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Community Services

by Christiana Bratiotis, PhD
Boston University

Hoarding is a problem that can require intensive, lengthy, costly and complex responses. Given that a large number of community, agency, family and individual resources are brought to bear on cases of hoarding, it is critically important that those who encounter hoarding respond thoughtfully and strategically. A coordinated plan of help that maximizes resources across community agencies is likely to get the best possible result for the person who hoards and those affected by the problem.

Each community has agencies staffed by professions from various disciplines that are likely to respond to hoarding cases.  These disciplinesmay include but are not limited to: 

  • housing
  • public health (including environmental health)
  • mental health
  • protective services (including child, adult and elder)
  • aging services
  • legal (including civil and criminal justice and law enforcement)
  • fire safety
  • medicine
  • animal control

Although members of each of these professions may become involved for somewhat different reasons, the underlying intention is the same—to protect the health and safety of the individuals suffering from and affected by hoarding.

Hoarding can pose a number of associated problems in a person's life. As such, the laws, policies and requirements that must be upheld include sanitation, safety, mental health, physical health, animal protection and others. More often than not, several areas of a hoarder’s life are affected. Helpful intervention requires professionals to work together to met legal and ethical regulations while also ensuring the current and future health and safety of the person who hoards and affected others.

In addition to public and government involvement, often private services such as visiting nurses, occupational therapists, professional organizers and professional cleaning companies may need to help.

Coordinated care across agencies can be very helpful in getting into the homes of, and providing stepped care for, those with serious hoarding. We recommend the following upcoming volume for service staff in these agencies:

Bratiotis, C., Schmalisch, C., & Steketee, G. (May, 2011). The hoarding handbook: A guide for human service professionals. New York: Oxford University Press.

Sections

Hoarding Task Forces

Christiana Bratiotis, PhD
Boston University

One way for dealing with hoarding is through agency and community hoarding task forces. The first task force in the United States began in 1989 in Fairfax County, Virginia. Since that time, the number of hoarding task forces has grown greatly as public recognition of the problem and its related social and community impacts have been known. At least 75 communities in the United States have formed task forces to help coordinate care. The mission, goals and functions of the task forces are as different as the communities themselves. The common purpose of all task forces is to provide a directed and managed response to hoarding cases that come to public attention. Whether in large cities or in small towns, task forces organize and provide public education about hoarding, give out service agency information, offer trainings and give support to families.

Task forces typically form from multiple agencies working together. Some smaller communities have chosen a model of within-agency task forces. In some communities, the town government has prioritized hoarding as a problem that requires a coordinated response from its police, fire, public health, social work and inspection departments.

While some task forces work within town, county and city governments, others are formed to respond to hoarding cases that affect a specific population. The most common example is hoarding among older adults. Another example is a task force formed specifically to address cases of animal hoarding.

How task forces are formed, organized, and maintained varies greatly. Some hoarding task forces form for a specific purpose, such as hosting a hoarding conference or providing support groups for hoarders and their families. Others develop to achieve set goals and commit to a specific timeline for meeting those goals. Still other task forces are formed because they have received funds for a specified period of time; these task forces often disband when funding is ends. Although most task forces do not have special funding or grants that support them, many are able to continue because the participating agencies provide various in-kind contributions. These resources include staff time devoted to task force projects, as well as donation of goods and services like meeting space and creation and copies of printed materials (meeting minutes, handouts, brochures). Task force agencies also donate services such as dumpsters and clean outs for people with compulsive hoarding who are working with the task force team.
 

Hoarding and Housing

by Cristina Sorrentino Schmalisch, PhD, LICSW 

Hoarding can lead to a wide range of serious problems as it gets worse. For people who live in the home, these risks include:
  • tripping and falling over things
  • being hurt and even killed when items fall on them
  • developing health problems from mold or pests that live in the clutter
  • delays in receiving emergency care when emergency workers can’t reach them
  • injury or even death when fire fighters can’t enter or control a rapidly spreading fire
  • living for months and even years without vital services like plumbing, electricity, and heating
  • eviction because of a lease violation
  • having the home condemned  due to unsafe or unclean conditions
In addition to these problems that affect people who live in a hoarded home, hoarding presents risks for neighbors, building owners, and for the property itself. These risks include:
  • public health problems (e.g., spread of pest infestation) for adjacent apartments and homes
  • structural problems because of too many heavy items (for example, books) that are too much for the load limits of the building
  • flooding when pipes are in need of repair
  • fire from electrical wiring or heating systems in need of repair
  • lost property value and of rent income for landlords who must make costly repairs due to hoarding or who have to pay legal fees (e.g., to end a tenant’s lease)
Some clients are motivated to seek treatment on their own. Others are pressured to seek treatment by court order after inspections from agencies such as fire and public health departments or the housing authority. Since hoarding can have serious problems, those around the person who hoards may feel pressure to end the hoarding problem quickly. Clean outs, while appealing, usually do not work. In addition, clean outs can create strong feelings of loss, anger, or severe emotional distress, and those who hoard may turn to getting more items to counteract these strong feelings. Since they have not learned to sort and discard items, even those who do not actively acquire new items eventually have a re-accumulation of possessions. Clean outs can also threaten mental health and even life. Three cases of death following clean outs by the Health Department in Nantucket were reported in the Nantucket Independent (2007). Further, clean outs are expensive, requiring many hours of labor. Families and agencies, such as local departments of public health, may spend many hours and thousands of dollars clearing the homes of family or community members with hoarding only to find that the problem returns, often within just a few months. 

Instead of a clean out, resources are better used to offer treatment to fix the problems of acquiring and saving that lead to too much clutter. Family members and friends, as well as housing agency staff and other local agencies that address hoarding problems can help. However, they should only help after learning about why people hoard and what interventions are likely to work best. It is essential to avoid blaming the person who hoards before trying to help. 

After learning to understand hoarding, cognitive and behavioral treatment can be very helpful [see the Therapy section of this website]. In this therapy, clients make all decisions about saving or discarding their possessions and learn skills to help them stand the discomfort of discarding, resisting acquiring more possessions, and organizing their homes. In addition, the person learns to correct faulty thinking and beliefs and to manage strong emotions. At this point they are in a position to set rules for what things can and cannot be gotten rid of and to arrange for disposal of unwanted items. It is at this point in the process that others can be of most help in sorting and hauling items marked for removal.

Elder Services

by Christiana Bratiotis, PhD
Boston University
 

When hoarding occurs in the home of an older adult, special consideration must be given to the risk and capacity of the elder. As a protected class under state and federal laws, older adults must be protected from abuse or neglect which may result from hoarding. Elder protective service agencies must protect older adults and can be contacted for information about state-specific laws and regulations. Once staff understand the definition of abuse or neglect, they can turn their attention to understanding how hoarding may be causing such problems. In addition to protective service agencies, specialized community aging agencies may be able to help when working with older adults. In particular, senior centers, councils on aging and area agencies on aging can assist with assessment and intervention of hoarding among elders. 

Developing a personal relationship with older adults is important. The relationship creates and jeeps the older person motivated to work on their hoarding problem. When starting this relationship, elder service workers may want to focus on convincing the older person that they have the freedom and ability to make a positive impact on their lives. Helping people who hoard understand how their problem interferes in living the life they desire can be a powerful motivator, especially as it pertains to being able to live independently. Additionally, elder service workers who attend to the meaning of important objects—especially those with sentimental meaning or memorabilia from past experiences and life events—can help communicate a sensitivity to the meaning of possessions. This attention to personal treasures can help create and keep the trust needed for continued work on the hoarding problem.

Professional Organizers

by Cristina Sorrentino Schmalisch, PhD, LICSW 

People with hoarding may seek the services of a professional organizer if they understand their problem as being primarily one of disorganization. Also, working with a professional organizer may be more acceptable to some people than seeking mental health treatment. Professional organizers work to improve the quality of their clients’ homes or work places through organization. They provide knowledge about: 
  • organizing skills – for example, sorting, categorizing and organizing possessions; setting regular routines like recycling and sorting mail and bills
  • tools - storage containers and file folders are typical examples
  • systems - for filing paper, for managing appointments and so forth
Professional organizers can also help clients to prioritize their activities (for example, running errands or doing housework on Saturday morning leaves the rest of the weekend free).

Professional organizers not only transfer skills and help create organizational systems, they also help motivate their clients to carry out the de-clutter work. Many individuals who hoard have severe motivational problems. As a result of working with a professional organizer and becoming more organized, clients can experience a range of benefits, such as being more timely as they are better able to find needed possessions and feeling less stress in their day-to-day lives.

Professional organizers working with those who hoard can use a range of organizing strategies. One standard strategy is O.H.I.O. (Only Handle it Once) for those who churn items. This happens because difficulty making decisions is a common problem in hoarding and many clients lack organizational systems. As a result, a client may start to work on a pile of items, become frustrated by various items (what to do with it; where to put it) and then put the object down in the same or different pile. O.H.I.O. raises awareness of churning behavior and encourages clients to make a final decision about the item.

Related to this, a key sorting strategy is to encourage clients to sort into a small number of categories. Typical first categories are “keep,” “discard,” and “unsure” (this last one allows for discussion about decisions – see below). Other important strategies are to identify a “home inside the home” for each item and to encourage the development of maintenance skills, like reading and sorting mail daily, regularly removing items, recycling, and putting items away shortly after use.

Professional organizers can provide important help for clients who are getting mental health treatment for hoarding. Very few mental health providers make home visits and even those who do can usually only provide limited visits (for example, once per month). Working with a professional organizer can give clients critical hands-on help with their hoarded items. Ideally, the professional organizer would contact the therapist and work with them to help the client's hoarding symptoms.

Some professional organizers have specialized training in working with hoarding or related problems, such as chronic disorganization (CD). This specialized Institute for Challenging Disorganization (ICD) provides information about CD and trains professionals to work effectively with this problem. However, CD is not the same as hoarding because a person may be chronically disorganized without having hoarding (for example, because of current depression or attention deficit disorder).  In contrast, most people who hoard do have CD. The NSGCD provides contact information for professional organizers with different levels of expertise in working with CD (www.challengingdisorganization.org). The National Association of Professional Organizers (www.napo.net) provides contact information for the broader group of professional organizers and also provides training opportunities.
International OCD Foundation Hoarding Center