Kerry Howley Community Health Nurse Age Concern Canterbury

 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

 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

 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

 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

 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?

 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

 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

 Increased risk of fatality  Increased response needed from fire service  Increased risk to emergency services if called to property  Increased risk to neighbours

 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

 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

 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?

 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

 Clutter Image Rating Scale (CIR)   Activities of Daily Living – Hoarding (ADL-H)   Hoarding Rating Scale  ng%20Rating%20Scale%20with%20interpret.pdf ng%20Rating%20Scale%20with%20interpret.pdf  Important so that all practitioners and team are talking the same language  Preferably implemented nationally

 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

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

 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