Tuesday, November 16, 2010

What Do You Do When Hoarding Turns into Neglect or Self-Neglect?

My guest blogger for today is Tiffany deSilva, a Certified Professional Organizer in Chronic Disorganization, Organizing & Productivity Coach, and ADHD Coach who has been featured on TLC's show Hoarding: Buried Alive.


There are three types of cases in which hoarding crosses the line from being "harmless" clutter to a serious instance of neglect or self-neglect. These three scenarios are: hoarding involving animals; hoarding involving children; and hoarding involving vulnerable (e.g. disabled or dependent) or elderly adults.

Types of Neglect Associated with Hoarding

Hoarding involving animals often results in animal neglect. Animal neglect refers to the failure to provide adequate food, water, safe and sanitary shelter, vet care, socialization, or the opportunity to exercise. Animal neglect is associated with both hoarding and animal hoarding. It’s not hard to see how difficult it might be to provide the basic needs to an animal living in a hoarding situation. Animal hoarding is often the most extreme form of animal neglect as it poses significant health hazards to the animals, anyone living in the home, and neighboring households.

Hoarding involving children may result in child neglect if the hoarding is affecting the parents’ ability to provide the children with basic needs such as, food, water, clothing, or a safe and sanitary place to live. Similarly, neglect occurs when hoarding negatively impacts a caregiver’s ability to provide the basic needs for an elderly or vulnerable adult.

According to the Aging and Disability Services Administration, self-neglect occurs when a vulnerable adult fails to provide adequately for his or her self and jeopardizes his or her well-being. This includes a vulnerable adult living in hazardous, unsafe, or unsanitary living conditions, or not having adequate food or water. A cognitively or physically impaired adult living in a hoarded home would be an example of self-neglect. If the adult is of sound body and mind, and
could independently care for himself, it is NOT considered to be self-neglect.

Unsafe Conditions in a Hoarded Home that May Constitute Neglect

  • Significant rodent or animal infestation
  • Significant insect infestation, such as roaches, fleas, lice, bed bugs, etc.
  • Extreme disrepair of the home (broken windows, structural damage, etc.)
  • Human and/or animal feces that is allowed to collect in the home in an unsanitary manner
  • Diseased or dangerous pets (e.g. a dog with rabies)
  • Animal hoarding
  • Sharp or dangerous tools, objects, or weapons that are easily accessible to children
  • Trash collecting or spilling onto the floors
  • Cluttered stairs or blocked exits
  • Extensive clutter which impairs essential daily functioning or creates a fire or safety hazard
  • Fire hazards such as improper wiring, the improper use of extension cords, or the inappropriate storage of combustibles.
  • Significant mold in the home
  • Toxic chemicals, gases, or other substances (e.g. lead, asbestos, radon, mercury, etc.)
  • Lack of utilities such as heat, electricity, running water, etc.

What You Can Do to Help

Below is my list of the top 5 things you can do to help in hoarding situations.

  1. Create a plan for safety. Determine what the next steps are for restoring safety after you’ve discovered any health or safety hazards. Prioritize based on what is the most immediate threat.
  2. Focus on eliminating any existing safety or health hazards listed above. I recommend reading Digging Out by Tompkins and Hartl to learn more about harm reduction. If agencies are involved, they’ll tell you what needs to be done to bring the home up to code or to restore safety.
  3. Find temporary safe shelter for children, vulnerable adults, elderly adults, or pets while you are working on eliminating the hazards in the home. Choices for temporary care include: shelters like the Redcross, staying with a relative, a hotel, respite care, adult daycare, or childcare centers.
  4. Educate yourself on your area’s local codes and laws regarding neglect. Agencies you might want to search for locally include: Child Protective Services (CPS), Adult Protective Services (APS), the Health Department, Zoning and Code Enforcement, the Division of Fire/Fire Code Enforcement, and Animal Control. If you have a hoarding task force in your area, they may be able to direct you to other resources, as well.
  5. Bring in allies. Familiarize yourself with local agencies, businesses, and professionals that can help you. This isn’t a situation you’ll want to handle on your own.

What do you do if there’s a "Stalemate?"

What do you do if you’re working to help someone in a hoarding situation that’s putting others or his or herself (in the case of self-neglect) at risk and they aren’t making progress in clearing out the clutter? Or, what if they aren’t receptive to creating a safety plan? Under these circumstances, you’ll need to contact CPS, APS, or another agency that is charged with looking out for those who cannot care for themselves.

In addition to being a professional organizer, I am a Licensed Social Worker. As such, I’m also a mandated reporter, which means I am required by law to report cases of abuse and neglect. In 18 states and Puerto Rico, ANYONE who suspects abuse or neglect is required by law to report it, regardless of their profession. If you live in Canada, you are also required by law to report child abuse or neglect. If you’re not professionally mandated by law, you can usually file a report anonymously. Check out
www.childwelfare.gov for more information.

Before working with my clients, I let them know that I uphold confidentiality except in cases I am required by law to report, or if there is a significant threat of harm or potential harm to them or someone else. This ensures my clients know exactly what to expect, as far as my confidentiality agreement is concerned.

If you do find yourself in a situation where you need to make a referral to CPS, APS, or another agency, trust that you’re doing the right thing to look out for those who are in danger and can’t advocate for themselves. If you’re a professional organizer, seek support from colleagues or other professionals to help you deal with the stress of making a referral. If you’re a family member, and you need to make a report, seek support from family, friends, colleagues, professionals, etc. and continue to support your relative who is struggling with hoarding. If you are struggling with hoarding and you fear that you may be putting others at risk, reach out for help and work hard to eliminate any dangers. If agencies do get involved, try to remember that they are on your side and ultimately want to help you get better, keep your home, and keep your family intact. In situations where hoarding requires significant resources to recreate a safe environment, local agencies can be your biggest allies. Making a referral is never easy but it may be the necessary step for finally getting desperately needed help.

Tiffany deSilva, MSW, LSW, CPO-CD, is the owner of Order and Balance(R), LLC and specializes in Chronic Disorganization, ADHD, and Compulsive Hoarding. Tiffany was featured on the original episode of TLC’s Hoarding: Buried Alive. Her new book,
Digging for Treasure: Uncovering the Gems Buried Beneath the Clutter, is scheduled for release in early 2011. Visit www.orderandbalance.com for more information and check out Tiffany’s new site, www.orderforHOARDERS.com.

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