Self-neglect is a broad, inclusive entity that largely, although not exclusively, affects older people. It involves multiple symptom areas, including failure to seek adequate medical care, maintain personal hygiene and a healthful environment, sustain proper nutrition, and manage financial resources. Refusal of needed services may be the defining feature of geriatric self-neglect and is usually the impetus for medical or legal intervention. Hoarding Disorder is a specific subcategory of self-neglect, the only one that is recognized by the American Psychiatric Association’s latest Diagnostic and Statistical Manual. At advanced levels of cognitive impairment, self-neglect becomes involuntary and therefore is likely to represent neglect or exploitation by others. A practical way of determining the boundaries of self-neglect in a given situation is to assess a client’s decision-specific capacity to refuse a service that is deemed necessary for that person’s well-being. Intervention begins with considering all possible psychiatric and medical causes for the self-neglecting behavior and addressing them to the extent possible. Cognitive-behavioral treatment paradigms can be applied, though their effectiveness has not been well established. Efforts to minimize social isolation and to encourage peer interaction have shown some promise. Individual coaching for hoarding behavior can be effective but inordinately time-consuming. All such interventions need to be tailored to the personal requirements of individual cases. In the end, legal sanctions mandating involuntary removal from one’s environment or guardianship are solutions of last resort used to assure safety when all else has failed.