How can cities tackle hoarding? Examining an intervention program bringing together fire and health authorities in Vancouver

Abstract

Hoarded homes can pose a threat to public safety, with heightened risks of fire hazards, pest infestations and noxious odours in both the home and neighbouring dwellings. Communities across North America are responding to these public safety concerns through a harm reduction approach. This descriptive study explores the implementation and outcomes of the City of Vancouver's approach involving a partnership between fire prevention and public health. Data were collected from the team's 2016–2018 case tracking systems, consisting of health records and team intervention record, as well as notes taken from case briefing meetings. Study objectives included describing the intervention model, providing descriptive statistics on clients and their clutter volume, the interventions undertaken, and exploring predictors of clutter volume and case outcome through exploratory analyses. The sample included 82 cases involving severely hoarded conditions or more moderate hoarding conditions paired with additional client vulnerabilities (e.g. health conditions, frailty). Results from paired samples t‐tests and regression analysis, suggest the Hoarding Action Response Team's (HART) model of a community‐based intervention for hoarding was associated with clutter reduction and tenancy preservation. HART successfully maintained engagement with most clients, and most cases were closed within six home visits. Despite these successes, the team dealt with several barriers including client avoidance and limited resources. This paper provides guidance for communities who are working to develop a coordinated response to problems associated with hoarding and begins to establish expectations for what can be achieved through a community‐based hoarding intervention model.

Evidence to guide ethical decision‐making in the management of older people living in squalor: a narrative review

“…Public sector responses to hoarding have primarily focussed on reducing the risk of harm to the individual, and mitigating the impact on others through environmental interventions. Clean‐ups can be effective in reducing clutter and preserving tenancy, 57 and are more tolerable if the older adult is engaged in the process 58 . Fire authorities have shown success in raising awareness of fire risks of hoarding households through education campaigns along with the free installation of smoke alarms, leading to higher success in containing fires to the room of origin and less property damage 59 .…”

“…Multidisciplinary teams have highlighted the lack of standardised responses, and inadequate funding and in‐home mental health services as significant barriers to achieving positive outcomes 61 . In addition, public sector providers who conduct expensive cleans identified the need for more training and improvement in multi‐agency service coordination 57,58 …”

“…Clean-ups can be effective in reducing clutter and preserving tenancy, 57 and are more tolerable if the older adult is engaged in the process. 58 Fire authorities have shown success in raising awareness of fire risks of hoarding households through education campaigns along with the free installation of smoke alarms, leading to higher success in containing fires to the room of origin and less property damage. 59 A novel programme offering neutering of female cats in animal hoarding households showed a 40% reduction in cat numbers at 12 months.…”

“…61 In addition, public sector providers who conduct expensive cleans identified the need for more training and improvement in multiagency service coordination. 57,58 Resource allocation and impact on others Older adults living in squalor can impose a burden on health system resources, and those around them. Findings in a case-control study indicated that compared with other psychiatric inpatients, older patients with squalor utilised more social services, stayed longer in hospital and were more likely to be discharged to dependent accommodations.…”

A critical review of cognitive behavioural therapy for hoarding disorder: How can we improve outcomes?

“…Two naturalistic studies indicate that harm reduction can be useful (Kwok, Bratiotis, et al, 2018; Kysow et al, 2020). In these studies, multidisciplinary teams consisting of individuals from local fire departments, housing, health and social services worked to help community‐identified hoarding cases meet fire and safety codes in their homes.…”