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Three major themes emerged from the participants: (1) "How can you live like that?" self-neglect as an unsolved riddle; (2) "It's very difficult for me, I go outside and immediately start thinking about myself": the personal burden; and (3) "I keep trying": seeking intervention strategies following the refusal to accept assistance. DISCUSSION & CONCLUSIONS: Social workers' direct involvement with the self-neglecting elders poses a very significant ethical, personal, and professional challenge. In this context, there is a need to impart tools for "solving the riddle" to social workers through self-reflection, improvement of knowledge, theory, and empirical findings regarding the conceptualization and understanding of the self-neglect phenomenon. Moreover, it may be that adopting a clearer ethical "ideology," which is rooted in a discourse of human rights, could assist social workers to reconcile their tensions and difficulties in providing assistance to older, self-neglected persons.

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