Hoarding

What pest control topic is hotter than bed bugs right now?

Hoarding!

It’s a reoccurring theme in my work with multifamily housing. In addition to the advice I’ve posted today, I wrote a guidance on IPM in a Hoarded Home ( Download Pest Control in a Hoarded Home ). In it you’ll find information on the risks of working in a hoarded environment, some suggestions for IPM in a hoarded home, and a list of resources on hoarding. I hope you find it useful! If you might work in a hoarding situation, take a look. Some of the hazards to consider may surprise you.

Although most people don’t immediately associate hoarding with pest control, there are a lot of connections. Pests need food, water and shelter. If a resident’s housekeeping is poor and pests get in, the pests will likely set up shop—an infestation in a hoarded home can easily get out of hand. A cluttered home makes inspection hard. A hoarded home, almost impossible.

Property managers usually inspect each unit at least annually for compliance with housekeeping standards, but regardless of the language in a property’s housekeeping standards and lease, there will be residents who don’t comply. I group these people into two categories: those who can’t and those who won’t. This post is about one category of people who can’t—hoarders.

I’ll likely post on how to address other issues that arise when trying to get residents to comply with housekeeping standards. For now I’ll just say that PMPs, maintenance staff, and anyone else working in units should know to report poor housekeeping. Property managers should take action ASAP. Early intervention sends a message property-wide that the development has high standards for cleanliness.

Hoarding, as most property managers at HUD-funded properties know, doesn’t just happen on reality TV. In fact, one researcher said that hoarding is 4 times more prevalent in low-income persons than those making over $20,000 a year. Regardless of why a resident with compulsive hoarding and acquiring behavior comes to reside at a property, they deserve to be treated with respect. Don’t think of a hoarder as nasty, think of him or her as someone needing reasonable accommodation. This may take some acting on your part, but it is critical for building trust from which therapy can proceed.

What defines hoarding?
Hoarding is a complex disorder that is made up of three connected problems: 1) collecting too many items, 2) difficulty getting rid of items, and 3) problems with organization. These problems can lead to significant amounts of clutter which can severely limit the use of living spaces, pose safety and/or health risks, and result in significant distress and/or impairment in day-to-day living.There is a self-diagnosis tool and a wealth of information at the Anxiety Disorders Center.

One of my favorite tools for hoarding is the Clutter Image Rating Scale from the Compulsive Hoarding and Acquiring Workbook. Take a look and you’ll see why I love it…finally a way for to define what we mean by “clutter!” I suggest property managers decide what range on the scale is acceptable for passing housekeeping inspections and take action when a unit falls above this range. This is helpful for all residents. To use it for educational purposes for residents that fail a housekeeping inspection (not just a hoarder):

1. take pictures of the kitchen, bedroom, and living room in the home,
2. print them out,
3. schedule a meeting with the resident outside their home (if possible),
4. have the resident place the pictures you took on the Clutter Image Rating Scale, and
5. have a discussion about what can be done to improve the conditions.

Property managers tell me that this strategy helps the resident see their home more objectively. Once the resident understands the problem, he or she may be more willing to improve. With both hoarders and residents who simply have trouble keeping their house picked up, have them set small measurable goals with deadlines. For example, “By next Monday, I will put all the newspapers piled on the kitchen table that are more than a month old in the recycling bin outside.” Don’t forget to check in and set another goal on the deadline.

I digress…
If left unmanaged, hoarding behavior will get worse over time. Early intervention is the goal. As with pest management, you can’t simply clean out an established problem in one fell swoop and expect it to last. In fact, “clean outs” are detrimental to a hoarder’s therapy and they may refill the space quickly. Managing hoarding behavior will be an ongoing process for the resident, staff, and anyone else you involve. Progress will take time. Patience is important. The goals are to reduce the clutter so that the home is no longer a hazard at the pace that the resident can manage and for the resident to reach a point when he or she can use learned strategies to manage compulsions.

What should you do?
I’ve read some books and talked to some experts, and this seems to be the consensus:

1. Proactively start a hoarding task force that is educated on the topic and is called on when hoarding is reported.
2. Once reported, the health department (stick) and a therapist experienced with hoarding therapy (carrot) visit the resident to work on the problem (see below for more on this analogy). If there is family that can be helpful, call on them too. This group develops relationship and trust before making a dent in the stuff.
3. Over the course of many months or years, the resident gets control of the clutter and learns to manage his or her compulsions. As I mentioned before, the group should set very small measurable goals. Only progress at a speed the hoarder can handle. He or she may need a lot of hand holding at first—patience is key.
4. Once the clutter is managed, someone who has been involved and has the resident’s trust is responsible for checking in so that a relapse can be addressed before the home fills up again. Hoarding can’t be cured.

Who is on a hoarding task force?
Think of people in your area who could help or have authority to enforce codes and standards. Each member learn about the others’ jobs, gets educated on hoarding, and plans out what role he or she will play if a hoarded home is reported.

The sticks in this situation are the consequences of no action or continuing to hoard. Involve the people in your area who have the powers to condemn, evict, and issue a fire code violation. Eviction is the biggest stick and the property management company should wield it wisely—be familiar with the housing court process ahead of time.

The carrot is the support the team offers, therapy, and the benefits of living in a healthy home—having the grand kids visit for example. Even the people who have the stick should be on the team developing a positive relationship with hoarding residents by helping where appropriate—everyone is working towards the same goal of safe, decent, sanitary housing.

 Some or all of the following groups should be on the task force:

• The health department—cares if a home is unfit for human habitation and vector control
• Fire department—cares about fire codes
• Protective services—cares especially when animals, children, or the elderly are involved
• Public works—may be needed for organizing bulk trash pickup
• Pest control—may be needed if pests are present
• Agency on aging
• Housing
• Mental health professional—check www.adaa.org for a local therapist. If there are none in your area involve a social worker familiar with the resident and/or setting.

I wish I had a guaranteed solution for hoarding, but I have done enough research to confidently say that one doesn’t exist. As with pest management, partnerships are key for hoarding management. For those of you going to the Entomological Society of America’s annual meeting, I put together a symposia on partnerships developed for IPM programs. One of the speakers on my panel is hoarding expert, Dr. Christiana Bratiotis. Hope to see you there!