Thursday, April 1, 2010

Hoarding Inverview


Last year I interviewed Susan Siroto, Program Director at Search and Care, Inc., and one of the founding members of the New York City Hoarding Task Force. Here is part one of my interview with her.

What is hoarding?

According to Dr. Randy Frost (whose definition of hoarding has become the accepted standard), clinically significant hoarding can be characterized by three criteria:

  • The acquisition of and failure to discard possessions which appear to be useless or of limited value
  • Living spaces so cluttered, their use is impaired or impossible, and
  • Significant distress or impairment in functioning as a result of the clutter

What are the differences between clutter and hoarding?

Cluttered conditions in a senior’s home can result from a variety of causes including, but not limited to, physical frailty, disability, dementia, and can look like “minor hoarding” behavior. In my experience, clutter seems to be identified by lack of surface space and “piles” (of paper, magazines, clothes, etc.).

Hoarding involves much more mass or volume and can appear significantly more overwhelming – a lot more is involved than just surfaces. We’re talking more “floor to ceiling”. Hoarding can be identified by collecting items that often don’t serve a purpose, collecting but not discarding, and such attachment to objects that there’s a huge amount of anxiety and stress caused by parting with them.

What are some reasons people hoard?

It’s hard to provide any one reason or answer. The most widely held thought comes from the cognitive behavioral model of hoarding. This suggests that individuals who hoard have problems with information processing, emotional attachments to possessions, strong beliefs about the nature of possessions, motivational issues, and behavioral avoidance. Individuals experience fear of getting rid of something that might be important or necessary later on, something that might be irretrievable, the fear of making a mistake (hoarders are often perfectionists).

“Depression-era mentality” is another commonly held belief. Individuals who grew up in the depression are thrifty, frugal and fearful of wasting anything that they might later need. Physical infirmity (arthritis, deteriorating vision, etc.) can also play a role. Individuals who live in walkup buildings or who need to negotiate stairs and live alone can also find it difficult to get rid of things – usually because it’s hard to take the garbage out.

Other contributors: it can become a spiral – things pile up, become messy; there’s a sense of shame, fear of being found out, all of which serve to isolate the person further. Depression also contributes to hoarding behavior and the literature suggests that this may be a more significant cause than initially thought. Dementia can play a role, too, with the person not being able to distinguish between useful and non-useful things and the fear of getting rid of something they shouldn’t have...." More on part 1 of the interview

Last week we looked at what hoarding is, why people hoard, and how to approach a hoarder. This week we’re going to look at how to help someone who hoards. Before we begin, however, it’s important to know that hoarding doesn’t have to be to the proportions seen on TV for it to be a problem. It really doesn’t matter if the situation you’re facing is hoarding or just clutter that’s gotten out of hand. Now is the time to address it so please read on.

What’s the best way to engage a person who hoards?

It’s a good idea to convey interest, be open, have a non-judgmental attitude, and express concern, if appropriate. Ask them how they view their situation; what can they see themselves accepting in the way of help, curiosity, how do they plan to use any available space. It’s generally not helpful to come across as overly professional or controlling as this won’t get you very far. It’s better to be flexible and patient.

What if they refuse to allow a cleaning of their apartment or house?

It’s first important to determine their level of capacity or awareness of their situation. Do they have the ability to make an informed decision; are they aware of the consequences or ramifications of their actions? Are they aware there might be legal repercussions… It’s helpful to take inventory of their support network – who is available to help, family, friends? Unfortunately, sometimes cleaning up only comes after a mandate or legal action that comes from the outside or is externally imposed. What one can do until that time is to explore options available to them, provide alternatives, and review the need for adherence to minimum safety guidelines.

If they do allow cleaning, what’s the best way to go about this task?

  • Engage the hoarder, confer with them, let them have some degree of control over the clean-up, if possible.
  • Allow them to be present and determine who else will be present.
  • Try to do as much organizing and sorting beforehand as this tends to save both time and money. (If the client is not in a position to assume the cost of cleaning, oftentimes Adult Protective Services or the Triple A’s may help out. Sometimes social service agencies have access to charitable grants for financial assistance.)
  • Determine whether the presence of friends and/or family will be helpful or will deter the process. (Sometimes their presence feels too intimate or personal. Often it’s better to have an impartial crew along with a professional organizer.)..." More on part 2 of the interview