1. A Wicked Problem Hoarding and Squalor
Kerry Howley
Community Health Nurse
Age Concern Canterbury

3. Wicked Problems 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

4. Definition of Compulsive Hoarding
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

5. Squalor 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

7. Why are People Hoarders?
Deprivation
Grief and loss – Post Traumatic Stress Disorder
Learned behaviour
Mental health
Major Depressive Disorder >50%
ADD 30% and Hyperactivity 15%
Anxiety 30%
OCD 17%
Social Phobia 30%
Dementia – reduced cognitive ability
Addictive personality – ETOH, collecting

8. DSM-5
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?

9. Feelings of Hoarders 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

11. What are the risks? Falls, trips and injuries
Becoming trapped by “stuff”
Mould and mildew
Respiratory problems
Poor food hygiene and personal hygiene
Increased risk of infection, contamination
Animals – diseases, excrement and urine
Vermin – rats, mice
Insects – fleas, cockroaches, flies, ants etc.
Fire risk

12. 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

13. Animal Hoarding 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

15. pREVALANCE We don’t really know how many cases there are
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

16. Who pays? There 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?

18. Intervention 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

19. Assessment Tools Clutter Image Rating Scale (CIR)
Activities of Daily Living – Hoarding (ADL-H)
Hoarding Rating Scale
ng%20Rating%20Scale%20with%20interpret.pdf
Important so that all practitioners and team are talking the same language
Preferably implemented nationally
Self assessment the client will often minimise extent of hoarding and squalor.
They will say how they intended to tidy it up tomorrow but tomorrow comes and go and nothing is started. The actually don’t have the ability to sort and classify.
Using standardised scales helps health professionals communicate in a meaningful way with each other and other agencies. For this to work all agencies who are working together need to use the same tools.

20. The way Forward
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

21. Other Helpful Tools App for Android or iPhones
Squalor and Hoarding Toolkit
yservices.com.au/
Working with People with Hoarding Behaviours (DVD)
Stuff Happens (Audio CD) Catholic Community Services – enquiries
The Hoarding Handbook
ISBN

22. Summary
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