Helping Residents with Hoarding Disorder Avoid Eviction

CFAR | April 06, 2017 | by Geralyn Magan

A pilot program developed by Senior Housing Assistance Group (SHAG) in Seattle helped 15 older adults with hoarding disorder avoid eviction from their SHAG-operated housing communities.

The year-long Eviction Diversion Program (EDP) was carried out in collaboration with The Hoarding Project, a Seattle-based nonprofit organization focused on supporting individuals and organizations affected by hoarding disorder.

SHAG and The Hoarding Project used a 2015 LeadingAge Innovations Fund grant to develop the program, which worked with residents whose hoarding issues kept their apartments from passing SHAG’s mandated quarterly apartment inspections.

“The managers are looking to see if residents are using their apartments as intended,” says Ashley Kraft, SHAG’s senior resident service coordinator, about the quarterly inspections. “Normally, people who have hoarding disorder are not able to use part of their bathroom or their kitchen, or they are using their bedroom as storage and sleeping on the couch.”

The quarterly inspections also focus on safety issues, says Kraft. For example, housing managers are particularly concerned about the risk that stacks of hoarded materials will fall and hurt a resident, that debris on apartment floors will present a fall or tripping hazard, or that piles of paper, plastic and other flammable materials will become a fire hazard.

Managers are most likely to get the attention of residents when they determine that paramedics would not be able to get a gurney to the very back of an apartment in an emergency. That’s when residents usually express an interest in getting help, says Kraft.

“I thought conversations (about EDP) were going to be difficult but they weren’t,” says Kraft. “I had 4 people who said they did not want help and that’s their right. But most of the residents were fully on board. They wanted the help. They didn’t want to lose their housing because of this situation. That makes me worry about the number of people out there who are suffering and who also want help, but who don’t know where to get it.”

Structure of the Program

EDP was managed by an interdisciplinary team that included:

  • Kraft, who served as a liaison between the team and residents;
  • A professional organizer who specializes in hoarding disorder and held weekly organizing sessions with program participants who had a hoarding disorder; and
  • Psychology students from Seattle’s Antioch University, who helped residents address the underlying mental health issues associated with a hoarding disorder. The students worked under the supervision of Jennifer Sampson, a family therapist who is The Hoarding Project’s executive director and an Antioch faculty member.

Addressing Different Types of Hoarding

The EDP team quickly learned that not every resident with a messy apartment has a hoarding disorder. Over time, team members used 3 categories to describe the behaviors of residents who had been referred to them by housing managers.

Hoarding Disorder: Therapists determined that 10 program participants had a hoarding disorder, based on the volume of the material they collected and the level of anxiety associated with those possessions.

Residents in this group met weekly with a therapist and worked separately with a professional organizer to take stock of their possessions and dispose of unneeded items.

“We realized early on that we had to have mental health providers involved in the project,” says Kraft. “There is often another diagnosis that goes along with hoarding. It could be depression, bipolar disorder, Obsessive-Compulsive Disorder, or another issues. So these residents need therapy. If you don’t have that one key component, then residents will do enough to pass their inspections, but then (the hoarding behavior) will come right back.”

During each session with the professional organizer, residents received an assignment that had to be completed for the next session.

“That gave ownership to the residents,” says Kraft. “It sent the message that we are not going to do the work for you. We are not going to solve all your problems. We will give you the tools to be successful. And then, you are going to help yourself.”

Situational Hoarding Disorder: Three participants in the program had a situational hoarding disorder. These individuals received help from the professional organizer, but did not require therapy.

“This might be a person who moved into an apartment and had not unpacked before they became ill,” says Kraft. “There is still a lot of work involved in teaching that person how to become organized and to use the environment to the best of their ability.”

Housekeeping Challenges: Three participants needed help only with housekeeping. These individuals were referred to housekeeping services, but did not receive other services.

Program Beneficiaries

By the end of the 1-year Eviction Diversion Program, all participants had passed their final apartment inspections, says Kraft. More important, she says, many had experienced a dramatic change in their lives because they were no longer burdened by hoarding.

“People often think that hoarders are lazy, but that couldn’t be further from the truth,” says Kraft. “They actually expend more energy than most of us, because they are always collecting things and moving things around. And they are constantly on the alert as they cover up their hoarding. They are living through quite an ordeal and it is exhausting.”

While residents who were able to keep their housing were the primary beneficiaries of the program, SHAG housing communities also benefitted from the intervention.

For example, housing managers got an opportunity to see program participants as individuals, not just as hoarders, says Kraft.

“They didn’t want to see anyone have to move out,” she says. “So as long as an individual was showing progress, they were willing to continue working with them.”

Housing communities also reaped a financial reward from the program. On average, the eviction diversion program spent $1,343 per participant for mental health therapy and professional organizing. This compares favorably with the $4,380 that the communities typically spend to process an eviction for housekeeping issues.

Kraft hopes that older adults with hoarding disorder throughout Washington state will eventually benefit from the fact that EDP exposed Antioch students to the satisfaction they could get by working with older adults.

“There are a very small handful of therapists in Washington that actually are hoarding specialists,” says Kraft. “So there is a huge need to introduce students to hoarding therapy and to show them how rewarding it is to help these individuals. We are hoping that the program convinced more students to specialize in hoarding disorder.”