Hoarding: Everything You Need to Know

At Hoarding Help Central, we understand that hoarding is an issue that affects many people regardless of age, race, or socioeconomic status. Hoarding is also an issue that affects more than just the hoarder themselves- it also affects the friends, family, and community of that person. We also know that the average age that a hoarder seeks treatment is around age 50. For these reasons, it is highly recommended that we learn as much about serving elderly hoarders as we can in order to provide effective treatment methods.

It is Hoarding Help Central’s hope that this article will provide new information that will prove useful to social agencies serving elders. Offering our combined expertise and experience in this field, it is our hope that, as we work to help elders affected by hoarding, we can achieve better results that have a positive impact on the safety, physical health, and emotional health of elders dealing with a hoarding issue. With that, let’s get started!

What is Hoarding?

Before we start, it is a good idea for you to have an understanding of what hoarding is. There has been much research to suggest that compulsive hoarding is both a chronic and progressive condition that begins early on in life and increases in severity as the individual ages. Further, research also suggests that compulsive hoarding is often underreported and an overall poorly understood mental health condition.

According to Bratiotis, Sorrentino & Steketee, 2011, 2-5 percent of the adult population suffers from compulsive hoarding disorder. According to the 2010 US census, the prevalence of hoarding within the United States can be estimated to be around 6-15 million people nationwide. This clearly illustrates the fact that hoarding is a huge problem in the country and that this is a particularly large issue facing communities with an older adult population that is on the rise.

While compulsive hoarding is regularly associated with a number of other debilitating mental health issues such as obsessive-compulsive disorder, generalized anxiety disorder, attention deficit disorder, depression, and social phobias, it should be noted that compulsive hoarding is defined as a disorder within itself. That being said, the presence of these disorders alongside compulsive hoarding disorder makes treating a compulsive hoarding issue that much more difficult. It should be noted that all of the research on an effective treatment model is relatively new and, at this point, there is a limited amount of knowledge in the mental health community on the most effective way to treat this condition. This highlights the need for not only the general public but also mental health providers to know what their options are when seeking help for a compulsive hoarding issue.

According to the American Psychiatric Association, compulsive hoarding disorder is defined as the act of “excessively saving items that others may view as worthless. Hoarders have persistent difficulty getting rid of or parting with possessions, leading to clutter that disrupts their ability to use their living or work spaces”. The American Psychiatric Association notes that hoarding is not the same as collecting. While collectors look for specific items and organize or display those items, hoarders often save random items and store them haphazardly. In most cases, hoarders save items that they believe they may need in the future, items of value, or items of sentimental value. Some hoarders may even feel safer around the items that they save.

How Does Hoarding Impact a Community?

In order to truly understand what makes hoarding a public health issue, we have to understand its impact on a community. According to Bratiotis, Schmalisch & Steketee 2011 hoarding can lead to direct health and safety risks to the individual, as well as their families and neighbors. This can create considerable costs for the community itself. In a report by the Massachusetts Department of Public Health, a survey of health officials in an area of 1.8 million people found that 471 complaints had been filed due to concerns about odors, odd behavior, sanitation, fire hazards, and three deaths- all likely to be the result of hoarding behavior.

The homes of hoarders present an extreme fire hazard for communities. This is due to the fact that fires that start in the homes of hoarders are far more difficult to extinguish. This makes them more likely to not only be more serious but to spread to the homes of neighbors. In March of 2012, a Massachusetts elder died in a fire because of the fact that firefighters were unable to reach him in time due to the amount of clutter and hoarded items that blocked their direct access to the dwelling.

Infestations are yet another hazard impacting not only hoarders but the communities in which they live. Insects and/or rodents can be nearly impossible to get rid of due to the enormous amount of possessions and clutter found in the home of a hoarder. In terms of cost, a single heat treatment to remove bed bugs from a home can cost $1,000 per unit. Considering the fact that a hoarder’s home or apartment could take several different heat treatments in order to be effective, it is of little surprise that the price to resolve such an issue in the home of a hoarder can be high. Cleanouts can cost as much as $16,000 or more and will likely need to be repeated after a year if the hoarder in question has yet to receive treatment for his/her behaviors. This can represent a hefty financial burden for city, state, or federal housing authorities.

For private homes, the repeated visits from public agencies such as health inspectors can be particularly costly for a community. It should also be noted that due to the numerous issues associated with compulsive hoarding behavior, victims are typically at risk for homelessness and eviction. Believe it or not, hoarding is considered to be one of the leading causes of eviction apart from non-payment of rent.

There are a few key areas that should be evaluated in order for treatment interventions to be effectively prioritized. These are a few of the important areas that should be considered:

Safety of the person (including any other people living in the home and/or pets)
Safety of the Structure of the building to the individual and others visiting the home
Insight of person regarding their situation
Capacity of the person to address the impact of their hoarding
Resources, i.e. financial help to pay for cleaning services, insurance to assist with paying for mental health and local agencies that may be able to assist

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Hoarding Basics for Community Agencies Working with the Elderly

Now that you have a greater understanding of what hoarding is as well as how it impacts a community, you are likely wondering how you can intervene. When one is able to do preventative work with older adults who hoard, there is a specific process that should be followed. Let’s look at each step of the early intervention process used by one particular social services organization for elders so that you will have a thorough understanding of what is required in order for the intervention to be effective:

Pre-Meeting/Referral Process: Gather as much information as you can over the phone from the referring person or the individual themselves. As a general rule, the more information you can gather ahead of time, the more you will be able to plan your initial approach. It is also of the utmost importance that you know the condition of the home so that you can prepare for any precautions you want to take upon entering the home.

Schedule the Initial Meeting: Depending on the comfort level of the individual in question, you might meet at their home or some public place such as the senior center or a park bench. It might just be a quick meet and greet or, rather, it could be a full assessment and tour of the home in its entirety. It is crucial that you remember you are working to build a long-term relationship. For this reason, it is okay to take things slowly at first and show the individual that you are willing to work as a partner in both their treatment and learning at their own pace.

Create a Service Plan Agreement Together: The service plan is used to formulate your partnership, to identify the overall goal, as well as both short and long-term goals. Both the client and the professional should sign the document in order to demonstrate that this is a joint effort as well as a mutually agreeable plan of action. It is important that you review and reference this often. The purpose of the agreement is to guide both your sessions and work time together.

Establish and Plan Consistent Appointments: Start by marking the appointment date on a calendar in the individual’s home. It is of good practice to meet either weekly or bi-weekly to start. You should also set in place a plan to move your appointments to once a month monitoring or check-ins once goals have been achieved. Always be sure to show up on time for appointments. It is also crucial that you make sure your client knows how to contact you in the event that they need to cancel.

Schedule One 1/2 -2 Hour (Max) Meetings: You should be sure to make it clear what your role is in the early intervention process. Discuss with your client that you are not a heavy chore worker. This fact should be stated at the beginning of the early intervention process. When it comes to memory or personality issues, roles can easily become confused. For this reason, it is crucial that you discuss this with your client immediately. This will provide a clear understanding to them of what you and others entering the home are there to do.

Form a Plan for Each Visit:

Check-In – During check-in at the beginning of each visit, you should talk about homework as well as success and challenges. Make sure to set aside some time to discuss any challenges that week as well as how these challenges are impacting the individual’s progress.
Exposure Work – Work on a single area for between 30 and 40 minutes, having the client do the hands-on work in each area. Rather than taking over, you are helping the client build a tolerance for the process of decluttering. At the same time, you are also showing them that they can do the work themselves. Your job is to offer support and to build your client’s self-esteem throughout the early intervention process. It is also your job to help them stay focused on each task and to motivate them to work towards achieving their goals.
Check-Out- Upon ending the visit, ask your client how the process felt and establish what the goals are for the following week.

It is our hope here at Hoarding Help Central that the information provided in this article can help you as you seek to either directly or indirectly assist someone you know who is struggling with compulsive hoarding. Taking these guidelines into account, you will be much more effective in facilitating the early intervention process for a hoarder. Best of luck!