Treating Hoarding Behavior in Older Adults: A Guide for Caregivers and Family Members

Hoarding is a complex and challenging behavior that often requires specialized treatment. It’s important to understand that simply cleaning up the hoarded items will not resolve the underlying issues. Effective intervention involves a combination of emotional support, mental health care, and gradual change. For caregivers and family members of an older adult who hoards, here’s how you can approach treatment in a way that supports your loved one’s long-term well-being.

1. Understanding Hoarding as a Treatable Condition

Compulsive hoarding is treatable, but it requires a comprehensive approach. The first step is recognizing that hoarding is not just about clutter—it’s a mental health condition that involves emotional attachment to possessions. People who hoard often see their items as valuable or necessary, which can make it very difficult for them to part with anything.

Key Takeaways for Caregivers:

• Don’t Label Items as “Trash”: Avoid referring to your loved one’s possessions as trash or clutter. Instead, try framing them as potentially useful or valuable. Discuss with them how certain items might benefit others if donated, or how they could be repurposed. This can help reframe the conversation in a way that feels less threatening.
• Understand the Emotional Connection: Hoarding behaviors are often linked to deep emotional attachments. Items may represent comfort, memories, or a sense of safety. Approach the situation with empathy, acknowledging that their possessions are not just “stuff” to them.

2. Behavioral Health Evaluation and Intervention

People with significant hoarding behaviors require a thorough behavioral health evaluation to address the root causes of the disorder. Hoarding is often associated with other mental health conditions, such as depression, anxiety, or obsessive-compulsive disorder (OCD). Addressing these conditions is key to effectively managing hoarding.

What to Do as a Caregiver:

• Encourage Professional Help: Hoarding disorder requires professional intervention. Gently encourage your loved one to seek therapy or a behavioral health evaluation. You can suggest a visit to their primary care doctor or mental health professional, emphasizing that this is a step toward feeling better and improving their life.
• Therapy: Cognitive-behavioral therapy (CBT) has been shown to be effective in treating hoarding. CBT helps individuals address the thoughts and behaviors that contribute to hoarding, teaching them how to make decisions, manage anxiety, and let go of items.
• Medication: In some cases, medication may be prescribed to address underlying mental health conditions like depression or anxiety. Talk to your loved one’s doctor about whether medications might be a helpful part of their treatment plan.

3. Building Clean-Up Skills Together

While therapy and medication are critical components of treatment, caregivers can also play an active role in supporting the person who hoards. One of the key challenges in managing hoarding is helping the individual build clean-up skills without overwhelming them. Here are some strategies for working together on this process:

Steps to Help Build Clean-Up Skills:

• Start Small: Begin by selecting a small, manageable target area for cleaning. Trying to tackle the entire house at once is too overwhelming and can lead to frustration or resistance. Break the task into smaller, achievable steps.
• Assess Items in the Area: Help your loved one assess the items in the selected area. Guide them through a sorting process, helping them categorize items by their utility or sentimental value.
• Use a Sorting Technique: Everyone has a different way of organizing their possessions. Help your loved one find a sorting method that works for them, whether it’s categorizing by type, usefulness, or emotional attachment. Be patient as they work through the decision-making process.
• Avoid Empty Spaces: When cleaning up, avoid leaving the area completely empty. This can create a sense of loss or anxiety for the person who hoards. Instead, leave the space slightly populated with a few items that are meaningful or necessary.
• Maintain the Gain: Once progress is made in a specific area, take steps to maintain the changes. This could include setting up a routine for keeping the area clean or finding ways to prevent future clutter from accumulating.
• Move on to the Next Area: Once the current area has been addressed and the gains have been maintained, work together to identify the next area for cleaning. Be sure to celebrate each success, no matter how small it may seem.

4. Be Patient and Realistic

Treating hoarding is a long-term process that requires patience and persistence. Even with professional help and consistent support, change may be slow and setbacks are common. It’s important for caregivers to manage their expectations and be prepared for a gradual improvement.

Tips for Caregivers:

• Avoid Pressuring Your Loved One: Pressuring your loved one to dispose of items too quickly can backfire. It’s essential to respect their emotional attachment to their belongings and allow them to process the decisions at their own pace.
• Celebrate Small Wins: Hoarding can feel overwhelming, but even small steps forward are important. Acknowledge and celebrate every bit of progress, no matter how incremental.
• Create a Supportive Environment: Hoarding is often a deeply personal and sensitive issue. Avoid being judgmental or critical, and instead create a supportive environment where your loved one feels safe to confront their hoarding behavior without fear of rejection.

5. Seek Ongoing Support

Hoarding is a chronic condition, and ongoing support is crucial for long-term success. Encourage your loved one to continue with therapy and follow up with any prescribed treatments. You may also want to look into community resources or support groups for families dealing with hoarding behaviors.

Support Resources for Caregivers:

• Support Groups: Caregivers can benefit from joining a support group where they can share experiences and gain insights from others who are facing similar challenges. Support groups provide a safe space for caregivers to talk about their feelings and receive advice.
• Professional Organizers: If necessary, consider working with a professional organizer who specializes in hoarding situations. These professionals can provide hands-on assistance with the clean-up process and offer guidance on maintaining a clutter-free environment.
• Mental Health Professionals: Continue encouraging your loved one to stay in touch with their therapist or counselor, and consider joining therapy sessions when appropriate to better understand their treatment.

WHAT DOESN’T WORK	WHAT DOES WORK
Trying to intervene alone or referring to other organizations	Working as part of an intervention team
Expecting that a one-time clean-out will solve the problem	Understanding that the person who hoards will require long term, periodic intervention
Being dramatic, distracted, criticizing, nagging, etc.	Listening without judgment; being planned and steady
Total clean-out unless necessary to protect health, safety and sanitation; surprise clean-outs	Skill-Building
Exaggerating Consequences	Real Consequences
Treating only the symptoms	Treating the issues that are causing the hoarding
Not having goals or plan of action	Being prepared-know available community resources