Hoarding is a mental health disorder that requires adequate support, tender care, and consistent treatment. Overcoming hoarding can be challenging, but with the right resources, it can be done. Read on to learn more about tips on overcoming hoarding for seniors.
John Maher: Hi, I’m John Maher. I’m here today with Marnie McDonald, Clinical Hoarding Specialist with North Shore Elder Services, a team of specialists making life easier for seniors and those who care for them. Today we’re talking about how seniors can overcome hoarding. Welcome, Marnie.
Marnie McDonald: Good morning. How are you today?
John: Good, thanks. Marnie, what is hoarding?
What is Hoarding?
Marnie: Hoarding disorder is actually a mental health disorder. It is marked by extreme attachments to items that make it difficult to let them go or sometimes even impossible to let them go.
These attachments are no different than attachments you and I would have to items, such as keeping things for sentimental reasons, keeping things for instrumental reasons, which means we can fix it. We can use it again later.
Somebody else might get a benefit from it, or even just being attached to something that for intrinsic reasons, we find it beautiful. Same type of attachments, just extremely exaggerated.
The difficulty is when more things are coming in than are going out, then you get a situation which we call “hoarding” where the home becomes unsafe, and it can be unsafe for the person living there and also for the people living around them.
John: Is this different than just, “My father‑in‑law has a lot of junk in the basement, and he refuses to get somebody in to clean out that basement.” Is it different than that?
Marnie: It is different than that. Because with hoarding disorder, there’s actually where you can see that somebody has difficult time getting rid of things and making decisions on items that you and I may think have no value, but that person is really attached to those items.
One of the things we look for is that if the items start to clutter up so many areas that you can’t use the home for its intended purposes. If it’s kept to a room, to a basement, or something like that, it may not be really an issue with hoarding, just excessive clutter.
If it’s where you can’t use your bed to sleep in and you can’t use the bathroom, you can’t use the kitchen sink or the stove to make food in, then that’s more of an issue where we’re looking at hoarding disorder.
John: Right, because all of the daily newspapers are stacked up in the kitchen sink, for example, and so you can’t even get to it.
How Does Hoarding Develop & Why is it Common in Seniors?
John: Why does this issue develop? Why is it particularly common among seniors?
Marnie: That’s a good question. First of all, hoarding disorder is actually a mental health disorder that they believe about 5% of the population struggles with. It’s a chronic disorder, so it starts in early adolescence as far as the behavior, but it continues throughout a lifetime, so it slowly progresses and is chronic.
The longer somebody has to actually accumulate items, then the worse a situation gets. A lot of people ask, “How come it seems that only seniors have hoarding disorder and those hoarding situations?” It’s really about the amount of time somebody has had to collect those items and keep those items and when somebody is what we call, “discovered.”
With elders, oftentimes, that’s the first time they’re getting some type of social services. Maybe they’ve fallen, and now they’re having a nurse come in and help them. Then again, somebody comes in and sees the unsafe conditions and reports it.
With the awareness nowadays of hoarding disorder, because of the TV shows, more people are reporting it, and that’s why it seems like it’s coming to the forefront now. But it’s really not just elders. It can happen at any age. It just depends on how long they’ve been able to progress with it. Then also, if there’s been some type of trigger for the behavior.
Somebody can go along with this hoarding behavior for a long time and it doesn’t jeopardize their safety. But if there’s some type of trauma or significant loss such as the loss of a loved one, the loss of a job, the loss of somebody’s identity, then that can trigger the behavior where it can start to increase rapidly.
Is Hoarding Less Common for People That Move Around Often?
John: Do you tend to see this in people who have maybe been in a house for a very long time? They’ve lived in the same house for 30, 40 years. Like you said, they’ve just had that time to accumulate these things. They have room for them to begin with, so they don’t feel like they have to get rid of things. Is it less common when somebody moves around fairly often?
Marnie: It’s a good question. I think if it’s truly hoarding disorder, it’s going to be common no matter what the living situation. However, there is a definite difference between somebody who’s been in a 10 room home, and then they move into senior housing and they have to downsize.
Oftentimes, I will get a call where somebody assumes it’s a hoarding situation, but in reality, it’s somebody’s who’s lived 40 years in a large home and has to downsize and really hasn’t had time to process through the items.
This could be somebody who could make the decisions easily. They just need some more help and more time to do it rather than somebody who cannot let anything go.
The Best Approach to Overcoming Hoarding Disorder
John: What’s the best approach to overcoming a hoarding disorder?
Marnie: With hoarding disorder, because it is a mental health disorder, there really needs to be some type of therapy and treatment. People with hoarding disorders often struggle with depression, anxiety issues, and mental health issues such as ADD or ADHD, OCD. Those things also go along with this most of the time.
Additionally, somebody with hoarding disorder has processing issues, so it makes it very difficult to make decisions. For example, their brain will incorporate options rather than eliminating options. Making a yes or no decision becomes very difficult and people start overthinking it.
Another thing is people with hoarding disorder are overwhelmingly perfectionists. That’s surprising to some people. But if you have to do something perfect, and you can’t see how you can get that done, it becomes overwhelming and it doesn’t get done.
John: You would think that a perfectionist would maybe want things to be clean and would be maybe overly obsessive about making sure that things are clean. How could this happen where all of a sudden things are so messy?
Marnie: An interesting thing is most of my clients will say, “I hate clutter. I hate having a mess.” That is not how people intended to live. That wasn’t their goal 20 years ago to live in this kind of situation. Talking, too, about getting help, there’s support groups out.
We offer support groups, individual counseling and therapy. There’s in home help that can actually help people sort through things. Oftentimes, the first thing people go to is to just clean somebody up. “We’re just going to go in and clean up the house. We’re going to clean it out, and then everything will be fine.”
Hoarding disorder, though, is like an iceberg. You see 10 percent of it on top. That’s what the clutter is. If you cut the top of an iceberg off, have you solved the problem? You haven’t, because what’s under the water sank the Titanic. If you don’t address why that clutter happened, and if you don’t address the skills, the strategies, the behaviors, it’s all going to come back again.
The best approach is to get some therapeutic or clinical support. Then we also use a plan called harm reduction. Harm reduction is the best way to help anybody with hoarding disorder get started. We’re talking about just safety issues.
For example, if somebody is having difficulty moving around their home, because there’s so much clutter, there’s no pathways, we would say, “We’re really concerned about your safety, and I don’t want you to slip and fall when you’re walking to the bedroom. How can I help you clear this pathway?”
We have a list of something we call “Uniform Inspection Checklist,” that we use for safety issues. “Let’s make sure you can get in and out of your home.” If you’ll notice, this is not talking to somebody about getting rid of their stuff. It’s just talking about safety issues and helping them manage those.
John: Does that help to get through to them when you put it in that way that, “Hey, this could be detrimental to your health. This is a safety issue and this is the reason why we need to approach it in this way.” That helps to get through to them?
Marnie: Yes. The harm reduction approach is the most effective no matter how much insight somebody does have or doesn’t have about their situation.
Not always, but oftentimes, if we start with that harm reduction approach, as we start clearing pathways, as we start making a space in the kitchen for them to prepare food, they start making decisions about things saying, “Oh, maybe I don’t need this. It was blocking the way.”
That helps walk them slowly into making these decisions and getting help rather than going in and saying, “Clean this up. Throw it out. I don’t think you need this.”
The First Step to Overcoming Hoarding
John: What’s the first step in terms of getting support and help in managing this hoarding behavior?
Marnie: The first step is, first of all, just to find somebody that you can talk to, to help you assess what the situation maybe is. Again, there are situations that are hoarding, but there’s also situations that are not hoarding, such as something that’s squalor.
That’s when there’s a heavy accumulation of trash and more unsanitary conditions. Those things are very different. You really do need to try to get some help from somebody to help you assess exactly what’s going on.
With the program that we have, that’s what we do. We take all referrals. We tell people, “If you think it’s hoarding, just refer it, and then we’ll work with it from there.” Then go in and just do some basic assessments, and decide, “Is this somebody who maybe it’s hoarding behavior because of some medical issues?”
Maybe they can’t clean up anymore. Maybe they’ve had some surgeries and things have just gotten out of control. Is it somebody really with hoarding disorder that needs that clinical help?
John: There’s a difference between needing that help for a clinical hoarding disorder and somebody who just needs some cleaning help to come in and help them get rid of things.
John: Marnie, thanks again for speaking with me. I appreciate it.
Marnie: Thank you.
John: For more information on North Shore Elder Services, visit nselder.org or call 978‑750‑4540.