Case Example: Hoarding Disorder from the Perspective of the Health Department

In the following case example, Meggan Tierney, Health Agent for the Town of Dennis, describes how the Health Department coordinated with other town agencies to successfully resolve a hoarding disorder complaint. The subject’s name has been changed to protect his identity.

Several years ago, the Health Department received a complaint of a hoarding situation from a Water Department employee. The Water Department was performing a routine meter reading at a single family home in Dennis. Needing to speak with the owner of the home, the employee knocked on the side entrance door of the home. The employee was able to see that the home was not being kept in a sanitary condition and referred a complaint to the Health Department.

Several attempts were made by Health Department staff to meet with the occupant of the home. Because the side entrance door was glass, staff could see into the kitchen and dining areas without entering the home. It was evident that there was hoarding and that a squalor situation existed. The galley type kitchen was passable only by a small path littered with papers and miscellaneous debris and the counters and appliances were stacked four to five feet high with belongings. The dining room was unrecognizable due to the amount of bins and belongings.

When we were finally able to speak with Tom, the occupant and owner of the dwelling, he was made aware of why the Health Department needed to access the home. Tom was an elderly man living alone. Our first impression of Tom was that he was a lonely man with possible mental and physical health issues. During our first meeting, Tom would not allow us into the home; he did however acknowledge his issue with trash removal. The kitchen contained many expired and rotting food items, old papers, and other garbage. The yard also contained trash and debris. Tom was willing to clean up the trash inside and out and we gave him one week to complete the task.

Needless to say, Tom did not comply with the order to clean up the trash inside or outside of the home. At this point, we felt that order letters and being “heavy handed” would not produce a successful outcome in this case. We made a referral to Protective Services and the Council on Aging (COA). The case was also presented to the Cape Cod Hoarding Task Force for opinions and assistance. Elder Services found Tom competent and able to make decisions. Tom refused their services; therefore they closed his case shortly after the referral.

Over the course of several months, the COA was able to make regular visits with Tom. We were able to fully inspect the dwelling and make a list of violations that were to be corrected in order to meet the Sanitary Code. There were many months of “two steps forward and three steps back”. Tom was willing to be a recipient of the “Big Fix” campaign which helped him get the exterior of the home cleaned up and repaired.

Tom’s insurance policy did not cover a home health aide or any type of cleaning services; therefore, funds were obtained through COA which allowed for a cleaning company to assist with a full clean out and weekly visits to ensure regular maintenance and upkeep. Tom was cooperative and grateful for the service, even though it has always been difficult for him to let things go. The clean out company and the COA have been able to help Tom organize his belongings and keep hallways and countertops clear.

It has been over two years since this case was opened. As with most hoarding cases, it has been extremely time consuming and required collaboration with several agencies. Once the squalor and immediate safety violations were corrected in this case, we stopped issuing order letters. We felt that Tom was cooperating with us to gain full compliance and further order letters would only put our Department in an impossible situation to regulate. Tom was getting the help he needed through COA and the home clean up company. Email communication and phone calls between the Health Department and the other agencies involved have minimized the amount of time we have needed to spend at this particular home.

Hoarding cases by nature usually require social services. Personally speaking, Health Departments should leave the mental/social work to the professionals; they are trained to deal with it. As Health Agents, we are compliance driven; we look for results within an allotted time frame. Our Codes and Regulations dictate the actions we need to take in order to comply. Often times, hoarding cases last well beyond the timeframe of any order letter we issue. Patience and multi-agency involvement are keys to a successful conclusion to a hoarding case.