Harmless Clutter or Hoarding Disorder? What Home Health Aides Need to Know About Senior Hoarding

As a home health aide, you provide vital services for seniors. You help with everything from household chores, to preparing foods and providing companionship. Your role is unique because you work with people directly in their homes and see how they function over time. Because of that, you are in a position to notice emerging safety or health issues before anyone else. 

Hoarding behavior is an issue you are bound to face if you work as a home health aide. In this article, we’ll discuss hoarding and why it can be so concerning for your senior clients.

What is Hoarding Disorder?

Hoarding disorder is a mental health condition where individuals collect and hold on to excessive amounts of belongings. Someone with a hoarding disorder feels distressed when asked to part with their belongings.

From the outside, hoarded items no longer serve a useful purpose---old newspapers, ice cube trays, paper bags, empty jars, etc. For the person with hoarding disorder, everything they keep has value and a purpose. 

Hoarding disorder can stem from other mental health conditions, such as anxiety, obsessive-compulsion disorder, or depression. It can also exist without other mental health conditions present. There is a correlation between hoarding disorder, aging, and dementia. Hoarding tends to get worse with age.

There are varying degrees of hoarding. People can engage in hoarding behaviors without negative impacts on their lives. We all know “pack-rats” that function well and don’t suffer because they have a cluttered home.

Hoarding behaviors become problematic when they interfere with day-to-day functioning and well-being. 

Why Does it Matter if My Client is Hoarding?

That’s a fair question. Who are any of us to judge what someone else should or shouldn’t keep in their home? Who among us doesn’t save things that someone could easily—rightfully—question: “Why the heck are you keeping that?” or “Why do you have so many of these?” 

Hoarding disorder is concerning for a few reasons. Safety is one. Some of the ways that hoarding is unsafe, especially for elders:

• Too much clutter—especially paper—poses a fire hazard.
• Walkways and exits get blocked.
• Items that are stacked up high can fall and cause injury. 
• Items can be tripped on and cause falls. Falls in older people can be debilitating or even fatal.

Physical safety isn’t the only reason hoarding is a problem. It also affects cognitive, emotional, and social well-being.

Hoarding Creates a Vicious Cycle

Hoarding behavior doesn’t exist in a vacuum. While someone hoards, day-to-day life goes on. Bills are due, meals need to be made and cleaned up, and appointments are kept. 

Hoarding makes all that more difficult. Excess clutter makes it harder to find things and harder to use things because there’s less room to move about. This limited functioning leads to poorer eating habits (it’s harder to prepare food), less physical activity (it’s harder to get out of the house), and increased stress.

Hoarding impacts social functioning. It causes strain in relationships. People with hoarding behaviors may be so trapped by managing their belongings that they forgo social events. They limit visitors out of embarrassment or fear that their stuff will get moved. Loneliness is correlated with cognitive decline.

The chaos of clutter makes declines in cognitive function harder to manage, which makes daily living tasks harder, and around and around again.

When Does Hoarding Become a Problem?

There are many factors that can elevate hoarding behavior from quirky to concerning. These are some things to consider.

• Do the items present a safety issue? Can items come toppling down and cause injury? 
• Do they present a fire hazard? Too many papers or boxes in a small space can be concerning. 
• Do they impede walkways or block exits? This could make getting out of the house during a fire difficult.
• Are animals being hoarded? (Posing health, safety and animal welfare concerns.)
• Do the items pose sanitation concerns?
• Does the hoarding interfere with the normal use of spaces in the home? For example:

• Is living room furniture too fill of “stuff” to sit on?
• Does the person avoid bathing because the bathtub is full of extra clothes or boxes or papers?
• Are kitchen counters taken over by telephone books or newspapers or mail, so there’s no place to safely prepare food?
• Does the person have a bathroom that’s too full of stuff to use?

When hoarding creates safety risks, interferes with day-to-day functioning, or exacerbates physical and mental illness, it’s time to call in reinforcements.

What Do I Do If My Client is Hoarding?

If you see that clutter is creating an unsafe living space for your client, you should report that to your immediate supervisor. It’s possible, depending on which state you live in, that you are considered a mandated reporter. A mandated reporter is someone who is legally required to report concerns of elder neglect or abuse to protective agencies. Neglect can include self-neglect which should also be reported. As we mentioned above, your role as a home health aide puts you in a unique position to identify concerns. You may be the first person to notice that your client lives in an unsafe environment. 

How is Hoarding Disorder Treated?

Hoarding disorder is a mental health condition that affects and is affected by other health issues. It’s difficult to treat and not everyone sees improvement. 

Medication helps with underlying anxiety and depression that may be driving hoarding. Mental health therapy, such as cognitive behavioral therapy (CBT) is another mode of treatment. CBT helps patients learn new patterns of behavior by addressing the thoughts behind the behavior. Occupational therapists also play a role in helping people with hoarding disorders better manage their belongings and organize their days.

In severe cases of hoarding disorder, outside help—such as professional organizers or senior move managers—is required to make the living space safe again. It’s a tough balancing act because forcing someone with a hoarding disorder to give away possessions can cause distress and psychological harm. At the same time, the physical dangers posed by hoarded belongings are very real. 

It’s important to establish trust between the person who has a hoarding disorder and anyone helping them to create a safe living space. 

Final Thoughts 

Hoarding behavior and hoarding disorders are complicated. To wrap up, here are a few things to remember:

• Hoarding disorder is a mental health condition that should be taken seriously.
• Hoarding behaviors can create unsafe living conditions for seniors.
• Hoarding behaviors affect all aspects of health and wellness.
• Home health aides play a vital role in alerting the caregiving team to concerns about hoarding behaviors. 

Our senior move managers don’t just help with moves—we make your senior living space feel more like home! Contact us for more information.