The Hoarding Dilemma: When and How to Help

Martha M. KernMartha M. Kern
Director, Lifecare Home Solutions
Oakbrook Terrace, Illinois  60181

Member of the national ElderCare Matters Alliance, Illinois chapter

The problem of hoarding has recently garnered a great deal of attention, particularly since becoming the subject of an A&E television show.  It is not, however, a new problem.  It pre-dates the Depression (and is not caused by Depression-Era upbringings), has been documented all over the world, and is believed to afflict 15 million Americans to a clinically-significant degree.  Hoarding causes trouble not just for the hoarder, but for everyone in their lives.  Paradoxically, allowing a hoarder to get into trouble rather than working to get them out of trouble may just be the key to lasting change.

Measuring the Problem
The assessment and perception of cleanliness and clutter is a subjective pursuit.  In our work with hoarders, we’ve received calls from people who claim they are presiding over the worst house we will ever see; we arrive to find some newspapers piled here and there and a few too many bottles of ketchup.

When evaluating the severity of a hoarding situation, we focus on safety and a person’s ability to reasonably meet basic human needs.  We ask ourselves the following questions when viewing a hoarded property:

  • Can the home’s occupant(s) get in and out of the doors in case of emergency?  Are the stairs cluttered with items that may cause a tripping hazard?
  • Do they have access to the kitchen, and can they safely prepare and store food?
  • Does the home’s occupant have access to bathroom facilities? Is the bathtub or shower filled with items or can it be used?
  • Where does the occupant sleep?  Can they get to the bed and is there room in it for a person to sleep?
  • Can the home’s residents launder their clothing?
  • Are the home’s mechanical systems (plumbing, heating, electric) in working order?
  • Are pets well cared for (i.e. clean, fed, given proper access to litter boxes or a yard)?
  • Are there health hazards present (body waste/fluids, mold, etc.)?

If the home’s occupant cannot get to their bed, bathroom or kitchen, for example, or faces hazards in doing these simple acts, the problem may be serious enough to consider intervention.

Trying to Help
Anyone who has ever tried to help a hoarder has likely learned that help is not wanted.  In fact, offers of help are often met with outright hostility.  It is important to understand that hoarders have very poor insight into their problem, and that they actually suffer from a malfunction in the brain.  They truly cannot help themselves.  Like the squirrel that compulsively collects nuts for the winter, a hoarder is merely serving his or her instincts to acquire new things and keep them, just in case they are needed at some point in the future.

Though some hoarders collect plastic containers and others prefer junk mail, there are some characteristics that are common to hoarders that make it especially hard to help them.  These include:

Perfectionism – Many hoarders know exactly where to find specific items, and they do not want them touched or moved.  Everything must be kept precisely as it is, unless they, themselves, determine a change is needed.

Procrastination – Hoarders will routinely cancel or postpone appointments, especially if these appointments involve going through their stuff with the hope of thinning it out.

Indecisiveness – Hoarders fear making a bad decision (i.e. disposing of something they will later have a use for) so they choose not to make a decision at all.  They keep things – and assure you they are going to “go through it” – because they are afraid something of real value is in a particular pile.

Lack of faith in their own memories – It is common for a hoarder to tell you they MUST keep a particular flyer, ribbon, photograph or other item because it helps them to remember something or someone.  Although they have no measurable memory impairments whatsoever, they believe they will forget things that are important without these visual reminders.

Trouble with relationships – A person who has accumulated mountains of personal property is understandably reluctant to have company.  Most understand that hoarding is not accepted by others.   And for many, the “stuff” they collect has replaced human relationships and is easier to trust than people.

Moving Forward
Patience is a vital factor in working with hoarders.  This is not a problem that can be changed overnight.  Cleaning away all the excess stuff for the hoarder will typically result in their going out and replacing every bit of it.  When trying to make progress with a hoarder, remember to:

Refrain from judging them – do not gasp or recoil when you enter the home.

Be their coach – remind them that their grandchildren will be able to visit if they clean up.  Offer encouragement.  Suggest a dinner party and help them get ready to have guests.

Take pictures – photos enable us to measure progress, and may be needed to show authorities just how bad a given situation is.

Help them establish new relationships and find new activities – getting rid of “stuff” may seem less consequential when there are other ways to occupy their time.

Alert the “authorities” – often, a hoarder will only respond when they are in trouble with an outside authority, such as a municipality, a landlord, the fire marshal.  Let them get in trouble.  Paying fines and facing eviction may be the only way to move them forward.

Call in professionals – let someone else be the “bad guy”.  Allow a professional care manager to come in with a bonded/insured crew to provide expert help.

A temporary or limited guardianship might be necessary if the hoarder simply cannot make changes to improve safety.  If the hoarding affects others (family members, neighbors, pets), the hoarder may no longer have the right to live the way they choose.  External pressure and professional assistance may be required to make lasting change.

Summary Blurb:

Hoarding is a widespread problem, though few people know when or how to help a person facing this issue.  If the occupant of a hoarded home cannot meet basic needs, it may be time to summon the help of “authority figures” and professionals who can create an environment that motivates change.

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