This Full House
Mission A & O: Support Services for Older Adults is a not- for-profit social service agency that offers life- enhancing programs and services to older adults 55+ living in the province of Manitoba. A & O’s programs and services support and enhance the physical, intellectual, emotional, social and spiritual lives of older persons and actively promote participation in all aspects of community life. 2
Vision A & O: Support Services for Older Adults strives to be a recognized community partner in the development and delivery of innovative services that empower older adults to lead healthy, vibrant lives. 3
The Agency • A not-for-profit organization that provides programs and services to older adults 55+ • Established in 1957 in response to the need from older adults and their caregivers • Governed by a Board of Directors 4
3 Pillars of Innovative Programs & Services: • Safety & Security • Social Engagement • Counselling 5
Overview • Hoarding Disorder • This Full House • How to Help 6
Case Study: The Collyer Brothers 7
Case Study: The Collyer Brothers 8
Case Study: The Collyer Brothers 9
Compulsive Hoarding • The acquisition of, and failure to discard a large number of possessions that appear to be of useless or of limited value; • Living spaces sufficiently cluttered so as to preclude activities for which the spaces were designed; and • Significant distress or impairment caused by the hoarding. (Frost & Hartl, 1996 ) 10
Hoarding Disorder Diagnostic criteria for DSM-5 (Obsessive-Compulsive & Related Disorders category): A. Persistent difficulty discarding or parting with possessions B. Due to strong urges to save items and/or distress associated with discarding C. Accumulation of a large number of possessions that fill up and clutter active living areas so that their intended use is no longer possible D. The symptoms cause clinically significant distress or impairment E. The hoarding symptoms are not due to a general medical condition (e.g. brain injury, cerebrovascular disease). 11
Collecting vs. Hoarding Collecting: Hoarding: • Organization • Usually disorganized • Mint condition • Takes over areas of home • Kept in specific areas • Cause of distress • Quality of life not • Risk to health compromised • Pride • Safety concerns 12
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What Items Do People Hoard? • Clothes • Books/newspapers/paper materials • Food • Craft items • Containers • Trash 15
Who is Affected by Hoarding Disorder? • Often begins in adolescence, severity increases with age • Average age for seeking help: 50 • Often single individuals • Range of education and income levels • Women seek treatment more than men • Might occur alongside other conditions (i.e. depression, anxiety) 16
Possible Causes for Hoarding Disorder • Family History of Hoarding – Genetics, environment • Beliefs about Possessions – Sentimental value, utility, beauty • Cognitive Deficits – Differences in brain function and thought processes • Avoidance (C. Ayers, 2012) 17
Reasons to Save • Object has emotional significance • Losing important information • Wasting useful objects • Object is beautiful or unique • It “doesn’t feel right” to get rid of it (C. Ayers, 2012) 18
Possible Effects of Hoarding • Physical Health & Safety – Falls, tripping over clutter – Unable to use bed, eat at table, navigate stairs – Food poisoning – Infestations – Services may not be available (i.e. plumbing, electrical, Home Care) 19
Possible Effects of Hoarding • Emotional/Social – Shame, embarrassment – Anxiety – Depression – Feel overwhelmed – Family/marital discord – Reluctant to have visitors – Stress from family, landlords, etc. 20
Possible Effects of Hoarding • Financial – Cost of accumulating belongings – Moving due to eviction – Complying with City orders – Fines – Damage to home/property – Losing bills/important documents 21
This Full House 22
‘This Full House’ • Voluntary program for older adults (55+) that addresses hoarding and squalor • Client participation is essential • Uses cognitive rehabilitation and exposure therapy with the goal of harm-reduction • Involves counseling, sorting/cleaning services, follow-up, and referral 23
Squalor 24
Squalor • The state of living in unsanitary conditions which may include human or animal feces, rotting food, and infestations of rodents/insects • May or not involve hoarding behaviors • Like hoarding, squalor can pose a myriad of health and safety concerns • This Full House can assist with cleaning services and connecting individuals to appropriate resources 25
Demographics (2012 – 2013) Gender: Age: • Female: 74.6% 55 - 64: 40.5% • Male: 24.2% 65 - 74: 30.4% • Couple: 1.2% 75 - 84: 19.6% 85+: 9.5% • Varied levels of education, income • Diverse ethnic and religious backgrounds 26
Getting Help Referrals come from a variety of sources: • Self-referrals • Family/Other Supports • Community/Government Agencies • Housing Contact A & O and request to speak with intake *In order for referral to be made, consent must be given 27
What Does ‘This Full House’ Do? Assessment: • Background information • Are appliances working? • Where do you sit/sleep/eat? • Where do you keep important documents? • Is it hard to use your home because of clutter? • What are your goals for your home? 28
Social Work Support: • Coping with difficult life situations • Identifying who can help • Working towards goals • Focus on developing skills – Memory and Planning – Attention – Problem Solving 29
Social Work Support: • Work with individuals to make decisions about their belongings • Categorize items: discard, keep, donate • Commitment to homework/lifestyle change – 15 minutes per day, 1 hour per day, etc. • Over time, decisions get easier and distress decreases 30
Harm Reduction Approach: • Create safer living conditions by working on one goal at a time (i.e. pathway to front door) • Reduce collecting – i.e. 1 item/week • Address dangers (fire, falls, infestations) • Focus on key areas 31
Team Approach: • Work with Fire Department, Public Health, health and mental health professionals • Liaise with landlords, Residential Tenancies Branch • Agency volunteers/paid professional services • Follow-up services • Referrals to appropriate resources – Home care, transportation, meals, financial assistance 32
This Full House: Outcomes • Prevent homelessness • Access to resources/supports i.e. home care, mental health services, social supports • Improve quality of life • Facilitate lasting change 33
Program Statistics (2012 – 2013) • 181 new referrals in the past year • Over 1160 service hours • Social workers have worked with over 1000 clients carried over from previous years 34
Challenges • Lack of trust • Past attempts • Physical barriers • Mental health concerns • Dementia • Lack of motivation • Time/Deadlines 35
How to Help: Strategies • Establish trust and respect • Share concerns about safety • Curiosity over criticism – ask questions • Respect each individual’s process • Allow the individual to take control • Provide resources • Respect decision(s) • Encourage any progress • Be patient • Family – take a step back 36
• Avoid: – Judgmental language – Touching/removing items – Forced clean ups – Arguing – Overwhelming demands/unrealistic goals – Manipulation 37
Helpful Questions: • How many of these do I have? • Does this item have a ‘home’? • Does this item work/fit/fulfill a purpose? • Can I afford this? • Will I use this within the next week/month/year? • Can I keep this item safely? • Will this item help me reach my goal? 38
Ideas & Approaches • Be patient, progress takes time • Work on one area at a time • Categorize items • Preparation is key (supplies, filing system, storage) • Shred documents with personal information • Help is available! 39
A & O Services Safety & Security Social Engagement Counselling • • • Elder Abuse Senior Centre Information & Prevention Services Without Walls Referral • • • Safe Suite Program Connect Program Intake • • • Older Victim Entry Program for Counselling Services Older Adult • Housing Immigrants • SafetyAid • Legal Clinics • Centres/Meals • This Full House Programs 40
Funders United Way of Winnipeg 41
Thank you! Contact info: A & O: Support Services for Older Adults 200-280 Smith St. Winnipeg, MB R3C 1K2 Phone: 204-956-6440 Toll-free: 1-888-333-3121 Fax: 204-946-5667 e-mail: info@ageopportunity.mb.ca 42
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