*Image courtesy of scottchan at FreeDigitalPhotos.net

We will be sharing three cases of hoarding that our care management team have helped with over the years. If you are concerned about someone who is hoarding, we hope that seeing these case examples and the care plan, challenges, outcomes and our team’s related advice will help you. Our team is just a phone call or email away if you need help for hoarding.

Hoarding can take many forms (check out our post on signs/what distinguishes a hoarder). Our first example is a specific type of hoarding and may be a little different than cases you have heard of or seen.

Hoarding Scenario

The client was an attractive, bubbly and social elderly woman who lived alone in a condo. Her family lived out of state and seldom visited, though they did talk to her on the phone almost daily. This client was the victim of multiple email and sweepstakes scams. She was also on every mailing list imaginable, and her mail box was overstuffed daily. As she wanted to read, respond, and write checks to help causes or win prizes, her home was full of mail/paperwork clutter to an extreme degree. Aside from the many thousands of pieces of mail everywhere, the home itself was clean and tidy.

Common signs distinguishing this behavior as hoarding include the inability to throw items away, difficulty organizing, severe anxiety about throwing anything away (in this case, a compulsive need to look through and respond to everything) and distress over the mail. She was quite social, but she would not let her many friends into the house.

Impairments/Problems from the Hoarding Behavior

In terms of functional impairment, not only was the mail and paperwork overtaking the home but the behavior was resulting in financial problems. Stacks, bags, boxes, piles and drawers full of mail were everywhere.  As she worked through a little at time, she would toss the envelopes to the floor, creating a slipping hazard.  She would eventually gather these up and recycle some. She would bounce checks because she would continue to write checks for the sweepstakes, the charity solicitations, etc. Even when she knew she had no money left, she would continue to write the checks. Family members were constantly being asked to send money for food, which would go towards one or two meals, and then go to feed her habit.

How did the client or family come to seek help for the hoarding?

The client’s son came down to help find paperwork for her CPA to do her taxes and found the house full of papers. Though they were aware she had been having money problems, as with many hoarders, she hid the problem as much as she could and they didn’t understand the full extent of the issue until they saw the home. The son took care of getting what was needed for the CPA but had to return home. He sought help from home and was referred to Aging Wisely.

First Approach to the Hoarding Problem

As with all hoarding cases, a careful and gentle approach is necessary. If a professional doesn’t understand hoarding, he/she will often fail at the first approach (it’s not an easy problem to tackle even for seasoned professionals, but knowing how to approach someone who is highly anxious about their items and deeply distressed is vital to getting anywhere with solutions).

In this case, a home visit was conducted as a possibility of getting a “housekeeper” in to help with “tidying”. The care manager used her experience with hoarding to gently work with the client toward solutions that would not overwhelm her. In this case, she would not agree to any other outside party to come in but would allow the care manager subsequent visits to help sort through the papers. The process began with client and care manager going through the mail piece-by-piece, but as the care manager built rapport and reduced the client’s anxiety, she permitted a more general “sorting” and recycling of many of the papers. It was essential that the care manager create a calming presence and discreetly handle the items chosen for recycling to minimize the anxiety-producing cues.

Case Challenges

Time was the biggest challenge in this case because so much work was needed, and there was not much money to fund care management assistance. In other cases, we have been able to bring in partners and/or get a client medical/psychological help but in this case only the gentlest approach would work and the client refused outside help.

The care manager made attempts to take the client off mailing lists, but the volume of mail (and continually being added to more lists) was staggering. The volume of papers was being reduced slightly, but more and more were being delivered. In other cases, the care manager has been able to convince the client to permit a change of address to redirect mail, but this client refused.

Outcome of Mail Hoarding Case

Unfortunately, the client was arrested for writing a bad check one weekend and spent the weekend in jail (due to her age, she was placed in the medical unit). Once released, she returned home and the care manager recommended a move closer to her family (and away from the overwhelming home environment). The client moved to an assisted living facility near her daughter, where the family could check in regularly and handled her paperwork for her.

Advice/Take-Away Lessons

It is important to evaluate changes in behavior (either new or increased) sooner rather than later.  This can be very difficult for family members and it is easy to find yourself justifying, condoning, placating, etc. as your loved one denies the behavior and even hides the extent of it.  Unfortunately, this often results in the problem becoming out-of-control and difficult to solve. As soon as you see it, you should attempt to bring in professionals to deal with the underlying issues. Hoarding is not about the stuff, it is about control, and the person’s feelings (real or imagined).

When there are functional signs (in this case, even if the family may not have seen the home safety dangers, but the financial problems were a strong sign of an increased problem), seek an experienced professional to do an evaluation and make recommendations. Someone experienced with hoarding can usually find a way to access the environment and make progress towards solutions (it may be slow progress, but the earlier that intervention starts the less urgent it will be).

Stay tuned for next week’s hoarding case studies, where we will discuss animal hoarding, online/phone shopping, and severe home safety/cleanliness issues and the resources and techniques our care managers used in helping these clients and families deal with hoarding.

Thanks to care manager Julie Scott for providing information on her work on this case. To read more about Julie’s extensive experience with professional care management and her specializations, click here for her complete bio.