Take Steps Early to Deal with Hoarding

In a recent television program, a 65-year-old woman living on her own became sick and collapsed in her home. When rescue workers arrived, they found her in the kitchen wedged among mountains of clutter, trash, and human feces. She had to be removed through the window. The show, called Hoarders, is not a television drama or movie of the week. It's a reality series airing on A&E that offers a gripping view into the lives of compulsive hoarders, and the impact that their illnesses have had on their lives and their families' lives.

Rising media attention has focused the public eye on hoarding, although individuals who suffer from the disorder tend to shy away from social contact, often making it difficult for outsiders to identify the early symptoms of hoarding.

“People who hoard don't like to broadcast it,” says Mark Schroeter of AmeriCorps VISTA, and former Adult Protective Services Program Chief for the Vermont State Agency of Human Services (AHS). Schroeter is a member of the AHS Hoarding Task Force. “They can be individuals who lead productive lives. Some are employed, but as the situation gets worse, they eventually retire or leave their job for health reasons.” Although it can be difficult to identify a compulsive hoarder when an individual owns his or her own home, “we're apt to see more folks who live in public housing come to light because of the housing inspections,” he says.

What Is Compulsive Hoarding?

Hoarding is a condition that affects between 1 million and 2 million people in the United States, according to the Obsessive Compulsive Foundation (OCF), a not-for-profit patient advocacy organization founded in 1986 by a group of individuals with obsessive-compulsive disorder.

The OCF defines hoarding as: “The acquisition of and failure to discard items that appear to be useless or of little value. It is manifested in excessive possessions in the home interfering with the normal use of living space and furniture, and is accompanied by significant interference or distress.”

“We all collect, we all save,” says James L. Abelson, M.D., Ph.D., an anxiety disorders expert in the University of Michigan Department of Psychiatry. “We apply the term ‘hoard’ when it's a more extreme version of acquiring and not discarding.”

Hoarders, he says, succumb to forces within their brains such that the overflowing garbage in their homes isn't seen or isn't experienced as distressing, Abelson says. “Whatever they see in terms of clutter doesn't seem to matter to them. What matters is the fact that these things have importance to them and the loss of these things would trigger distress.”

Hoarding is challenging and frustrating to treat because there are no simple drugs that have an impact on it, he says. Therapy is helpful but challenging because it requires the person who needs treatment to be highly motivated and willing to talk to a professional.

How Can Hoarding Affect Your Site?

People who engage in hoarding put themselves and their neighbors in danger, say experts at the University of Michigan Health System. Their living conditions can present a fire hazard and are often unsanitary and unsafe.

“Egresses are blocked, there may be infestation of insects, and in a congregate living situation, the health risks associated with hoarding hazardous materials could transgress from one unit to another,” Schroeter says. “I have seen some pretty alarming situations where it was just a matter of time before somebody expired as a result.”

How can you tell if a resident may be more than just a collector or pack rat?

One signal may be changes in his behavior, says Schroeter. “For instance, someone who likes to entertain all of a sudden becomes more reclusive. Or you may see individuals bringing more items into their unit than they bring out.” People who hoard are often embarrassed or are uncomfortable with others seeing their possessions, so they may not allow site staff to enter their unit, or may make excuses to postpone inspections or routine maintenance visits.

During inspections and maintenance of units that you suspect may be occupied by hoarders, your site staff can fill out our Model Form: Use Form to Determine Whether Resident's Clutter Is a Safety Risk.

Approaching a Resident Who May Be Hoarding

Many times, site managers are reluctant to get involved with residents who begin hoarding, says Schroeter. But “if they don't deal with it right away, the behavior compounds itself and gets worse, which enables the problem. The site manager is responsible for a minimum standard that has to be met in order for housing to be safe for that individual,” he says. “You need to work with social services or the family, because while the bottom line is to help this person maintain his or her housing, it has to be safe for the other residents, as well.”

If you have verified through an inspection that a resident is hoarding in his unit, take care to treat the person with dignity and respect. “You cannot be judgmental, because that will just shut the person down,” he says. It may seem like trash or junk to you, but “the possessions are significant and important to the individual, and letting go can be difficult.”

Work with your state agency's service coordinator and the resident to make small inroads to get rid of the clutter. Schroeter suggests dedicating a certain amount of time each day—10, 15, or 20 minutes—to working on clearing the clutter, or designating a particular area to work on, such as the dining room table or the top of the stove. Start small and then work to expand the space.

“There needs to be a lot of positive reinforcement from the property manager, service coordinator, family members—all of the people who are working with that person,” he adds. “Hoarding is a problem that can be dealt with. It's not easy—it's a life-changing process for these folks, but the important thing is to preserve their housing so that they can live safely in their own homes.”

Insider Source

Mark Schroeter: Hoarding Task Force and AmeriCorps VISTA, Vermont State Agency of Human Services (AHS); markd.schroeter@ahs.state.vt.us.

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