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Hoarding case study. Michael Vapp, Care Manager, Aged and Disability Services City of greater G eelong. Initial presentation. 2009 received a referral from clients son for assistance with clean up of client’s home. Client background Early 80’s

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hoarding case study

Hoarding case study

Michael Vapp, Care Manager,

Aged and Disability Services

City of greater Geelong.

initial presentation
Initial presentation
  • 2009 received a referral from clients son for assistance with clean up of client’s home.
  • Client background
    • Early 80’s
    • Issues with short term memory loss and dementia (had not been assessed by memory clinic).
    • Client very reluctant to have assessment and saw no need for Home care assistance.
    • Pleasant polite lady
    • Had a very distinguished professional career.
condition of house
Condition of house.
  • Cluttered with rubbish
  • Very strong smell of discarded rotten food especially in the kitchen area
    • Piles of half eaten food left for long periods of time
  • Throughout the home clutter was at shoulder height with laneway through to each room.
  • Due to memory loss it appeared Client
    • Had not showered for a long period of time, but was usually adamant that she had showered that morning. Very reluctant to do so.
    • Clothes very dirty and did not want to change clothes
attempted interventions
Attempted interventions.
  • Attempts at clean up were very distressing for client. Refused any assistance with industrial clean.
  • Refused referral to Aged Psych team to discuss hoarding behavior. Hoarding not recognised in DSM at this stage.
  • No insight into hoarding behavior, felt environment completely appropriate.
  • Placed great value on her ‘treasures’.
  • After CCWs would put rubbish in bin client would go out and bring it back in again.
  • Could not put in HC due to condition of house and professional agencies that specialize in dealing with hoarders not local and not practical.
  • No support group for people with hoarding type behaviors.
attempted interventions1
Attempted interventions
  • Client could receive assistance through mental health plan with GP, but unwilling to discuss with GP as she felt there was no issue.
  • Could find no bulk billing psychologists who had any experience with Hoarding and none willing to visit client home.
  • Would not accept referral to memory clinic and son unwilling to pursue this with Mother.
  • Son would not support VCAT application.
the clean up
The clean up.
  • Only service client would accept was Meals on wheels but was enough to keep in contact with client and gain trust.
  • This service was in danger due to OHS.
  • After 2 years client finally consented to go into respite so that ‘emergency’ works could be carried out on home.
  • During this respite stay son carried out industrial clean.
after the clean up
After the clean up.
  • Client had little insight of clean up due to short term memory loss.
  • Commenced HC services, shopping.
  • Basic level of cleanliness but a constant struggle to keep clutter down.
  • Services continued until client moved into permanent care when clients dementia reached a point where she was unable to remain at home.
reflections on practice
Reflections on practice.
  • Without clients short term memory loss there could have been serious consequences to clean up .
  • Very supportive son in this particular case.
possible future interventions
Possible future interventions.
  • Currently working with Medicare funded counseling agency that is willing to provide home visits to work with clients with Hoarding behaviors . This service can be accessed through clients mental health plan.
  • Direct referral to psychologist.
advantages of referring directly to psychologist
Advantages of referring directly to psychologist.
  • Difficult to get client to acknowledge that hoarding is an issue and may not think it necessary to attend GP.
  • Reluctance to leave home. May be embarrassed.
  • Trust issues with GP, does not want clean up.
  • May be difficult to articulate their request for assistance through mental health plan.
  • May not have GP or ability to get transport to GP.
  • GP may not be aware of Hoarding.
possible future interventions1
Possible future interventions.
  • Care manager or client contact would assist client to liaise with agency and all work together to come up with a plan to support client and reduce clutter and address Hoarding behavior.