Hoarding is a prevalent and yet largely unseen problem. The latest edition of the Diagnostic and Statistical Manual of Mental Disorders includes hoarding disorder as a separate diagnosis within the category of obsessive-compulsive and related disorders. Persons with hoarding disorder have difficulty discarding possessions, even those that have little or no value. The accumulation of these possessions can result in physical, emotional, social and financial distress.
EMS responders need to be aware of the implications of hoarding disorder in order to achieve a positive outcome. Hoarders may accumulate different things, including animals, newspapers or items that are on sale, but the major problem is that their ability to manage their life and their home becomes compromised.
Most hoarders experience feelings of shame about the condition of their homes, so they may be reluctant to contact emergency services for fear of being found out. They may also be estranged from family and friends or may only ever agree to meet others away from their home.
The accumulation of items can result in injuries from falls, poor hygiene, poor nutrition because kitchen facilities are not accessible and an increased risk of fire because items are stored in or near cooking appliances and heating equipment.
Some outside signs that you may be dealing with a hoarder include an observation that all of the blinds are closed, evidence that the front door is never used, items stored on porches or in vehicles and unkempt yards. In extreme cases, access to the patient may be very difficult. Doors may be blocked by stored items and stairs are frequently left with only a narrow pathway.
In some cases, family members will resort to calling EMS because they can no longer care for the patient themselves. Additional resources may be necessary to safely remove the patient from the home.
In dealing with the patient, compassion for the situation is most important. The typical hoarder can't control the impulse to collect and retain the items that are causing the problem. Most hoarders recognize that what they are doing is wrong; they feel shame but many may also feel relief when their hoarding is discovered.
Once the immediate medical needs have been addressed, appropriate steps must be initiated to resolve unsafe and unsanitary conditions resulting from the hoarding. Understanding what resources are available within your community before you encounter a hoarding situation will make a response much smoother.
In many localities, the fire marshal's office will take the lead. This is because the fire prevention codes have sections dealing with fire hazards, egress, storage and other environmental hazards. The local health department and adult protective-services agency can also provide assistance in many cases.
In some cases, the property may be declared unfit for habitation until the owner or family can resolve the problems created by the hoarding. If the hoarding has taken place in a townhouse or multifamily unit, however, action must be initiated to abate life-safety hazards. There are contractors that specialize in working with hoarders to reduce the storage and assist in disposing of unnecessary items.
Whenever possible, the hoarder must be allowed to help in the process and have a say in what's kept and what's discarded. With the proper approach, many hoarders will cooperate with this process. Restoring an element of control to their lives will benefit their physical and mental well-being. Most hoarders feel overwhelmed by the accumulation, but can make progress if an outsider steps in and breaks the work into smaller tasks that the individual can manage.
Simply removing the accumulation resolves the symptom, but does nothing to address the underlying issues. Continued follow-up with a hoarder by an appropriate agency is critical to preventing a return to a dangerous situation.