Buried in Treasure: Understanding and Addressing Hoarding in Affordable Housing

Transcription

1 Buried in Treasure: Understanding and Addressing Hoarding in Affordable Housing Ashley Kraft Resident Services Manager (206)

2 The Short Answer: What is Hoarding Disorder With the DSM5 hoarding disorder is a diagnosis, the common defini7on has 4 parts: 1. Excessive acquisi.on of stuff 2. Difficulty discarding possessions persistent difficulty discarding or par7ng with possessions, regardless of their actual value 3. Living spaces that can t be used for their intended purposes because of clujer 4. Causing significant distress or impairment (Frost & Hartl, 1996 )

3 What is Hoarding Disorder? The BIOPSYCHOSOCIAL Model of Compulsive Hoarding states that: Compulsive hoarding behavior arises from a variety of external and internal variables that are biological, psychological, and social in nature. We can t talk about one of these pieces without talking about the others! Family Cultures Social Biological Psychological Communi7es Environment

4 What s the difference between clutter, collecting, and hoarding? Clutter: possessions are disorganized and may be accumulated around living areas No major difficulty with excessive acquisi7on AND no major difficulty discarding items Can carry on normal ac7vi7es in home Collecting: new possessions = part of larger set of items - Display does not impede ac7ve living areas in home Hoarding: possessions become unorganized piles of clutter -Prevent rooms from being used for normal ac7vi7es Mo7va7on to display items: lost 4

5 Hoarding o o o o o Mental health disorder not a decision Not a moral issue; It is not caused by laziness, lack of standards, or lack of responsibility Clutter is only a symptom of the problem 92% of individuals have 1 or more other mental health conditions (e.g., depression, generalized anxiety, obsessive-compulsive disorder, social phobia) It is often characterized by low insight. Others are often more aware of or bothered by the clutter than the individual 5

6 Person Who Hoards Feel embarrassed Scatter randomly, often w/o functional organization Results in the loss of functional living space Feel uncomfortable with others or refuse to let others see (isolation) Often have debt, sometimes extreme Feel ashamed, sad or depressed after acquiring additional items.

7 How the Individual is Affected ü Difficulty managing daily activities, procrastination and trouble making decisions. ü Limited or no social interactions. (Isolation) ü Perfectionism: worry about making the right decision about what to do with each possession. ü Excessive attachment to possessions and discomfort letting others touch or borrow.

8 Signs of Hoarding.. Infestations (Bedbugs, Cockroaches, Gnats) Rotting food Human/animal waste Long-term neglect of home maintenance Non-working utilities, such as heat, running water, sewer and refrigeration 8

9 Reason to Keep They must keep it because A. Environmentalist B. Guru of Information C. Storytellers D. Collectors 9

10 What it looks like in our Buildings Extreme collection and storage of unneeded or seemingly useless items, including trash. Accumulation of combustible materials (keeping stacks of newspapers, magazines or junk mail) Blocked exits (doors/windows) Cluttered living spaces, narrow pathways 10

11 What that could look like 11

12 Health & Safety Complications Unsanitary conditions that pose a risk to health. (odors, rodents, roaches, pets, etc.) Increased risk: safety, fire hazard and death. Inability to perform daily tasks, such as bathing or cooking. (ADLs) Increased risk: loneliness and social isolation.

13 Ini7al Inspec7on Inspectors ini7al reac7on- Be professional Keep composure Be aware of non- verbal communica7on The reac7on sets the mood for how that resident will respond to you. Start to build trust Focus on safety Do not touch items or make comments on par7cular items unless you are discussing how to make the space Safe Take Photos- avoiding capturing personal iden7fiers (ask permission first) 13

14 Notification Accountability q Difference between 10 day and 30 day housekeeping notice q If resident does not pass the 1st inspection,10 Day notice for non-compliance should be issued and RS notified. q If resident does not pass the 2nd inspection, second and final 10 day to be given and RS notified. q If resident does not pass the final inspection, termination of tenancy issued and RS notified. q At any time a resident can sign up for a clean-up plan, where the PM, RS, and resident create a plan to work on unit room by room till clean-up occurs. (stipulation)

15 Resident Must Agree to ü Follow general guidelines ü Prompt reporting of repair needs ü Clear access to repair areas ü Prompt reporting of pest/rodent infestation ü Full cooperation with necessary extermination ü Agreement to managements inspection schedule (quarterly, monthly) 15

16 Animal Owners Must Agree to Cats: Proper daily removal of waste from cat litter pan, weekly disposal of all litter in the pan Dogs: Must be taken outside so that there is no feces or urine in the unit. Immediate pick-up of all feces on grounds and kept on a leash when in common areas. (Pet Policy) 16

17 Team Approach Interagency Team 1. Resident 2. Manager/Portfolio Manager 3. Service Coordinator 4. Maintenance Supervisor Coordinator Outside Support Team 1. Family (if possible) 2. Clinical therapist 3. APS/GRAT 4. Professional organizer 5. Professional cleaner 6. Exterminator/pest control 7. External storage company 8. State/county building sanitary code enforcement

18 Acknowledge your team, your roles and what we can do together Resident Goal: Retain residency Obligation: Property Manager Cooperate with the plan Goal: Healthy and clean community Obligation: Procedural FHA/ ACOP & cooperate 504 Coordinator (Reasonable Accommodation) Goal: Balance Obligation: Resident s rights to equal access and opportunities 18

19 Acknowledge your team, your roles and what we can do together Service Coordinator Goal: Support and prevent unnecessary eviction Obligation: Lease education/complianc Maintenance Supervisor Goal: Pest free building Obliga7on: Procedural FHA/ACOP and cooperate 19

20 Assessing Hoarding A clinical assessment or diagnosis of hoarding as a mental illness condition should only be done by a mental health professional. Property Manager s role is to recognize the symptoms, involve Resident Services and to assure the apartment passes routine HQS inspections, keep open lines of communication and share information. Intervention should be collaborative, although PM can be the first step in intervention at inspection time. 20

21 Understanding the Challenges of Working with People who Hoard Beliefs and emotions associated with objects Highly anxious Vulnerabilities (Time, Family History, Loss, etc.) Cognitive Distortions (Problematic Thinking) Motivation 21

22 Ineffective Intervention Strategies q q q q q q Making fun or allow jokes to be made Make decisions about a plan of action FOR a resident Argue/ persuading/ ridiculing Pressure the tenant to discard Tell the resident how to feel Give verbal and non-verbal cues that are judgmental or negative in nature 22

23 Effective Intervention Strategies q Be clear about expectations and limitations q Ask open-ended questions q Reflectively listen q Use respectful, non-judgmental language q Mirror the language used by the resident q Work with the resident instead of doing for 23

24 The Plan Step 1 Have a meeting to address concerns ü Resident, Service Coordinator and Manager (PM) ü Explain concerns regarding health issues Trash collections, pest infestations, odors, kitchen and bathroom fixtures accessible, operable and sanitary. Explain desire to make sure no HUD, housing safety violations exists: overloaded outlets, sprinkler heads blocked, vents clogged, extension cord hazards and exits and egress blocked 24

25 The Plan Step 1 ü Explain/set achievable goals to honor their rights, decrease the clutter and prevent lease rule violations - not a clean out - Create Safe environment ü Schedule monthly/quarterly/annual monitoring inspections and maintenance tasks ü Discuss the need for quick access to repairs Pest infestations, leaks, mold, structural issues, etc. 25

26 The Plan Step 2 Guiding the process, not making a mandate 6 C s Ø Clear guidelines, expectations Ø Calendar Ø Clear deadline Ø Clean up and trash removal responsibilities Ø Cost Ø Consequences for failure to follow guidelines

27 2015 Leading Age Innova7on Fund Hoarding and Senior Housing: An Evic7on Diversion Program Pilot Project Project Goals: To develop best practices for handling potential hoarding situations in senior housing. This program created the Eviction Diversion Program (EDP) which was developed in collaboration between Senior Housing Assistance Group (SHAG) and The Hoarding Project. The goals of this program were two-fold: 1) To assist seniors in avoiding eviction proceedings resulting from failed inspections due to housekeeping/ hoarding concerns. 2) Develop best practice recommendations for replicating this EDP in other senior housing facilities. 16 Total Participants 9 participants diagnosed with Hoarding Disorder by Mental health therapist 5 experienced clutter and organization challenges (no hoarding) 2 experienced Housekeeping issues only 27

28 Before During 28

29 EDP Pilot 29

30 Hoarding is a Housing Problem When it violates or progresses toward viola7ng: HUD Standards including REAC and HQS Local or state health and safety codes Animal cruelty standards 30

31 Hoarding is a Housing Problem The Lease (e.g.) Sec7on 6. TENANTS RESPONSIBILITY IN OCCUPANCY: G. Impairment of Neighborhood- Shall refrain from illegal or other ac7vity which impairs the physical or social environment of the project or neighborhood H. Maintenance/Damages 1. shall keep the premises and such other areas as may be assigned to Tenant for Tenant s exclusive use in a clean, orderly, safe condi7on, including but not limited to, cleaning drapes, windows, floors, cabinets, refrigerators, ranges and ovens... 31

32 HUD Sec HUD housing must be descent, safe, sanitary and in good repair. 32

33 Hoarding is An Apparent Disability 33

34 Person with a Disability Civil Rights Defini7on A physical or mental impairment which significantly interferes with one or more major life activities. In this case, the major life activity affected by hoarding includes housekeeping and possibly other activities, bathing, cooking, sleeping, etc. (ADLs) 34

35 Hoarding as a Disability Civil Rights Definition is functional, not diagnostic? (DSM-V) US Supreme Court: the person is unable or very restricted in the ability to do some daily life activity (housekeeping) 35

36 Reasonable Accommodation Applicable when: Resident requests an accommodation Resident has a disability Disability is cause of housekeeping problem. Nexus must exist between the disability and the RA request. 36

37 Reasonable Accommodation Applicable when: Disability is obvious or there is relevant verification including ability and willingness of resident to cooperate Accommodation does not pose undue burden require a fundamental change in nature of program 37

38 Undue Burden Financial burden No set formula Cost of accommodation vs. size and financial condition of owner s overall housing business Administrative burden (staff time) How much time? Effect on ability to carry out other responsibilities 38

39 Fundamental Change In the Nature of the Program Fundamental Nature determined by: Landlord-Tenant Laws Health, Safety (fire and building code enforcement) and Animal Protection Codes Funding source regulations Lease and House Rules Industry Practice 39

40 Reasonable Accommodation Plan Includes 1. Explain the specific standards in specific areas. 2. Determine an agreeable timeline for each step and deadline. 3. Agreement on who will be responsible for clean up and trash removal? Burden of costs? 4. Who will monitor and how often? 40

41 Reasonable Accommodation Plan Includes 5. Identify services resident will accept. 6. Acquire relevant ROIs. 7. Clearly state the consequences for failure to follow plan. (be consistent) 8. Conduct on-going monitoring. 41

42 Hoarding is a Legal Problem When It violates applicable housing health and safety Standards, including those for animals It endangers vulnerable people as defined by state law Children Elders Persons with Disabilities Mandated reporters 42

43 Seek Court Agreement When There is the potential danger self and to others (Adult Protective Services/Mental Health Professionals) Resident refuses to acknowledge the seriousness of the violation and unwilling to work with housing management to address the issues and concerns. For successful outcome it is important to involve service providers, family members, fire/building code enforcement, etc. (Document! Document! Include Photos) 43

44 Prevention and Education ü Early intervention Are Essential ü Host a community housekeeping meeting (Annual/quarterly) Show photos Set the standards Show the self-diagnosis photos 44

45 Have a Great Alernoon! Ashley Kral Resident Services Manager ashleyk@shag.org The linked image cannot be displayed. The file may have been moved, renamed, or deleted. Verify that the link points to the correct file and location. 45