Hoarding case study

1. Hoarding case study Michael Vapp, Care Manager, Aged and Disability Services City of greater Geelong.

2. Initial presentation • 2009 received a referral from clients son for assistance with clean up of client’s home. • Client background • Early 80’s • Issues with short term memory loss and dementia (had not been assessed by memory clinic). • Client very reluctant to have assessment and saw no need for Home care assistance. • Pleasant polite lady • Had a very distinguished professional career.

3. Photo’s prior to clean up.Bedroom.

4. Outside shed

5. Condition of house. • Cluttered with rubbish • Very strong smell of discarded rotten food especially in the kitchen area • Piles of half eaten food left for long periods of time • Throughout the home clutter was at shoulder height with laneway through to each room. • Due to memory loss it appeared Client • Had not showered for a long period of time, but was usually adamant that she had showered that morning. Very reluctant to do so. • Clothes very dirty and did not want to change clothes

6. Attempted interventions. • Attempts at clean up were very distressing for client. Refused any assistance with industrial clean. • Refused referral to Aged Psych team to discuss hoarding behavior. Hoarding not recognised in DSM at this stage. • No insight into hoarding behavior, felt environment completely appropriate. • Placed great value on her ‘treasures’. • After CCWs would put rubbish in bin client would go out and bring it back in again. • Could not put in HC due to condition of house and professional agencies that specialize in dealing with hoarders not local and not practical. • No support group for people with hoarding type behaviors.

7. Attempted interventions • Client could receive assistance through mental health plan with GP, but unwilling to discuss with GP as she felt there was no issue. • Could find no bulk billing psychologists who had any experience with Hoarding and none willing to visit client home. • Would not accept referral to memory clinic and son unwilling to pursue this with Mother. • Son would not support VCAT application.

8. The clean up. • Only service client would accept was Meals on wheels but was enough to keep in contact with client and gain trust. • This service was in danger due to OHS. • After 2 years client finally consented to go into respite so that ‘emergency’ works could be carried out on home. • During this respite stay son carried out industrial clean.

9. House after clean up.Bedroom.

10. House after cleanup.Shed.

11. Clean up

12. Day 2

13. Day 3

14. Day 4

15. After the clean up. • Client had little insight of clean up due to short term memory loss. • Commenced HC services, shopping. • Basic level of cleanliness but a constant struggle to keep clutter down. • Services continued until client moved into permanent care when clients dementia reached a point where she was unable to remain at home.

16. Reflections on practice. • Without clients short term memory loss there could have been serious consequences to clean up . • Very supportive son in this particular case.

17. Possible future interventions. • Currently working with Medicare funded counseling agency that is willing to provide home visits to work with clients with Hoarding behaviors . This service can be accessed through clients mental health plan. • Direct referral to psychologist.

18. Advantages of referring directly to psychologist. • Difficult to get client to acknowledge that hoarding is an issue and may not think it necessary to attend GP. • Reluctance to leave home. May be embarrassed. • Trust issues with GP, does not want clean up. • May be difficult to articulate their request for assistance through mental health plan. • May not have GP or ability to get transport to GP. • GP may not be aware of Hoarding.

19. Possible future interventions. • Care manager or client contact would assist client to liaise with agency and all work together to come up with a plan to support client and reduce clutter and address Hoarding behavior.