Clutter and Hording FAQ

A: Introductory phrases such as these can ease a client's anxieties when we first meet.

• "May I come in?" If a client says "No", accept that boundary and sit outside the door and talk from there.
• "How do you want me to address you? By your first name? Last? Mr.? Mrs.? Miss.? Dr.?" We then introduce ourselves in same degree of (in)formality they choose.
• "Why do you think I am here?"
• "I'm here to meet you, learn about your needs, and find ways to take care of your situation".

Initially, we don't mention the external circumstances that necessitated our intervention and a clean-up. Common examples include building or fire code violations, complaints by neighbors, court orders, or the need to accommodate a home care attendant. Discussion of these terms usually comes later, depending on how the work progresses.

We avoid using words that could feel judgmental, or drastic. Instead of "clean out", try "clear up", or "sort out". Instead of "you shouldn't", "you don't need", try "you deserve better", "lots of people do things like that", even "you deserve a lot of credit for making these changes". But, it is crucial to negotiate goals for discarding items, and keeping the client on track.

It's important to further engage the client by asking questions such as

• "Are there items that you have might have lost and can't find?"
• "What is the most important area to you – where would you like us to start?"
  We find beginning in the kitchen and bathroom gets momentum going and is best.

Kristin P. Bergfeld,
Owner, Bergfeld's Estate Clearance Service

A: Before bringing anyone in to do any work or engaging cleaners, we first meet informally with a client and anyone on their personal support team such as a trusted relative or social worker. If a client is in the hospital, we visit them there.

Kristin P. Bergfeld,
Owner, Bergfeld's Estate Clearance Service

A: In assessing the home in the first introductory meeting, we examine both the contents (personal property) and the structure itself. Look for patterns in the clutter. Check the plumbing, appliances, drains, electric outlets and wiring. Later, alert the building manager to repairs needed.

To write a contract, we review goals of all parties involved. Our contracts specify schedule, tasks, fees and expenses. Written agreements are essential.

We take photos of their apartment to review progress with them only if the client has given us prior permission.

Kristin P. Bergfeld,
Owner, Bergfeld's Estate Clearance Service

A: Yes, you need to ascertain if the building staff will be disposing of the items or if you need to hire a carting service. You also need to coordinate with management and have all the necessary supplies.

Disposing Discarded Items

If building staff is to dispose of discards which you bag, agree on an appropriate gratuity on a per bag basis.

If you need a carting service, get written bids from 2 or more companies. Check their license, insurance, and record. Guidelines for estimating volume:

• 60 filled bags plus a mattress and box spring add up to 6-8 cubic yards
• 100 bags plus 2 beds and 1 sofa will fill 10-12 cubic yards
• 150-200 bags plus 3 beds, 2 sofas will fill 20 yards

Check regulations for bulk items. Check municipal and state regulations for private medical waste such as 'sharps' (syringes) if applicable.

Coordinating with Management

Ask the Building Manager for and comply with their:

• Requirements for certificates of insurance, and coinsurance
• Procedures for service elevator and entrance
• Bathroom for use by cleaning staff
• Any other relevant building issues
• Scheduling minor repairs during your onsite work: e.g., inspecting electrical outlets, unclogging a sink

Organizing Supplies

We recommend using the following:

• Protective gear for all workers – face masks, gloves (both rubber and cloth), body suits, and caps. Change gear frequently.
• First aid kit, fully stocked with swabs, cleansers, bandages, disinfectants as well as paper towels. Be prepared for accidents. Stock plenty of water for cleaning staff.
• Alerts and protection for neighbors, building – use building paper and blue tape to cover public hallways; and yellow 'caution' tape, especially around a truck, dumpster, piles of discards.
• Most clients have health concerns. We use non toxic, heavy duty cleansers.
• Use 3 ml. thick, 30 gallon plastic 'compactor' bags. Don't overload them. If a bag is too heavy for you to lift, it will likely be too heavy for the Department of Sanitation. Use black bags for discards, blue or clear for recycling.

Kristin P. Bergfeld,
Owner, Bergfeld's Estate Clearance Service

A: While many people engage in hoarding behavior, clinically significant hoarding can be defined by three criteria:

1. The acquisition of, and failure to discard possessions which appear to be useless or of limited value
2. Living spaces so cluttered that their use is impaired or impossible, and
3. Significant distress or impairment in functioning as a result of the clutter

Randy Frost, Ph.D.,
Harold Edward and Elsa Siipola Israel Professor of Psychology, Smith College

A: Although we cannot yet determine the ultimate cause of compulsive hoarding, we do know enough about the problem to develop some theories about it. Based on what we know about this problem, we have proposed a Cognitive Behavioral Model of Compulsive Hoarding. This model suggests that hoarding is based on 5 interrelated deficits or problems:

1. Information processing deficits
2. Problems with emotional attachments to possessions
3. Strong beliefs about the nature of possessions
4. Motivational problems
5. Behavioral avoidance

Randy Frost, Ph.D.,
Harold Edward and Elsa Siipola Israel Professor of Psychology, Smith College

A: Close examination of the behavioral problems of people with compulsive hoarding indicates three main types of problems:

1. Compulsive acquisition
2. Saving behavior or difficulty discarding possessions
3. Disorganization in many areas of life, but that mainly manifests in extensive clutter

Randy Frost, Ph.D.,
Harold Edward and Elsa Siipola Israel Professor of Psychology, Smith College

A: Cluttered conditions in a senior's home may result from a variety of causes including physical frailty, dementia or hoarding behavior. Clutter becomes problematical when areas of the home cannot be used for their intended purpose (i.e. bed cannot be slept on, stove cannot be used for cooking) or possessions pose a safety hazard or endanger the senior's tenancy. Hoarding is a behavior characterized by 1) collecting items that either do not serve a purpose or are redundant 2) collecting but not discarding, 3) extreme emotional attachment to the items collected and an inability to part with them without significant anxiety and stress.

Amanda Leis, CSW
Hartley House

A: There are many factors involved in hoarding behavior in older adults, including obsessive compulsive disorder and dementia. According to a study of 133 patients with dementia admitted to a geropsychiatric ward, 22.6% had hoarding behavior (Hwang, et al, 1998).

Individuals with hoarding behavior related to dementia tend to have difficulty in engaging in sequential tasks, making cleaning and organizing more difficult. Additionally, if they experience delusions associated with Alzheimer's Disease, this subgroup will be more concerned with hiding their possessions as they may believe people are stealing from them. In the upcoming year, we will be developing guidelines on how to therapeutically work with hoarding behavior in adults with dementia.

Rosemary Bakker, MS
Research Associate in Gerontologic Design in Medicine
Division of Geriatrics and Gerontology
Weill Medical College of Cornell

A: Frequently, people with problematic hoarding behavior refuse help. It is tempting for concerned neighbors, friends and family to suggest that redundant articles are given away and useless ones, thrown away. However, researchers, such as Dr. Frost and others, have found that it is often more effective to focus on sorting possessions before suggesting removal of items. The de-cluttering process can be extremely slow and labor-intensive and is best accomplished if the person with hoarding problem is able to maintain a sense of control. A few motivational techniques proven to be useful include: discussions about the daily functions that can't be carried out because of the clutter, breaking down larger tasks into manageable small areas, and choosing target areas so progress is apparent. Since de-cluttering is likely to be extremely stressful, it is important to provide emotional support and encourage open communication about the emotional difficulties experienced during de-cluttering. It may be useful to enlist the assistance of a professional, such as a social worker or psychologist, who has had experience in dealing with people who have hoarding problems.

Janet Lessem, CSW
Associate Clinical Professor and Social Work Supervisor
Cardozo Bet Tzedek Legal Services
Benjamin N. Cardozo School of Law of Yeshiva University

A: Rarely do clients come to voluntary social service agencies with hoarding as the presenting problem. Rather, clients present with a pending eviction, landlord or neighbor harassment, refusal of heavy duty cleaning for home care eligibility, or some other need totally unrelated to hoarding, e.g., needing home delivered meals or assistance in applying for entitlements because of difficulty locating documents.

Some clues that a potential client might be a hoarder:

• Odor
• Unkempt appearance
• Hesitation at the mention of a home visit
• Statements such as, "My place is kind of a mess. I haven't been up to cleaning lately.", or "I'm not a very good housekeeper.."

Judy Willig
Executive Director, Heights and Hill Community Council

A: It is important to be non-judgmental in asking these kinds of questions and not show any shock at the answers:

• Are you reluctant to have people come over because of clutter in your home?
• Are you able to use your kitchen appliances?
• Is there a place to sit down and eat?
• Do you have to move things off the furniture to sit?
• Are you able to sleep in your bed? Do you have to move things off the bed at night?
• Are there clear pathways to the bedroom and bathroom?
• Are you able to get to and use your toilet, tub, shower?
• Do you have trouble finding things because of too much "stuff. in your home?
• Have you fallen over the clutter in your home?

Judy Willig
Executive Director, Heights and Hill Community Council

A: Many people who hoard are afraid of being "found out. and fear being forced to remove their clutter or are afraid of being evicted. As it takes time to develop a trusting relationship, suggest that you meet in the hallway or in the lobby. After a few meetings outside the home, with perhaps some non-judgmental discussion about the state of the home, the person may be willing to allow you inside to see their home.

Judy Willig
Executive Director, Heights and Hill Community Council

A: In the event a client needs emergency psychiatric care during a cleanout, it is useful to be prepared with the following phone numbers. If the client is under a psychiatrist's care, the worker should have this number. The psychiatrist can be contacted to see if he/she feels hospitalization is indicated and, if so, which hospital he/she would prefer. If the client is not under a psychiatrist's care but APS is involved, then it would be useful to have the number of the APS caseworker. Usually the APS caseworker is present during the heavy duty cleaning, but in the event he/she is not, it's a good idea to have the number of the supervisor as it might be necessary for APS to send one of their affiliate psychiatrists to assess the situation. If the client is without a psychiatrist, the names and numbers of family, friends and/or significant others are helpful as they can be contacted for support or backup as needed. The worker should also have on hand the number for the appropriate community-based mobile crisis team. If a call to "911. is indicated, one should have the number of the client's primary care physician to inform him/her of the client's distress and imminent trip to the ER. It is also helpful to have a list of the client's medications as this information will be requested by the EMS technicians upon their arrival at the client's home.

Susan Siroto, CSW
Program Director, Search and Care, Inc.

A: Whenever a person has pets that appear thin, sick, neglected, or excessively confined in unclean conditions, that person has more pets than they can properly care for, and is defined as an animal hoarder.

Stephanie LaFarge, Ph.D.
ASPCA

A: Animal hoarders may start out with good intentions but their irrational behaviors cause significant suffering to large numbers of animals in their care.

Stephanie LaFarge, Ph.D.
ASPCA

A: Most animal hoarders put their own health at risk through exposure to animal feces, malnutrition, alienation from family and neighbors due to excessive involvement with the animals. Their own health is neglected because they spend limited financial resources on the animals.

Stephanie LaFarge, Ph.D.
ASPCA

A: Animal hoarding is thought be a variant of obsessive-compulsive disorders. It is a behavior that can be managed and control, but rarely cured. Even after animals are removed, people are likely to resume collecting excessive number of animals unless closely monitored.

Stephanie LaFarge, Ph.D.
ASPCA

A: It is best to involve a multidisciplinary team made up of: social service workers, animal control or animal welfare agents, and members of the legal and housing system. Most animal hoarders are capable of responding to the efforts of a caseworker. But it is important to have the legal leverage to reinforce the fact that the animal hoarder must stop.

Stephanie LaFarge, Ph.D.
ASPCA

A: Animal shelters usually cannot absorb the many unadoptable animals that come from the homes of animal hoarders. The ASPCA will work with the hoarder to spay/neuter the animals so they can remain in the home. In New York City various animal rescue groups will also assist.

For more information please contact me at the phone number listed below.

Stephanie LaFarge, Ph.D.
ASPCA (212) 876-7700 ext. 4355

A: Yes, Adult Protective Services (APS), a state-mandated program, can provide free heavy duty cleaning for their clients, but only if they agree to it.

A person is eligible for APS is they are 18 years of age or older, regardless of income or assets and they meet all of the following conditions:

1. They have a physical or mental impairment;
2. They are unable to
   1. manage their own resources
   2. carry out the activities of daily living
   3. protect themselves from physical, sexual or emotional abuse, self-neglect, financial exploitation or other hazardous situations without assistance from others; and
3. They have no one willing and able to assist them responsibly.

Cases that are accepted as presumptively eligible for services will be visited within three working days, or within 24 hours in life threatening situations, by an APS caseworker. APS investigates referrals from friends, relatives, neighbors, private and governmental agencies, the courts and other concerned individuals within the community.

Many APS clients refuse to allow APS to perform heavy duty cleaning. If the client's tenancy is threatened as a result of this refusal, APS, through the HRA Office of Legal Affairs, will assess them to determine if a legal action can be brought for the appointment of a guardian. Guardians can be empowered to perform heavy duty cleaning on an involuntary basis.

Referrals to Adult Protective Services may be made by telephoning the Central Intake Unit during the hours of 9 a.m. and 5 p.m., Monday through Friday at: (212) 630-1853.

Dan Devlin
Adult Protective Services

A: In New York State Article 81 of the Mental Hygiene Law stipulates that a guardian may be appointed if a person is likely to suffer harm because of an inability to provide for personal needs and property management and is unable to adequately understand and appreciate the nature and consequences of such an inability.

Each Court Order should be individually tailored to address the specific needs and functional limitations of an incapacitated person. Frequently, people are referred to a guardian because of conditions of squalor, filth and danger in their home that has resulted from years of hoarding behavior. In cases where a judge deems it appropriate, therefore, the guardian may be given the specific authority and court mandate to obtain key access to a ward's home, conduct a heavy duty cleaning and apply for and obtain homecare services.

Michael Schmidt, CSW
Director, New York Foundation for Senior Citizens Guardian Services, Inc.

A: With regards to the cleaning, the answer is more straightforward. If a guardian has the powers to implement a cleaning, then the guardian can arrange to hire (if the guardian has powers over a ward's finances) a contractor to do the cleaning. Although the cleaning may be quite traumatic for the ward, such a cleaning can be done against the wishes of a ward. The guardian, of course, should take every appropriate step necessary to prepare his/her ward for the cleaning. Explaining what is being done, why it is being done and how the cleaning will be done can go a long way toward reducing some of the anxiety felt by the ward. Also, empowering the ward to set aside items he/she wishes to keep can be helpful. Ultimately, in some cases, the guardian will simply need to direct the cleaning contractor to proceed with the cleaning and throw out items the ward deems as "valuable" and "necessary." In certain cases, the guardian might be able to negotiate with the ward to save, for example, the previous month's copy of a particular magazine, but throw away the prior twenty years collection of that magazine. The guardian needs to use his/her discretion as to what items should be removed and what items can be salvaged and saved. The guardian should carefully supervise the cleaning because it is the guardian who is ultimately responsible for what is thrown out.

Once the cleaning is completed, the guardian generally wishes to prevent the ward from bringing (or hoarding) new items into his/her apartment. The ward may also require the services of a home attendant who can monitor the ward's situation while providing assistance in shopping, cooking and cleaning or with the ward's Activities of Daily Living (ADLs). If a ward can afford to private pay for home care services, the guardian may be able to negotiate with a homecare agency so that even if the ward will not allow access to his/her home, the home attendant will agree to attempt to provide services. This may or may not be successful and much depends on the ward's willingness to allow the home attendant to physically enter his/her home.

In cases where a ward has limited income and assets/resources and homecare is funded through Medicaid, there is generally less willingness on the part of the homecare agencies to provide services against a client's wishes. Home attendants who are not allowed entrance to an apartment, or to whom a ward is abusive once they gain access to the apartment, will likely refuse to continue to provide services. Additionally, although "safety monitoring" is an important (and often essential) function for home attendants in cases involving individuals who hoard, it is not considered a Medicaid approved service through homecare. Thus, in essence, wards who do not allow access to their home, are abusive to a home attendant, or who require a higher level of care, will be denied services by a Medicaid homecare vendor. This leaves the guardian in a difficult role: he/she might have the authority to implement homecare, but be unable to realistically implement it.

Michael Schmidt, CSW
Director, New York Foundation for Senior Citizens Guardian Services, Inc.

A: As home care companies have individual policies on safety in the home environment, discuss your client's situation with them. However, many home care companies will look for

1. working toilet and sink
2. adequate walking paths in rooms used on regular basis
3. safe walkway (appropriate flooring and caution with area rugs)
4. no infestations of insects and/or rodents
5. no excessive accumulation of garbage
6. absence of fire hazards, including
   • no combustibles near radiators or stoves
   • no blocked egresses
   • no overloading of outlets
7. a chair surface without clutter for a health care worker to sit on (if necessary)
8. working phone or nearby access to one (neighbor, etc.)

Rayna E. Taylor, MSW, CSW
Manager, Social Work
VNS CHOICE Community Care

A: Yes, various New York City Laws and codes (building, electric, fire, plumbing, health, etc.) mandate basic standards to ensure occupants' health and safety - and people with hoarding behaviors are often in violation of these standards. One New York City code is the Housing Maintenance Code (HMC), which overlaps many of the other codes, and applies to residential buildings. HMC establishes the minimum standards of health, safety, fire protection, light, ventilation, cleanliness, maintenance and occupancy in residential apartments in New York City.

The Housing Preservation Department (HPD), the nation's largest municipal housing agency, enforces the HMC and the Multiple Dwelling Law on all residential properties. Violations if not remedied, are grounds for eviction. Knowing what the violations are can be a powerful leveraging tool to encourage clients to cooperate in a minimum clean-up.

The HMC has a section specifically about what constitute grounds for eviction. Sec. 27-2009 of the HMC states that conduct that causes damage to the dwelling units or substantially interferes with the comfort or safety of another person is grounds for eviction.

Rosemary Bakker, MS, ASID
Research Associate in Gerontologic Design in Medicine
Division of Geriatrics and Gerontology
Weill Medical College of Cornell

A: The following examples are excerpts from the HMC. To view the entire sections of HMC, click here.

Blocking of Doors/Egress

Sec. 27-2007 Certain specific duties of tenants and others
In addition to other duties imposed upon him or her by this code, no tenant, or any other person, shall:
c. Place any encumbrance before or upon, or cause access to be obstructed to, any fire escape, or obstruct by a baby carriage or any encumbrance, the public halls or any required means of egress;

Not Allowing Owner or Agent to Enter Apartment For Repairs

Sec. 27-2008 Owner's right of access
No tenant shall refuse to permit the owner, or his or her agent or employee, to enter such tenant's dwelling unit or other space under his or her control to make repairs or improvements required by this code or other law or to inspect such apartment or other space to determine compliance with this code or any other provision of law, if the right of entry is exercised at a reasonable time and in a reasonable manner. The department may by regulation restrict the time and manner of such inspections

Unsanitary Conditions in Hallways Outside Dwelling Unit.

Sec. 27-2011 Cleaning of interior shared space
The owner of a dwelling shall maintain the public parts in a clean and sanitary condition.

Unsanitary Conditions in Dwelling Unit.

Sec. 27-2012 Cleaning of interior of dwelling units
a. The occupant of a dwelling shall maintain the dwelling unit, which he or she occupies and controls in a clean and sanitary condition except as provided in subdivision (b) of this section.
b. The owner of all rooming units in a rooming house or an entire multiple dwelling used for single room occupancy, or the person in control of an apartment containing rooming units, shall clean any such unit before change in occupancy and at least once a week during the period of occupancy and shall at all times maintain the same in a clean and sanitary condition.

Sec. 27-2022 Frequency of collection of waste matter from dwelling units in multiple dwellings

a. The tenant of a multiple dwelling shall dispose of waste matter in accordance with the method provided by the owner under subdivision (b) or (c) of this section. The tenant shall not accumulate any waste matter in his or her dwelling unit so as to create a condition, which is unsanitary, or a fire hazard in the judgment of the department.

Insect and Rodent Infestations

Sec. 27-2018 Rodent and insect eradication; mandatory extermination
a. The owner or occupant in control of a dwelling shall keep the premises free from rodents, and from infestations of insects and other pests, and from any condition conducive to rodent or insect and other pest life.

Non -Working Electrical Outlets
Sec. 27-2037 Duty to provide electric lighting equipment in all dwellings
b. Duty to provide electric lighting equipment in all dwellings. In addition to required light fixtures, the owner shall install and maintain such receptacle outlets as may be required by the electrical code.

Susan Carr
Director of Operations For Program and Materials
Management, Office of Property Services, HPD

A: The department responds to emergency complaints by dispatching inspectors to the property to verify the validity of the complaints and issue the appropriate violation to the landlord. There are 3 classifications of violations. Classifications are based on the effect of the violation upon the life, health and safety of the occupants of the building and upon the public. In cases of hoarding tenants, examples include

"A", non-hazardous, such as

• leaky flush pipe connections in the toilet (water closet)
• dirty and unsanitary walls

An owner has 90 days to correct an 'A' violation and two weeks to certify repair to remove the violation.

"B", hazardous, such as

• requiring removal of vermin.

An owner has 30 days to correct a 'B' violation and two weeks to certify the correction to remove the violation.

"C", immediately hazardous, such as

• inadequate means of egress
• remove accumulations of rubbish and clean and disinfect
• lead-based paint
• lack of heat
• lack of hot water
• lack of electricity or gas

An owner has 24 hours to correct a C violation and five days to certify the correction to remove the violation. If the owner fails to comply with emergency C violations such as lack of heat or hot water, HPD initiates corrective action through its Emergency Repair Program.

Susan Carr
Director of Operations For Program and Materials
Management, Office of Property Services, HPD

A: In city-owned buildings, the city is the landlord. As the landlord, the city attempts to prevent its tenants from becoming homeless by offering support services through the Division Of Property Management (DPM). DPM provides a variety of early and crisis intervention services primarily to families and tenants in HPD-managed buildings. These services include referrals to social service agencies, home visits, assessment of both the client and the dwelling unit, interaction with families, and relocation of tenants to new city-owned apartment units. In 1 out of 3 cases, TSS has been able to intervene successfully with tenants who hoard by relocating them to a freshly painted apartment with new furniture, larger closets, and working appliances, obtaining homemaker services, and providing on-going contact to continue support. These services are also provided to residents of HPD's emergency housing shelter program. To contact DPM regarding a client living in city-owned housing or in the emergency housing shelter program under HPD's jurisdiction, call (212) 863-7108. To find out if your client's building comes under the jurisdiction of HPD, click here. Tenants in public housing should contact the New York City Housing Authority (NYCHA) by calling 311.

Susan Carr
Director of Operations For Program and Materials
Management, Office of Property Services, HPD

A: Since a hoarding problem might possibly pose a hazardous fire, safety, health or nuisance condition to the tenant in question or other tenants, it is very important that the Development Manager be contacted about such a problem. Even though the Housing Assistant is the front line management representative who assists the resident with matters such as maintenance complaints, annual income reviews, transfer requests, social service issues, and nuisance complaints, the Manager would be aware of all pending actions concerning the resident. The Manager also makes referrals to NYCHA Social Services Department and Adult Protective Services. He or she would also be best able to decide the best resources, including their own janitorial staff, to tap into to assist the resident.

Each NYCHA development has a management office. You can call the management office phone number to contact the Manager of the development. To find out if a building is a NYCHA property, go to NYCHA's website at http://www.nyc.gov/html/nycha/home.html and click on the Property Guide button. You can search by "building address", "development", or "block and lot" number.

Andrea Richardson, Executive Department
NYCHA