let them inside. 

"If you just go in there, you just might push them over the edge," she said. "It takes a very long time, and you move in little steps."