MARCH 2010 • ON THE JOB

Hoarding is getting a lot of attention these days on talk shows and as the subject of a reality TV series. But for public health nurses who deal with hoarding every day, it isn’t entertainment — it’s serious business.

Ask Carolyn Crisp. She is one of three public health nurses with the Health Hazard Prevention and Management team in Ottawa Public Health, which gets more than 250 referrals a year. Crisp works with health inspectors, social services, police and fire departments, housing and other agencies to provide people who hoard the support and services they need.

Crisp sees an average of three to four hoarding clients a week. Typically, a call will come from someone in the community — a neighbour or family member — that a property is being neglected, or that there’s a concern about a person who lives there.

Nurses never go in alone, says Crisp. Depending on the situation, a fire prevention officer or public health inspector will check the home for threats to health and safety, such as flammable materials or blocked exits, and order the hazards eliminated. Failure to comply can result in fines or eviction. If there is a chance that the person might be angry or violent, Crisp will ask the police to come along.

During visits, Crisp establishes a rapport and tries to build trust while assessing the client and the extent to which the hoarding interferes with normal daily activities. Some homes are so cluttered the occupants can’t use the kitchen or get into the bathroom, she says.

“As nurses, we’re looking at the person and how they are coping,” explains Crisp. “We don’t want to take anybody out of their home. We want to make sure they are able to manage and can stay in their home for as long as possible.”

Excessive hoarding poses risks to the individual, family members and those nearby. Children or elderly relatives may have to be removed from the home, and eviction and homelessness are potential consequences. In extreme cases, hoarding can have life-threatening results. The cumulative weight of books, old clothes and broken appliances can cause floors to collapse. Fires are common.

Clutter-filled homes are dangerous for hoarders and for the police, paramedics and firefighters who may have to go in and climb over piles of stuff to rescue them. “Every second counts when you have to get out of a burning house,” says Crisp. “Hoarding means the chances of making it out alive are slim.”

Hoarding raises the risk of falls and accidents, and clutter, trash and feces from humans or animals can result in mould and infestations, causing breathing and other health problems. “The smell of ammonia from the accumulation of urine can be unbelievable,” says Crisp, who wears gloves, steel toe boots and a respirator mask on the job.

Since starting six months ago, Crisp has seen her share of rats and roaches. After 18 years working part time at Ottawa’s Sexual Health Centre, she says the change was a bit of a shock, but she finds the work rewarding. Each case is different, and she enjoys the many learning opportunities.

Although she encounters homes that do look like the ones on the reality show Hoarders, the “dig out” depicted on TV isn’t part of her job. “Our role is to make sure clients get the help they need to deal with their issues. We may need to set them up with a family doctor, link them with a counsellor or find a cleaning service,” says Crisp. “We’re like the middle man.”

People who hoard save items that some would consider useless or of limited value, she explains. Many are emotionally attached to their possessions and become anxious when confronted with discarding them. These attitudes make changing hoarding behaviour difficult. Some people deny they have a problem or are oblivious to the risks.

Others want to clean up but don’t know where to begin; they may be completely overwhelmed and unable to organize or sort their belongings. Still others simply refuse any help.

“Hoarding is a sensitive issue,” says Crisp. “We try to help without humiliating or demeaning the individual. We want people to maintain their dignity.”

Lise Barrette, Crisp’s nursing supervisor, has been dealing with hoarding for nearly 10 years. She notes that although everyone collects one thing or another, these clients take it to a different level. “Emotions run high with this kind of work,” she says. “You have to be nonjudgmental and not take anything personally.”

Barrett says it is great to see successes and to have clients reconnect with family and friends, but she admits the work can be frustrating and that you have to expect relapses. Clients who are making progress will suddenly refuse to let a worker in or abruptly cancel the cleaning service.

“You have to accept that you can’t help everyone. Sometimes clients make the decision to live at risk. Those are the most frustrating cases,” she says. “You know it’s just a matter of time before something bad happens.”