Geriatric Grand Rounds
March 29, 2011
This Full House - An
Intervention Program to
Assist Older Adults who
live with Compulsive
Doneka Simmons, BA, RSW
Social Worker/This Full House
I have no relationship that could be perceived
as placing me in a real or apparent conflict of
interest in the context of this presentation.
Presentation Outline
Hoarding: What it is…What it isn’t!
Promoting Health Homes, Healthy
Relationships, Healthy Communities – How
do we do that?
A Journey Worth Traveling – How we got
here and where we want to go – Overview
of Program specifics, including success
stories and challenges.
Definition of Compulsive Hoarding
The acquisition of, and failure to discard a large number of
possessions that appear to be of useless or limited value
Cluttered living spaces that cannot be used as intended
Significant distress and/or impairment caused by the clutter
(Frost & Hartl, 1996)
Only pathological if it meets #2 and #3 = clinical problem (e.g. – surfaces full, no
organization, inappropriate things in places like kitchen, main door blocked)
Not the saving that’s the problem – it’s the dysfunction (e.g. saving everything –
valuable and non-valuable)
Commonly Hoarded Items
Clothing & Shoes
Plastic bags
Objects from other people’s trash
Handouts, brochures, extras (do you really need an extra pen?)
(Tompkins, 2008)
Hoarding behaviors may also be
present in the following disorders:
Obsessive Compulsive Personality Disorder
Attention Deficit Hyperactivity Disorder
Impulse Control Disorders
Eating Disorders – Anorexia Nervosa
Brain Injury
Bipolar Affective Disorder
Various Dementias
(Age & Opportunity Inc. Presentation, 2008)
Co-morbid Problems (in addition
to hoarding)
Depression – 57%
Social Phobia – 29%
Generalized Anxiety Disorder – 28%
Obsessive Compulsive Disorder – 17%
Attention Deficit Disorder – 15-20%
Personality Features – Anxious/avoidant, dependent, paranoia, Dementia
(Age & Opportunity Inc. Presentation – April 2008)
DSM-IV Criteria
Anticipated that in the revised DSM-IV
(2013), will have its’ own classification
Currently, listed as accompanying other
disorders (e.g. OCD with hoarding)
(OCD Conference, August 2008)
Neurobiologically Distinct
MRI and PET scans indicate lower
Lower levels of brain activity in the
anterior and posterior
cingulate gyrus –
those parts of the brain
associated with focused attention,
motivation, decision-making and
problem-solving, as well as spatial
orientation and memory.
Other Significant Factors:
Genetic Links – a large number had relatives who hoard –
hoarding phenotype
Usually a long-term behaviour pattern – (e.g. can’t decide and
fear of putting things out of sight)
Usually single or divorced
Usually more women than men
(Age & Opportunity Inc., Presentation, 2008)
Samuels et al., 2008 – Prevalence and correlates of hoarding
behavior in a community-based sample, Behaviour Research
and Therapy 46 (2008) 836-844
Adjusted prevalence rate of hoarding in adults = 5% - Over 10
million people in the US have clinically significant hoarding
With increasing age, the prevalence is higher – average age is 50
Model of Compulsive Hoarding
(Frost & Hartl, 1996)
Biological Vulnerabilities
Information Processing Deficits
Erroneous beliefs about possessions
Problems with emotional attachment
Reinforcement Factors
Letting Go Exercise
It is a proccess:
Why do I have this?
Why did I keep it?
Was it difficult to let it go?
Clients might ask…Does it make sense to keep
it now? (reported by client of TFH Program)
Clutter and Hoarding
Behavioral manifestation – e.g. avoidance of distress, avoiding what is
hard = Clutter
Decision making may be the central feature of hoarding
Physically reducing clutter does not address the hoarding problem
Changing beliefs and the meaning of possessions eventually reduces
Improving organizing habits is a necessary component for change
(OCD Conference, August 2008)
Course of Compulsive Hoarding
Saving can begin in childhood, onset age 13
Little evidence for history of material deprivation – e.g. war times
Hoarding may be precipitated by loss
Chronic or worsening course
Insight fluctuates
Severity range from mild to life-threatening
(OCD Conference – August, 2008)
Hoarding Complications in Elders
Fire hazard
Risk of falling
Unsanitary conditions
Medical problems
(Kim, Steketee, & Frost, 2001)
Awareness of Problem (insight) among
Clear insight = 15%
Partial insight = 12%
No insight = 73%
(Frost et al., 2000)
Implications for Service Providers
- trust, fear, loss of hope
- motivation
- average length of intervention = 1.5 – 2.0 years
- clients like to talk about past & their
relationships/losses and less on problem-solving
This Full House – Intervention Program to
assist Elderly Compulsive Hoarders
Pilot began in December 2007 – December 2008 (extension to
January 2009)
Funding provided by the Government of Canada, New Horizons for
Seniors Program
At that time, we were only the second program in Canada to
specifically address hoarding behavior among seniors. The first
program is was being delivered at Age & Opportunity, a senior serving
organization in Winnipeg.
3rd Program being delivered now in Calgary
Pilot Specifics
Explore the need for a “This Full House” program in
Learn from the Winnipeg experience and customize our
program to meet the needs in Edmonton
Pilot the program with a limited number of people to validate
the program design
Pilot – #1 – The Need in Edmonton
No other program or agency in Edmonton with formal approach or program geared
specifically to hording in seniors
Very little known about hoarding and seniors
Program Advisory Committee:
- Alberta Health Services, Environmental Health
- Alberta Health Services, Home Care
- University of Alberta, Faculty of Extension
- Alberta Seniors Citizens’ Housing Association
- The United Way
- Alberta Health Services, Addictions and Mental Health
- Alberta Seniors & Community Supports
- Senior citizen
- Greater Edmonton Foundation
- Edmonton Fire Rescue Services
- Edmonton Humane Society
Pilot - #2 – Winnipeg Program –
Customize Edmonton Program
Age & Opportunity Consultant – Spring 2008 (similarity of organizations and findings)
Delivered in Winnipeg since 2004
Increase in cases where intervention required (2000 = 38 cases, previous years = 1-2)
Vulnerable persons committee interested – effective community development approach
Costly in terms of professional time devoted to issue
Costly in terms of hiring other professional services
Some homes require a major “clean-up” prior to This Full House involvement
Health & Safety Issues
Pilot - #3 – Validate Program Design
As of December 15, 2008 – 32 clients have been
referred – referral sources effective
Protocol effective
Community based approach best – Advisory
Post-Pilot Program Updates
- Monthly Lunch Group – Had our First Year Anniversary in June
Increased funding for clean-ups – Alberta Seniors and
Community Supports
Increased awareness – more media attention
Increase in referrals
Success of current vs. future intervention programs
Sustainable, ongoing funding is challenging to find
University of Alberta, Faculty of Extension – Research Study
Grant MacEwan University Research Study
Year 2 & Year 3 – Need Increases
In 2008 (pilot year) – 32 Information & Referral Requests
In 2009 (post pilot year) – 74 Information & Referral Requests
In 2010 – 151 Information & Referral Requests
Continue to double our numbers from previous year
Average Caseload for 0.5 Social Worker = 43
Program Outcomes
Prevent homelessness.
Increase seniors’ connection to other needed community
Increase senior’s quality of life.
Increase awareness in the community.
How we do what we do
Referral received
Appointment for office or home visit
Assessment Process (home visit) – Assessment Tool
used to assess level of risk
Develop Action Plan – goals and objectives, timelines,
costs – Harm Reduction Model
How we do what we do cont…..
6. Develop Care Plan – Social Work Needs Assessment
7. Individualized and client centered
8. Relationship building and trust – foundation of any
successful intervention
9. Participation in Lunch Group
10. Ongoing after-care
Some of what we’ve learned along the
Value of home visit – have to see to believe
Affects the whole family
Emotional rollercoaster
Effective communication and helping strategies
Individual and group support crucial to help with motivation
and insight
Progress does happen – sometimes in baby steps,
sometimes much quicker
Don’t assume anything – getting to know your client
Heros – every story is different but we are inspired by them
Lunch Group Participants
I realize that I have conquered a lot but I am still open to new
When it comes to this group, I feel like I don’t have to lower my
eyes when I’m speaking.
Since coming to this group, I am not ashamed to speak of
where I am at.
This group provides a social opportunity for me, otherwise, I
wouldn’t go anywhere.
I like the relaxed atmosphere of the group. I’ve been going to
groups for years and this one is the best.
I wish we could meet every week.
Still Traveling the Road…
Strengthening our community capacity:
- Advisory Committee evolves in to a Hoarding
- Additional Supportive Groups to include a
therapeutic group for graduates of the Lunch Group
- Needs of families and caregivers –education &
- More financial resources
- Etc., etc…
Questions & Answers