Kerry Howley Community Health Nurse Age Concern Canterbury
Dec 17, 2015
Difficult to clearly define Many interdependencies and multi-
causal Problems may be unstable and continue
evolving Problems are socially complex and
many stakeholders No clear or correct solution Responsibility stretches across many
organisations Proposed measures may have
unforeseen effects
The accumulation of and failure to discard a large number of objects that seem to be useless or of limited value
Extensive clutter in living spaces that prevents the effective use of the spaces, and
Significant distress or impairment caused by hoarding
Squalor may be present in hoarding homes
There can be squalor without hoarding Squalor may result from rotting food,
animal or human waste, insect infestation or vermin
Offensive odours Home maintenance poor – plumbing,
wiring, structure of the home, roof etc Health risk to occupant(s) and visitors to
the home
Deprivation Grief and loss – Post Traumatic Stress
Disorder Learned behaviour Mental health
Major Depressive Disorder >50% ADD 30% and Hyperactivity 15% Anxiety 30% OCD 17% Social Phobia 30% Dementia – reduced cognitive ability Addictive personality – ETOH, collecting
Diagnostic and Statistical Manual of Mental Disorders due out in May 2013?
OCD classification currently Move to a separate classification in
DSM-5 Hoarding Disorder Is living in clutter a lifestyle choice?
Reclusive Socially awkward and isolated Embarrassed and/or ashamed Fear of authorities Resistant to enforced change Wanting help with the problem Wanting non-judgemental support
Falls, trips and injuries Becoming trapped by “stuff” Mould and mildew Respiratory problems Poor food hygiene and personal hygiene
Increased risk of infection, contamination Animals – diseases, excrement and urine Vermin – rats, mice Insects – fleas, cockroaches, flies, ants
etc. Fire risk
Increased risk of fatality
Increased response needed from fire service
Increased risk to emergency services if called to property
Increased risk to neighbours
Can occur in hoarding environments Person prioritises animals over
themselves Middle aged or older and 75% women Denial and minimisation of problems Unsanitary conditions due to animals Often identified following complaints
from neighbours Public expectations of SPCA Animal welfare is their primary concern
We don’t really know how many cases there are As statistics not collectedNo single point of entryCases with multiple agenciesLittle sharing or collaboration between
agenciesAnecdotally more cases since the
earthquakesPossible increase with ageing populationPossible increase with decrease in domestic
assistance
There is always a cost to helping the hoarderSupport workerRubbish disposal and/or skip hireStructural repairs to the homeTreatment for the person Garden maintenance and removal of green
waste Clients ability to pay The challenge of finding money Practitioner time spent finding funding Each practitioner working as individual What is the landlords responsibility?
Currently slow response Confusion as to who is responsible/lead
worker Earlier intervention better Assessment tools Team approach needed Need skilled workers, GP, psychologist,
social workers etc. Ongoing training and support for staff
working in this area
Clutter Image Rating Scale (CIR) http://stoppests.typepad.com/files/clutter-image-rating-scale-1.pdf
Activities of Daily Living – Hoarding (ADL-H)
http://www.cornellaging.org/gem/pdf/assessment_tool.pdf
Hoarding Rating Scale http://www.ocfoundation.org/uploadedFiles/Hoarding/Resources/
Hoarding%20Rating%20Scale%20with%20interpret.pdf
Important so that all practitioners and team are talking the same language
Preferably implemented nationally
Bring together a small group of interested people to coordinate management of cases
Modify assessment tools to suit NZ conditions Develop a factsheet for general distribution Single point of entry Identify funding sources Gather statistics Measure outcomes and successes Professional development and supervision for
people working with hoarding and squalor
App for Android or iPhones Squalor and Hoarding Toolkit http://
squalorandhoarding.catholiccommunityservices.com.au/
Working with People with Hoarding Behaviours (DVD)
Stuff Happens (Audio CD) Catholic Community Services – enquiries 1800 225 474
The Hoarding Handbook ISBN 978-0-19-538551-9