Friday, November 14, 2008

Helping Hoarders to Clean Up and Live Better

One of my cousins once joked the we come from a family of “collectors.” My dad and his brothers are never as happy as when they are picking out new treasures at a garage sale. Many of us have friends and relatives like this. “Hoarding”, however, is different from being a run-of-the-mill packrat. Once you have set foot in a hoarder’s house, you know the difference immediately. In order to provide good representation to hoarders, it is important to understand the condition.

The DSM-IV lists hoarding as a symptom of obsessive compulsive disorder. Recent research, however, suggests that it may be distinctly different from OCD in several ways. It is most commonly driven by obsessional fears of losing important items that the person believes they will need later. It can also involve distorted beliefs about the importance of possessions, excessive acquisition and exaggerated emotional attachments to possessions. People who engage in hoarding save items that seem to have no value such as newspapers, mail or trash. In some, it can involve obsessively acquiring animals. Eventually, the mountains of trash get to the point that they can endanger the hoarder or the community.

Hoarders often do not see their condition as a problem and are sometimes loners. As a result, the situation can continue for many years. In some cases, the hoarding does not pose a risk to the individual or the community. In combination with dementia or other problems, however, hoarding can cause legal and safety issues. Some common problems that arise are discussed below.

Ignoring Important Financial Matters

The combination of perfectionism and procrastination can create havoc on the hoarder’s finances. It is not unusual to discover that property taxes have remained unpaid, tax returns have not been filed or that utility bills are far behind. Any one of these problems can cause serious consequences.

Municipal Violations

Eventually, the mess inside the house spills outside. When it does, the neighbors complain and the city comes out. They find a disaster and start writing violation notices. Common complaints against hoarders include overgrown lawns, peeling paint, broken windows, rodent infestation and excessive cats.

In addition to the urge to save, many hoarders also experience indecisiveness, perfectionism, procrastination, difficulty organizing and avoidance. Understanding these traits can be an important to understanding the legal consequences. In the case of municipal violations, for example, it is common for the tickets to remain unpaid and the problems to continue. Only when the city begins to threaten more drastic sanctions does the hoarder seek help.

Illness

As hoarders age, and the house becomes more unmanageable, health problems can follow. If the kitchen becomes unusable, it is less likely that they will eat nutritious meals. If the bathroom is a mess, bathing can become a chore. Because they are often isolated, things like mental illness may go unnoticed for many years. Likewise, curable health conditions may remain untreated.

One of the critical points at which hoarders obtain help is when they become critically ill. Dementia, Alzheimers and stroke are common conditions that can force a hoarder to move into a nursing home. Unfortunately, at that point, it may be impossible to obtain information from the client about their legal affairs.


Getting Help for Hoarder

Understanding issues common to hoarders is perhaps the most important part in helping them. Here are some steps that you can follow to help a hoarder get the help they need:

1. Earn their trust

You cannot do anything to help a hoarder unless you earn their trust. To help them it is going to be necessary for the client to give up control over the “stuff.” This is the task that they have found most difficult over the course of their lives. Their initial reaction to giving things up will be to resist it. Many offer to start sorting through the information themselves. This simply won’t work. If they could do it on their own, they would have already done it. Still, they must be willing to allow you to help them. This requires a relationship and it requires trust.

2. Obtain Help

There are a variety of people who can help a hoarder: a social worker, a neighbor, a lawyer or a care manager are just a few examples. The title is less important than the personality of the person who is going to lead the project. Whoever is going to work with the hoarder to improve things, they will need to assemble a team. Each member of that team must be able to understand and show respect for the client’s wishes. Hiring a lawyer who has experience with hoarders and good social skills can be a big help in this process.


3. Get Control

A power of attorney or a guardianship can be an important next step. If the hoarder will agree to let somebody else work to fix the situation, half of the battle has been won. Many hoarding clients find a sense of relief in knowing that somebody is taking care of their looming problems. Of course, for clients who have decisional capacity, it is important to consult with them about major issues even when they have signed a POA.



4. Act quickly

Because many hoarders do not obtain help until their health is declining, it can be important to act fast. Clients who lack a living will, POA and basic will should have one prepared as quickly as possible. Thereafter, it is important to tackle the bigger issues first. Locating sufficient resources to pay for immediate care is obviously critical. Thereafter, resolving IRS debts is a high priority. As you develop a picture of the client’s financial situation, other priorities will become clear. A 75 year old client who is fully invested in the stock market should probably be talking to a financial planner. If the assets start to add up, the client may need to set up a living trust. Acting quickly can greatly help.



The Good News

By acting to help a hoarder, you can have a dramatic impact on their life. Many hoarders live in fear of losing their home, their assets and their health. More than a few are living in squalor, when they could be living very well. If you can play a part in getting them there, it is a good day at work.

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