Hoarding behavior: 4 EMS response principles
When you respond to to the home of a patient with hoarding behavior, these principles should serve you well
Updated May 17, 2017
Our patient was found on the floor of a cluttered hallway by a visiting relative and was not able to get up on her own.
After we determined that she only had some aches and pains and received her consent for treatment, the patient insisted on using the commode before leaving.
She had been on the floor for several hours, and her request seemed reasonable. We assisted her to the bathroom and gave her a few minutes of privacy.
"Can you tear me a square of paper?" she asked.
Seeing more than 20 rolls of toilet paper on the tank behind her and several unopened cases in the tub, I hastily tore off a big wad of paper for her.
She saw the length of paper and became enraged, berated us for wasting and ordered us to leave.
It took another 15 minutes to calm her and get her to agree to her original acceptance of transport.
Our patient clearly had a problem with hoarding. With the exception of narrow pathways, boxes and belongings were stacked floor-to-ceiling throughout the two-bedroom home. Piles of clothing on tables blocked the windows. Unopened paper goods and canned foods covered all of the kitchen counters.
As an EMS professional, you have probably seen your share of homes just like this.
In this video, Michael A. Tompkins, author of "Digging Out: Helping Your Loved One Manage Clutter, Hoarding, and Compulsive Acquiring," describes four behaviors that characterize hoarding:
- Excessive acquisition
- Trouble discarding
- Cluttered living space
- Distress and impairment
Responding to the home of a hoarder
When I am responding to the home of a hoarder, these principles have served me well:
1. Size-up the scene
Scan for safety risks to me, my partner, other rescuers and the patient. Those risks might include difficult-to-navigate rooms and hallways, unstable piles of belongings, weakened floors from the excessive weight of belongings, slippery surfaces, sharps or other medical waste being hidden by clutter, noxious odors and insect or rodent infestations. If the patient is able to self-extricate, it might be best to invite him or her out of the house for assessment and treatment. If the patient requires lifting and moving assistance, use proper PPE, and remove the patient to a safer environment for additional assessment and treatment.
2. Remember the reason you are there
I focus the time with the patient on assessment and treatment of the injury for which I was called rather than diagnosing or judging the excessive acquisition. Hoarding is a type of mental illness that we are not adequately prepared to treat or solve during our short encounter. Avoid body language, words or actions that judge the patient and the illness.
3. Keep calm; everyone keep calm
Avoid inducing anxiety in the patient by minimizing movement or removal of belongings. I inadvertently and needlessly caused my patient great distress with the toilet paper debacle. Although we have trouble understanding a patient's collection and attachment to belongings, it is not our role to clean or dispose of a life collection.
4. Activate other resources to treat hoarding behavior
Share your findings of unsafe living conditions to the appropriate agency in your service area. It could be law enforcement, social services or hospital staff. This is especially important if the patient's hoarding behavior is putting others at risk, such as children, a dependent spouse living in the home or neighbors in multiple-unit housing.
What have you learned about hoarding in your experiences and encounters? How has your agency safely assessed and treated patients with hoarding behavior? Tell us in the comments.