Storz Fiduciary Services

I have worked with Elder Care Management since 2015 and support their advocacy for
my clients as well as other fiduciaries’ clients. For questions regarding trainings,
community events, and supporting May as National Aging Life Care Month, contact
Maureen Lawrence at maureen@eldercm.com

Hoarding and Older Adults

By Felecia Juntunen, Director of Elder Care Management – Posted May 2024

Among the challenges that confront Aging Life Care professionals, working with a client
who has hoarding behaviors is one of the most perplexing. Families may engage a care
manager when they’ve discovered an aging parent or loved one’s safety and well-being
are jeopardized by excessive clutter in their home. In our practice, we have encountered
situations with varying degrees of hoarding: from a client who collected shopping bags
full of drugstore items that were never unpacked or used, to those whose homes were
impassable because of many saved items including garbage and old food. A care
manager’s task in these circumstances is multifold as they work to address the needs of
their client while also helping families or other concerned individuals understand how the
issue can be addressed. Care managers collaborate with other service providers to
discern how and when to intervene in a hoarding situation, how to overcome an
individual’s resistance to help, and how to evaluate whether the hoarding behavior is a
choice or the result of diminished capacity.

In her article, “Hoarding and Elders: Current Trends, Dilemmas, & Solutions,” Emily Saltz
explains the basic tenets of hoarding behavior. Hoarding behavior typically begins early
in life – usually by the time a person is adolescent, and it can take years or decades to
develop until it becomes an obstacle to functional living. A central characteristic of
hoarding is continuously bringing items into one’s home – whether with excessive
purchases or collecting random items. Those with hoarding tendencies cannot categorize
or organize their belongings and are disabled by the thought of discarding or parting with
an item. They typically have little or no insight into the problem and experience significant
denial about their situation. People who hoard may be prone to experience depression,
social phobia, isolation, anxiety, or substance abuse. Hoarding is further complicated by
aging. The effects of chronic illness, physical and mental decline, and increased isolation
compound the problem. When dementia is present, hoarding can present a significant
obstacle to health and safety as those with dementia are even less able to differentiate
the importance of items or deal with the effects of their hoarding.

While the cause of hoarding behavior can vary from individual to individual, it is
understood that previous trauma and unresolved grief are common driving factors. Those
who hoard receive emotional comfort from acquiring items and have a compulsive need
to control and manage their belongings. It’s important to understand that denial is a
prime characteristic of those who hoard and presents a formidable obstacle to treatment.
Hoarders would prefer to live in a cluttered and unsafe space than forfeit their
possessions. There is no easy solution for hoarding and current forms of treatment have
limited success. It is now recognized that the forced removal of possessions without an
individual’s permission can cause feelings of violation and additional trauma. Care
managers tend to concentrate their efforts on what is referred to as a harm reduction
approach – focusing on helping the individual with hoarding tendencies to live more safely
rather than eliminating the hoarding.

Providing compassionate support begins with the hallmark of quality care management:
a good assessment. Aging Life Care professionals will screen for capacity and consult with
other professionals for an objective and clinical perspective. Determining if the person is
legally competent to choose their lifestyle is critical in determining how to mitigate any
issues created by their hoarding. The goal is to protect the autonomy of the individual
(their fundamental right to their own decision-making) and balance that with their
safety. Developing a trusting relationship with the person who hoards is essential to any
success in working with them toward some resolution. As trust develops, care managers
can encourage treatment for underlying conditions like depression and anxiety. When
empathy is conveyed that respects the individual and the meaning of their possessions,
goals can be developed that enable them to maintain a sense of personal control as they
collaborate with the care manager to improve their safety and wellbeing.

Saltz, Emily B., “Hoarding and Elders: Current Trends, Dilemmas, and Solutions.”
Journal of Geriatric Care Management, Fall 2010, pp. 4-9.