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 � Animals risk of infection, contamination – 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) http: //stoppests. typepad. com/files/clutter-image-rating-scale-1. pdf � Activities � http: //www. cornellaging. org/gem/pdf/assessment_tool. pdf � Hoarding � of Daily Living – Hoarding (ADL-H) Rating Scale http: //www. ocfoundation. org/uploaded. Files/Hoarding/Resources/Hoardi ng%20 Rating%20 Scale%20 with%20 interpret. 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 i. Phones � Squalor and Hoarding Toolkit � http: //squalorandhoarding. catholiccommunit yservices. com. au/ � Working with People with Hoarding Behaviours (DVD) � Stuff Happens (Audio CD) Catholic Community Services – enquiries 1800 225 474 � The Hoarding Handbook ISBN 978 -0 -19 -538551 -9

� 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