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Carer information sessions web resource


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

Published in: Health & Medicine
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Carer information sessions web resource

  1. 1. Hoarding & Squalor Family/Carer Information Session
  2. 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. 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. 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. 5. What is hoarding?
  6. 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. 7. What is squalor?
  8. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.
  18. 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. 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.
  20. 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. 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. 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. 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. 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. 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. 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. 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. 28. What help is out there?  Counselling  Mental Health Plan via GP  Community Services  Animal services  Cleaning services  Case management (limited)  Buried in Treasures
  29. 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. 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. 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. 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. 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. 34. References 1. Hoarding and Squalor: A practical resource for service providers 2. Pathways to Dealing Effectively with Hoarding & Squalor in Australia 3. Catholic Community Services: Squalor & Hoarding Toolkit 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 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