This presentation was for carers and family members of people with a hoarding disorder.

1. Hoarding & Squalor
Family/Carer Information
Session

2. Agenda
1. Hoarding Background
2. What is hoarding and squalor
3. Why do people hoard and/or live in squalor?
4. Supporting your loved one
5. Things to keep in mind
6. Ways to assist
7. Caring fro yourself
2

3. Hoarding background
 People living with hoarding behaviour or in a squalid living
environment need to be acknowledged and supported to enable
them to manage their behaviour so they might live safely with
minimal risk to themselves and the community. (1)
 New Australian population research estimates (2.6%) of people may
suffer from hoarding disorder, putting themselves and their
families at risk of squalor and health risks, fire hazard, eviction and
homelessness. (2)
 Hoarding behaviour and squalid living conditions define quite
different circumstances, but under certain conditions may co-exist.

4. Hoarding is a mental illness
 The DSM-5 edition (published May 2013)59 classified
hoarding as a distinct disorder with its own diagnostic
criteria within the chapter about obsessive-compulsive
and related disorders.
 Hoarding disorder is new to DSM-5 and is supported by
extensive scientific research. It recognises the behaviour
usually has harmful effects – emotional, physical, social,
financial and even legal – for a hoarder and family
members. (1)

5. What is hoarding?

6. What is hoarding?
 Hoarding behaviour is the persistent accumulation of, and lack
of ability to relinquish, large numbers of objects or living
animals, resulting in extreme clutter in or around premises.(1)
 This behaviour compromises the intended use of premises and
threatens the health and safety of people concerned, animals
and neighbours. (1)

7. What is squalor?

8. What is squalor?
Squalor describes an unsanitary living
environment that has arisen from extreme
and/or prolonged neglect, and poses substantial
health and safety risks to people or animals
residing in the affected premises, as well as
others in the community. (1)

9. Animal Hoarding
Animal hoarders often fall into one of the following three categories, but can
sometimes exhibit characteristics across categories:
The overwhelmed caregiver initially provides adequate care for the animals
and believes that while a problem has slowly developed, it’s not as serious as
others think it is. The overwhelmed caregiver may be socially isolated, but is
willing to accept intervention.
The rescue hoarder develops a compulsion based on a strong desire to rescue
animals from possibly deadly situations, actively acquiring animals, believing
no one else is capable of caring for
 them.
The exploiter hoarder takes in animals to serve their own needs and is
indifferent to any harm caused to the animals. (1)

10. Why people hoard?
 Family/life experiences and psychological factors may also play a
role in the development of hoarding and emotional stress may
heighten symptoms.
 Hoarding can begin after brain damage, such as strokes, surgery,
injuries, or infections.
 Intellectual / cognitive reasons such as acquired brain injury or
physical disability
 Hoarding may be hereditary. (1)

11. Why people hoard?
People who hoard have a variety of reasons for doing so:
to avoid wasting things that might have value
they have a fear of losing important information
the emotional meaning of objects
they appreciate the aesthetic appeal of objects, especially
their shape, colour, and texture
The feeling they get from acquiring things (1)

12. Impacts of hoarding & squalor
Hoarding and Squalor not only effects the person who
hoards and/or lives in squalor but also potentially
dependents, partners, family, carers and neighbours and
communities. Everyone has different perceptions on how
to best deal with this issue.
Conflict with family members and friends who are
frustrated and concerned about the state of the home and
the hoarding. (4)
What impacts has hoarding and/or squalor had on yours
and your loved ones life?

13. Impacts of hoarding & squalor
Impacts can be:
Relationship strain/conflict
Loss of living space
Emotional distress on family and friends
Social isolation-inability to have family/friends visit, inability to visit
family/friends, unable to have friends over to play etc
Financial stress
Health/fire risks
And much more. Every situation is difference and impacts can be
different

14. If you could think of words to
describe feelings that you feel
around hoarding and/or squalor,
what would they be?
Feelings can vary for each
individual as every situation is
different
It may make you feel:
Frustrated
Sad
Helpless
Disappointed
Excluded
Stressed
Anxious
Tired
Isolated
Angry
Claustrophobia physically and
emotionally
Impacts of hoarding & squalor

15. Providing support
 Often , the person agrees with you that the problem exists and
something needs to be done about it. However, for many of you,
your loved one (who might be smart, logical, and rational in every
other way) denies of minimises the problem. This can be
maddening for families (carers/friends).
 His or her denial or minimisation (may not think the problem is as
bad as you see it) is part of the problem and is a common feature
of hoarding.
 This doesn’t mean there is no hope of change, we will be watching
a video that demonstrates change can happen. (4)

16. Supporting families/carers
Click on green
square for
video with
Becca Shuer.
(partner of Lee
who is a “finder
keeper.”)
16
Tips that may be helpful for families/carers see Resources for Helping
others with motivation. (7)

17. Impact on children
 Recent case in Melbourne of an infant’s death
highlighted issue.
 Children might feel embarrassed, secretive, protective,
may not know any different.
 Supporting children to talk, to acknowledge how they
feel, to consider ways to cope or ask for change.
 Useful resource: An Ordinary House by Tania Reid.
http://anordinaryhouse.com

18. Strategies
 What strategies have worked for your loved one, what
contributed to this working?
 What has hasn’t worked so well, what do you think has
contributed to this not working?

19. Strategies
Things to keep in mind:
It’s hard to know what to do if your loved one seems less
motivated than you are to work on the problem.
Ambivalence is normal. Its rare for someone to want
anything 100%, with no hesitation. Especially when people
are trying to decide whether or not to make a dramatic
lifestyle change. (4)
Ambivalence is- uncertainty or fluctuation, especially when
caused by inability to make a choice or by a simultaneous desire
to say or do two opposite or conflicting things.
http://dictionary.reference.com/browse/ambivalence

20. Strategies
Things to keep in mind:
People have the right to make their own choices. There are, or course,
some exceptions to this, where a person has been found legally not
competent to look after their own affairs, and who have an appointed
guardian. Its important to respect freedom of choice.
Nothing will happen until the person is ready to change. The key,
therefore, is to help the person understand and weigh up all the factors
so he or she can make an informed choice. You can’t argue him or her
into it. (4)
If you and your loved one don’t already have a common bond of trust
and support, consider having someone else be a designated support
person or consider seeking outside help to work on mending the
relationship and rebuilding trust if it seems necessary.
TRUST is the key for making progress with your loved one.

21. Strategies
 Show empathy. This doesn’t mean that you necessarily agree with what
the persons says, but it does mean your willing to listen and trying to
see things from the other persons perspective.
 A good rule is if you don’t truly mean what your about to say to your
loved one, don’t say it! (4)

22. Strategies
 Don’t Argue. Ever, there is simply no point.
 It’s a well known fact that the more we say something, the more we
tend to believe it. So when you engage your loved one in an argument
about hoarding, you are essentially putting him or her in a position to
make an argument for NOT changing.
Things to watch out for:
 Warning or threatening
 Preaching
 Judging, criticizing or blaming (4)

23. Strategies
 Respect autonomy. Remember, most of you are dealing with an adult
who has freedom of choice about his or her own possessions. You do
not have to like the condition or his or her home, nor to you have to be
happy about the behaviour.
 If the person with the hoarding problem is your spouse or lives with
you, or if the hoarding impacts on your living space, you do have the
right to ask the person to change.
 Even in this circumstance you are most effective when you reassure
your loved one you are not trying to take away his or her autonomy. (4)

24. Strategies
 Try and engage your loved one in a conversation rather than an
argument, about the home and his or hers behaviour.
 Talk about your concerns in an open and frank manner, without being
confrontational, argumentative or hostile.
 Ask your loved one what they want to do, rather than just telling them
what you want them to do.
 “what do you think you would like to do about the clutter and what do
you suggest things happen?” (4)

25. Strategies
 You may be thinking about now, that your loved ones hoarding issue is
a serious problem and all you can do is be nice about it and not argue
when something needs to change, here's some thoughts.
 Before anything can get better you need to put the brakes on things
that are not working.
 “The definition of insanity is doing the same thing over and over,
expecting a different result!” (4)

26. Strategies
 Ask about there goals and aspirations.
 “what's really important to you in life”
 “How would you like your life to be 5 years from now?”
 “What are your hopes and goals for life”
 Then ask if their hoarding fits within these goals, for example:
 “ does the condition of your home fit within you being a good grandmother”,
“you have said being a grandmother is important to you can you pursue this
with the way your home is now?”
 If your accustomed to arguing, it may take some time for your loved one to
adjust and begin to trust you. (4)

27. Strategies
 Set Limits. If your efforts aren't working you may need to set personal limits to
cope with your own needs. Try and so this calmly without arguing.
 Decide what you can and can’t tolerate in regards to your own personal needs
and space and those of others (children, elderly people) you are responsible for.
Tell your family member:
1. How you feel
2. What you want, and
3. What you will do. State your request clearly. “Susan, those piles left on my desk
upsets me. That is my space and you don’t have the right to put things there.
Please remove by the end of this week”. (4)

28. What help is out there?
 Counselling
 Mental Health Plan via GP
 Community Services
 Animal services
 Cleaning services
 Case management (limited)
 Buried in Treasures
www.hoardingresources.org.au

29. Clean ups
 “quick fixes” or major house clean do not work, its important to take
one step at a time.
 Big clean ups can cause severe emotional distress and have serious
implications i.e. mental health issues.
 If you, your loved one or someone cant physically sort and clean, The
Green Clean Team can assist at a cost and have an extensive
understanding or helping people who hoard with cleans.
The Green Clean Team (03) 5443 5184

30. Suggestions
Only Handle It Once (OHIO) Rule
If you pick something up, make a decision then and there about it, and either put
it where it belongs or discard it. Don’t fall into the trap of moving things from one
pile to another, again and again. (5)
Suggestions when assisting someone to work at discarding goods:
Keep/donate/maybe approach
Stickers- put difference coloured stickers on goods to keep/donate/throw away

31. Sorting questions
 How many do I have, and is that enough?
 Have I used this in the past year?
 Do I have a specific plan to use the item again, in what timeframe?
 Does this seem important just because I am looking at it now?
 Is it current?
 Is it of good quality, accurate, and/or reliable?

32. Ideas to suggest
MAPS
Many people who hoard are extremely visual.
They often fear that if they put something away they will not remember
where it is because it is not out in the open. A trick could be to label the
outside of a draw, a storage bin, or create a map of where important
items have been put away. (1)
Set guidelines for ‘helpers’- families and carers
i.e. only disregard when they are present. May draw up an agreement as
to what can/can’t be thrown out. (4)

33. Caring for yourself
 Setting limits
 Have support of non judgmental family and fiends
 Speak to someone
 Have positive things outside of the home that you can focus on i.e.
hobbies
Supports:
 Counselling
 Carer’s or peer support groups
 Further meetings for this group?

34. References
1. Hoarding and Squalor: A practical resource for service providers
http://www.health.vic.gov.au/agedcare/publications/hoarding/hoarding_resource.pdf
2. Pathways to Dealing Effectively with Hoarding & Squalor in Australia
http://hoardingsqualorconference.com.au/2014/wp-content/uploads/2014/03/HS-Conference-Report-2014.pdf
3. Catholic Community Services: Squalor & Hoarding Toolkit
http://squalorandhoarding.catholiccommunityservices.com.au/getting-started/definitions-of-squalor-and-hoarding
4. Buried in Treasures
Tolin, D.F., Frost, R.O., Steketee, G. (2014) Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding, 2nd
edition. New York,
Oxford University Press.
5. World of Psychology
http://psychcentral.com/blog/archives/2011/03/19/compulsive-hoarding-and-6-tips-to-help/
6. An Ordinary House
Reid, T. (2014) An Ordinary House. Australia, For the Crowded House.
An Ordinary House. Published by For the Crowded House, 2014. Author Tania Ried.
7. Hoarding Web Based Resource
www.hoardingresources.org.au