What You Need To Know When A Resident Hoards

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According to the American Psychiatric Association, 2-6% of the U.S. population exhibit a hoarding disorder. This tendency doesn’t suddenly disappear when a person enters a senior living community. So, if you’ve worked in eldercare for any length of time, I’m sure you’ve encountered hoarding.

What is hoarding?

Hoarding goes far beyond being a messy person.  We often define it as the excessive collection and retention of things until they interfere with day-to-day functions.

In my experience, hoarding in long-term care usually expresses itself in one of three ways. The first is simply a refusal to get rid of things when they’re no longer useful. Second, some residents ask relatives and friends to bring in lots of possessions they don’t need. Finally, residents may shop (including online) for merchandise for which they have no need and no storage space.

There’s another type of behavior we often see in nursing homes that some might consider hoarding. It happens when a resident lives with dementia. This involves a resident “shopping” in other residents’ rooms and then hiding the collected items in their own room. However, hoarding related to dementia will be a topic for another day.

What are the consequences of hoarding?

Fortunately, with all the supervision available in senior living communities, we never reach the point of the hoarding catastrophes we see on TV. However, hoarding can still result in a variety of problems:

• Fire hazards
• Insects and rodents, especially with food hoarding
• Social isolation
• Increased risk of falls
• Financial problems
• Hazards for staff who enter to provide care
• Family conflicts
• Structural damage to the room or apartment
• Health risks (eating expired food, etc.)

Why might a resident hoard?

Hoarding sometimes exists as a condition by itself. More often, it is associated with an illness such as obsessive-compulsive disorder (OCD), depression, anxiety, or a personality disorder.

Some studies suggest that hoarding may run in families. This is because many people with hoarding tendencies also have a close relative who hoards. Sometimes, this may be because of modeling. However, there is also evidence of genetic links to hoarding.

Hoarding usually develops over many years, and it generally gets worse as a person grows older. Often, a traumatic event triggers the behavior. This might include the death of a loved one, a divorce, or losing possessions in a tragedy such as a fire.

Elderly people may have even more difficulty getting rid of “stuff” because those items represent memories. Also, for those who experienced difficult financial situations in the past, there may be fear associated with letting go of anything.

Finally, some elderly people simply don’t have the energy or mobility to keep up with their possessions. As a result, they let things pile up rather than asking for help.

What can we do when a resident hoards?

• Include the resident in the cleanup

Resist the temptation to swoop in armed with garbage bags and try to clean up the mess as quickly as possible. This is the worst thing we can do.

Unfortunately, I often see out-of-town family members do this when they come to visit. While it may seem like a solution to the problem, the results won’t last if we don’t address the underlying issues.

Also, don’t secretly throw things away or do a big clean up when the resident is out of their room or apartment. This only causes mistrust and makes them cling even more tightly to their possessions. The resident must be part of the decluttering process.

• Protect the resident’s rights

Hoarding becomes a unique challenge in senior living communities because of residents’ rights. A fine line exists between providing care for our residents while not overstepping our boundaries.

Some people don’t see their hoarding as a problem, so they resist all offers of help. If this is the case, I strongly encourage you to consult your ombudsman. They can help come up with solutions while preserving the resident’s rights.

• Don’t push too hard

In some situations, residents may feel embarrassed by their cluttered space. As a result, they’re more willing to accept help with cleaning up the mess.

It’s still important to allow the resident to maintain a sense of control and not to move too quickly. If you put pressure on the resident, it only increases their anxiety. This could cause the resident to halt the clean-up process and refuse further help.

• Access community resources

Over the past several years, our society has become more aware and more understanding of hoarding. As a result, many cities are developing resources to help people overcome this problem.

These resources may include educational materials, mental health services, professional organizers, and support groups. Residents of senior living communities can often find help through these resources, too.

• Involve mental health specialists

In some situations, a referral to a psychiatrist or psychologist can address underlying mental health problems such as depression or anxiety. Medications may help younger people overcome hoarding tendencies. However, you’ll want to be very cautious with psychotropic meds in the elderly because of the high risk of adverse side effects.

• Work as a team

Every resident’s situation is unique, and it takes a team to address a hoarding problem. Besides the resident and their family, invite input from all disciplines including housekeeping, social services, chaplaincy, the physician, and other specialties. This results in the best plan of care for the resident.

A final note

It’s easy to feel frustrated and perhaps even disgusted when dealing with a hoarder. However, we need to remember that this represents a condition that’s often beyond a resident’s control. Through education, patience, teamwork, and understanding, we can help restore the best quality of life for the resident.

Have you ever dealt with a hoarding situation in a senior living community? I would love to see you share your suggestions in the comment section.

Please note: Because of a significant amount of interest in this topic, I wrote a follow-up post that offers more resources to help with hoarding situations.