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A Wicked Problem Hoarding and Squalor

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

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A Wicked Problem Hoarding and Squalor

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

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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?

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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?

  13. 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

  14. Assessment Tools • Clutter Image Rating Scale (CIR) • http://stoppests.typepad.com/files/clutter-image-rating-scale-1.pdf • Activities of Daily Living – Hoarding (ADL-H) • http://www.cornellaging.org/gem/pdf/assessment_tool.pdf • Hoarding Rating Scale • http://www.ocfoundation.org/uploadedFiles/Hoarding/Resources/Hoarding%20Rating%20Scale%20with%20interpret.pdf • Important so that all practitioners and team are talking the same language • Preferably implemented nationally

  15. 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

  16. Other Helpful Tools • App for Android or iPhones • Squalor and Hoarding Toolkit • http://squalorandhoarding.catholiccommunityservices.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

  17. 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

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