October 24, 2015

Hoarding: How Case Managers Can Help



Hoarding is one of the most difficult situations to handle as a case manager. Hoarding is basically the excessive accumulation of items in the home.  This behavior significantly impacts the quality of life and can cause a number of health and safety concerns. In many cases, the situation is completely out of control by the time the case manager gets involved. In these situations, the case manager’s primary goal is to insure the health and safety of the client. Hoarding can lead to some serious health and safety hazards. An excessive amount of items piled in a home is a fire hazard and could prevent escape in an emergency situation. Hoarder houses are often in a less than sanitary condition. An unsanitary environment can lead to illness or exacerbate existing health problems. Hoarding is often linked with other mental health issues and just asking them to clean it up won’t solve the problem. People hoard for a number of reasons. Traumatic events, mental health disorders, and genetics are being studied as possible causes of  Hoarding Disorder.


In my experience with hoarding as a case manager, there seems to be an association with a mental health disorder as well as traumatic events that led to the hoarding behavior. It’s difficult to understand why anyone would want to live in such clutter and filth. The things we consider junk is seen as prize possessions and it’s extremely difficult to get them to part with these items. Even if the home is cleaned, it is often right back into a hoarder state within months.


Case managers are often involved when the situation involves someone who already has some mental health or developmental disability. In these situations, case managers are called upon to help coordinate services and provide oversight to ensure client safety. Here are just a few ways that case managers and service coordinators can help hoarders manage and improve their situation.

Collaborate with other Local Agencies- Hoarders usually need a variety of services to help stabilize their situation. It takes a collective effort from local code enforcement, protective services, and sometimes law enforcement, and attorneys. In some cases, a legal guardian may be appointed if the homeowner is found to be  legally incapacitated.

Contact Child or Adult Protective Services- Depending on the situation, child protective services (CPS) or adult protective services made need to be contacted to provide assistance. In some cases both agencies can get involved, especially if there is a situation with an adult with mental health disables and small children. The family may not consider this as helping but opening a CPS/APS case assist with finding resources to help clean and link the client to additional mental health services. The judge may also be able to order support services be put in place. APS/CPS can also provide long term case monitoring in addition to active case management to provide regular monitoring. Moreover, case managers are mandated reporters so a call to protective services is inevitable in this situation.

Research Hoarder Resources in the Community-  Hoarding resources are usually available in most states and localities. There are several local companies that offer cleaning services for this situation. The coordination between agencies is critical because these services can be expensive. Case management and social service agencies can pool resources and help defray some of the cost.  

Assist with Alternative Housing Options- Alternative housing may be needed during the cleaning process or if the house is deemed to be inhabitable. Again, this is time when case managers provide the linkage to community resources. Case managers in public agencies may be able to obtain funding for temporary housing in a hotel or other living arrangement. Some agencies that own group homes may also provide emergency respite services on a temporary basis. Case managers can coordinate this placement by finding the home and requesting the funds if needed.

Provide Emotional Support- It’s also important provide emotional support. In many cases, the client feels embarrassed and helpless in the situation. The client may also feel that their freedom and independence is being taken away. A non-judgmental, caring approach can play a significant role in persuading them to accept the help they need.

Assist with other Mental Health or Medical Issues- Provide assistance with obtaining counseling and addressing any medical problems. Each situation is different and additional counseling may be needed to handle the results of an extreme cleaning or being forced to leave their home. They may also need help to address any medical issues that resulted from living in an unhealthy environment. This is when researching local resources that assist with hoarding can come in handy. Many agencies offer counseling services in addition to the cleaning services. As with any case management service, constant monitoring and following is essential to helping clients maintain a safe, healthy environment.



Additional Hoarding Resources: Hoarders.org