A Holistic Approach to Hoarding Among Seniors


Westchester Family Care has from time to time encountered clients’ homes having an excessive accumulation of items and clutter, raising them to the level of hazardous to the client’s health and wellbeing.  When WFC Registered Nurses detect such hoarding behavior in the normal course of in-home assessments, we employ a comprehensive plan to make the home environment safe for clients affected by these issues.

Our team approach comprises purposeful phases and partnering with appropriate professionals to provide a total solution:

  • Detection of the hoarding problem;
  • Development and Ownership of a functional action plan, which includes Professional Organizers and Cleaning Services as partners;
  • Improvement of the home environment;
  • Follow-up to ensure likelihood that client is able to live safely in their home.

Understanding Hoarding Behavior

Wikipedia defines hoarding and its emotional components as:

“Compulsive hoarding, also known as hoarding disorder, is a behavioral pattern characterized by excessive acquisition of and an inability or unwillingness to discard large quantities of objects that cover the living areas of the home and cause significant distress or impairment.”

“Compulsive hoarders may be aware of their irrational behavior, but the emotional attachment to the hoarded objects far exceeds the motive to discard the items.”

WFC’s Holistic Approach to Caring for Hoarders

When WFC is contacted by a potential client, we conduct two assessments: the clinical needs of the client and a home inspection before the start of care. This home assessment is conducted by a Registered Nurse and is among the many benefits offered by a Licensed Home Care agency. Our RN’s are trained to determine home safety needs and whether health risks exist, such as:

  • Presence of stairs and their condition
    • Pet hair, dander, food bowls, other sanitary conditions
    • Would grab bars be appropriate?
  • Unsanitary conditions
  • Presence of overwhelming clutter

The home environment of a person with hoarding tendencies can be assessed as dangerous when s(he) has no room to maneuver and is consequently prone to falling or tripping. Alternatively, these types of home settings can be hazardous to the client’s health due to a lack of sanitary upkeep.

Detection of these circumstances leads to a multi-phase program of decluttering and clean-up, supervised and managed by WFC, thus ensuring removal of these risks. We remain the single point of contact for the client while partnering with professional decluttering and cleaning services. We can pay for these services directly to simplify the process for the client who, in turn, pays WFC.

The WFC process encompasses an initial assessment by one of our Registered Nurses to detect the presence of hoarding and / or unsanitary health conditions. WFC partners with members of the National Association of Professional Organizers (NAPO) and, depending on severity, two alternate paths of decluttering / cleaning the client’s home environment are pursued:

1. If the client’s home requires a ‘standard’ decluttering

The NAPO Professional Organizer goes through the clutter with the client and / or an adult relative to decide which items are absolutely necessary to keep. This can be a painstaking process as the senior client will usually have emotional attachments and be unwilling to let go. Professional Organizers are trained to understand these sentimental feelings but will push on with a firm yes / no decision.

In more severe circumstances, WFC will enlist from a smaller network of NAPO Professional Organizers who are specially trained to work in high clutter conditions, and who’ve demonstrated solutions to get more difficult decluttering assignments accomplished. These Partners / Organizers are very familiar with the emotional objections and work with WFC caregivers to effectively get the job done.

2. Most often this involves setting up bins labeled “KEEP” / “DISCARD” / “DONATE” and the process is successfully concluded.

There are times when either the client or adult relatives can slow down the process by spending excessive time on an item’s history or connection to family history. In these cases, the NAPO Organizer partners with the WFC caregiver to encourage the client to take time away so the professionals can get the job done in the home for review later in the categories above.

Once the home environment has been decluttered, WFC arranges for a qualified cleaning service that will methodically sanitize the entire household, allowing for safe and healthy surroundings in which the client can enjoy and thrive.

Finally, WFC RN’s and Management will continue to follow up to check on the client’s home condition. This ensures that the home hasn’t fallen into disrepair and the client’s hoarding is stabilized.

Throughout the entire process, WFC is completely immersed with its Nurses, caregivers, Professional Organizers and cleaning services to ensure that the client’s needs are best served.

Two case studies will illustrate how the format works and our intimate connection to every phase.

Case Study 1: Client with Parkinson’s Disease Has a Fall in the Home

WFC was referred to help a Parkinson’s Disease sufferer who had a fall in her home and ended up spending six months in hospital and rehab facilities. We were brought in to provide caregiving in anticipation of the client returning home.

A Registered Nurse visited the potential client in Rehab prior to discharge. This, too, is part of our holistic approach in that we need to assess that the client is safe to go home and ultimately, to live independently. Often, patients can be being rushed out of the institution to free up bed space while the client has lost muscle tone from 6 months of hospitalization and may need clinical or rehab care.

The Nurse was also dispatched to the home environment to inspect its condition for the client’s eventual return. The RN determined that the client was a person with hoarding tendencies and her fall was likely related to the cramped conditions in the household. Additionally, the home was unsanitary and the client would likely be at an elevated risk for infection once returning from hospital / rehab. The unclean conditions would affect not only the client but her family and the caregiver. Her return home was delayed until the house was decluttered and cleaned.

WFC contracted with a highly skilled NAPO Professional Organizer with whom we had prior experience in similar situations. The Organizer initially encountered resistance from the wife’s husband and their adult children who lived nearby. There was a lifetime’s worth of possessions and the family struggled emotionally about parting with these items. The family was also concerned about throwing out valuable belongings. The NAPO Organizer surmised the project’s completion would be delayed as result.

With the help of the Professional Organizer, the family was persuaded to use the “KEEP” / “DISCARD” / “DONATE” method and soon the Organizer and his team decluttered the house. The Organizer determined what needed to be done and when the time would be safe to bring the client home. At the end of the decluttering, two large dumpsters had been filled and the home was ready for the Parkinson’s client to return.

A WFC caregiver has been with the client and, 2½ years later, we are happy to report that all is well: the client has not had another fall and the home is still a safe and sanitary environment.

Case Study 2: Attorney in Degenerative Stages of ALS Shuts Down Office

An attorney with ALS had reached the degenerative phase of the illness and needed to close down his law practice’s office. He had been relying on his wife to help pack up a career’s worth of office files and legal documents. The spouse found the task to be overwhelming in addition to the emotional stress of her husband’s advanced state of ALS.

The attorney’s wife contacted WFC and specified that her husband needed a caregiver who was above the “run-of-the-mill.” An office examination revealed a typical 30+ year solo practice which needed to be dismantled with sensitivity. More revealing was that this is what the attorney wanted done during his last 6 – 9 months.

With WFC taking over the responsibility of the office, the attorney’s wife was freed up to tend to legal and medical tasks for her husband during his final days, with the help of a WFC caregiver. WFC was also involved in helping with the MD appointments.

Meanwhile, WFC assembled a team to manage tasks holistically, in tandem with each other:

  • Client … In this case, both the attorney and wife who were needed to identify the different levels of care and declutter needed;
  • WFC Caregiver … On the ground with both client and spouse; accompanying client(s) to his MD appointments; providing the necessary emotional support to both client and wife, above and beyond the challenges of ALS;
  • NAPO Professional Organizer … Painstakingly and effectively shutting down the attorney’s office in six months, to the satisfaction of both the attorney and his wife;
  • WFC Management … Managing clinical (nursing) and office team (schedulers) elements of the case, keeping the major players connected and abreast of each other’s activities.

Hoarding can be a challenge for a home healthcare agency. At WFC, it is our mission to treat each client on an individualized basis. Case by case, we’ve developed a holistic approach to hoarding, while always keeping our focus on what WFC can do to work through the individual situation.

Westchester Family Care Inc. assists people of all ages, by customizing home care plans to maintain healthy quality of life and safety at home. We let family members be family again while we provide the personal care.

Contact WFC for an immediate family need or when planning for future needs: info@westfamilycare.com, 914-764-7500, www.westchesterfamilycare.com.

Westchester Family Care Provides Peace of Mind and Confidence that the Elderly Are Safe and Living with Dignity in Their Own Home.

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