Welcome Wisdom

Hoarding and Older Adults

by Felicia Juntunen, MA, CMC, Director of Care Management

Among the challenges that confront Aging Life Care professionals, working with a client who has hoarding behaviors is one of the most perplexing. Families may engage a care manager when they’ve discovered an aging parent or loved one’s safety and well-being are jeopardized by excessive clutter in their home. In our practice, we have encountered situations with varying degrees of hoarding: from a client who collected shopping bags full of drugstore items that were never unpacked or used, to those whose homes were impassable because of many saved items including garbage and old food. A care manager’s task in these circumstances is multifold as they work to address the needs of their client while also helping families or other concerned individuals understand how the issue can be addressed. Care managers collaborate with other service providers to discern how and when to intervene in a hoarding situation, how to overcome an individual’s resistance to help, and how to evaluate whether the hoarding behavior is a choice or the result of diminished capacity.

In her article, “Hoarding and Elders: Current Trends, Dilemmas, & Solutions,” Emily Saltz explains the basic tenets of hoarding behavior. Hoarding behavior typically begins early in life – usually by the time a person is adolescent, and it can take years or decades to develop until it becomes an obstacle to functional living. A central characteristic of hoarding is continuously bringing items into one’s home – whether with excessive purchases or collecting random items. Those with hoarding tendencies cannot categorize or organize their belongings and are disabled by the thought of discarding or parting with an item. They typically have little or no insight into the problem and experience significant denial about their situation. People who hoard may be prone to experience depression, social phobia, isolation, anxiety, or substance abuse. Hoarding is further complicated by aging. The effects of chronic illness, physical and mental decline, and increased isolation compound the problem. When dementia is present, hoarding can present a significant obstacle to health and safety as those with dementia are even less able to differentiate the importance of items or deal with the effects of their hoarding.

While the cause of hoarding behavior can vary from individual to individual, it is understood that previous trauma and unresolved grief are common driving factors. Those who hoard receive emotional comfort from acquiring items and have a compulsive need to control and manage their belongings. It’s important to understand that denial is a prime characteristic of those who hoard and presents a formidable obstacle to treatment. Hoarders would prefer to live in a cluttered and unsafe space than forfeit their possessions. There is no easy solution for hoarding and current forms of treatment have limited success. It is now recognized that the forced removal of possessions without an individual’s permission can cause feelings of violation and additional trauma. Care managers tend to concentrate their efforts on what is referred to as a harm reduction approach – focusing on helping the individual with hoarding tendencies to live more safely rather than eliminating the hoarding.

Providing compassionate support begins with the hallmark of quality care management: a good assessment. Aging Life Care professionals will screen for capacity and consult with other professionals for an objective and clinical perspective. Determining if the person is legally competent to choose their lifestyle is critical in determining how to mitigate any issues created by their hoarding. The goal is to protect the autonomy of the individual (their fundamental right to their own decision-making) and balance that with their safety. Developing a trusting relationship with the person who hoards is essential to any success in working with them toward some resolution. As trust develops, care managers can encourage treatment for underlying conditions like depression and anxiety. When empathy is conveyed that respects the individual and the meaning of their possessions, goals can be developed that enable them to maintain a sense of personal control as they collaborate with the care manager to improve their safety and wellbeing.

 

Saltz, Emily B., “Hoarding and Elders: Current Trends, Dilemmas, and Solutions.” Journal of Geriatric Care Management, Fall 2010, pp. 4-9.