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I recently attended the joint ASA/NCOA conference in Philadelphia. I was excited to find a pre-conference day long intensive on hoarding. This is a topic that has always been an interest of mine. As the Director of Social Service at a large nursing home, I’m even more interested now that we are working with a resident who hoards in her room at our facility.
Although the conference primarily focused on hoarding in the community, I found the information extremely helpful. I was shocked to see the pictures of hoarding behavior. I couldn’t imagine living in such an environment. Homes were filled with clothes, trash and random items from floor to ceiling. Some individuals have small paths carved out to get from one area to another. Others had merely a ‘nest’ created in one area in which they lived. I struggled to comprehend how someone could live in such an environment.
Individuals who hoard are often socially isolated, depressed, anxious, have poor insight and deny the problem. The presenters stressed the importance of building trust with their clients. We all know how important this to a professional relationship. One professional shared a story about a co-worker who met with a client in the lobby of the client’s apartment building. It took her 6 months to build the level of trust needed with her client, just to get to the client’s front door. It was obvious to me that the professionals in the field had a great commitment to helping those with hoarding behaviors. I greatly admired all of the professionals who were passionate about working with this population.
I was interested to learn that the typical onset begins during childhood or adolescence. As much as 80% of all hoarders grew up in homes with someone who hoarded. Hoarding behavior often increases with age, and 20% of hoarders have dementia. Other suspected causes of hoarding behavior include: psychosis, OCD, ADHD, or a combination of those mentioned. Hoarding is often associated with difficulty processing information, such as:
Inability to make decisions: should I discard something or not?
Inability to organize or categorize items.
Fear of forgetting: will I remember what I read in the article? If not, I need to keep the magazine just in case.
There can also be an emotional attachment to items. Some hoarders try to fill voids caused by losses, often the loss of a loved one. The most commonly hoarded items include: paper (mail, newspapers, magazines), containers, clothing, food, books, furniture, other people’s trash, catalogue purchases, collectibles, electronic appliances and animals.
Treatment is a slow process. As mentioned, it’s important to build trust. This can sometimes be the first positive relationship for the client. It’s important to empathize and see the situation from the client’s point of view. I think this can be the most challenging part for the worker. Professionals also assess the individual for underlying conditions, such as depression or bi polar disorder. Focusing on treating the underlying mental health issues sometimes impacts the hoarding behavior.
Here are some other tips for dealing with hoarding behavior:
Help client maintain a sense of control.
Use a persistent, gentle approach.
Be sincere.
Give positive reinforcement.
Help client to name the problem.
Identify standards that might conflict with the behavior, such as fire & safety codes.
Help client to begin to reorganize (often discarding items can be too traumatic).
The conference helped me to reevaluate the situation at my facility. There are no easy answers, but with support and empathy we can move toward an improved situation for everyone.
Do you struggle to deal with hoarding behaviors at your organization? If so, I’d love to hear about your experience and how you’ve attempted to resolve the situation. I think we can learn so much from each other. There is great value in sharing our experiences. As we learn from each other, we share successes that can help us to provide even better services to our residents.
Please send your hoarding experiences to: lori@sswanh.org
Karen Alizzi, MSW, CEAP
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