Kerry Howley
Community Health Nurse
Age Concern Canterbury
 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
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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
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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
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As statistics not collected
No single point of entry
Cases with multiple agencies
Little sharing or collaboration between agencies
Anecdotally more cases since the earthquakes
Possible increase with ageing population
Possible increase with decrease in domestic
assistance
 There
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is always a cost to helping the hoarder
Support worker
Rubbish disposal and/or skip hire
Structural repairs to the home
Treatment 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

http://www.cornellaging.org/gem/pdf/assessment_tool.pdf
 Hoarding

of Daily Living – Hoarding (ADL-H)
Rating Scale
http://www.ocfoundation.org/uploadedFiles/Hoarding/Resources/Hoardi
ng%20Rating%20Scale%20with%20interpret.pdf
Important so that all practitioners and team are
talking the same language
 Preferably implemented nationally
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 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.catholiccommunit
yservices.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
 Most
hoarders have a mental health
condition which can be treated
 Most people want help
 Treat client with respect
 How to decide when to intervene
 Plan assessment and treatment
 Involve other help and agencies
 Information sharing to support people