By Sarah McKay
As I entered the small apartment, I was met immediately with piles of books and bags of clothes that I needed to walk sideways to fit through. The living room was surrounded by different sets of dishes and china; the couch was being used as a bed; the bath tub was filled with shoes and the shower was used to hang clothes. The toilet and sink were covered with items and neither seemed functional. Everywhere I turned, I needed to be careful not to trip over anything. There was a distinct odor of spoiled food and garbage. I left the apartment feeling as though what I had seen could not have been real.
I experienced my first hoarding case during my internship at an Office on Aging. The woman who lived in the senior living apartment was in her 80s and had a history of hoarding, along with other psychological problems. She was known for wrapping her food in napkins from the dining hall and storing it in her room; she also used the public restroom for bathing. She eventually was evicted due to the poor living conditions and moved in with a family member. The social worker who had worked with this client in the past explained that her hoarding behavior was the result of a tumultuous childhood filled with abuse. The social worker was able to assist the client in sorting through her collections and explaining the need to have a safe living environment, but eventually those hoarding habits would arise again. It fell to the social worker with whom I was working to make the necessary calls to family members and come up with a plan for the client.
This type of situation is an example of self-neglect. Self-neglect is a form of elder abuse that is three time more likely to occur than physical abuse or caregiver neglect (Pavlik et al, 2001). Self-neglect in older adults is becoming more widespread as people live longer and stay in their homes longer. Hoarding is the extreme case of self-neglect that threatens the health, safety, and dignity of older adults (Poythress et al, 2006). The private nature of hoarding poses a threat because this type of behavior can remain unseen by the general public. Social service agencies in the community that service older adults can help monitor this behavior before it becomes harmful to the client.
As a graduate student pursuing a Masters in Social Work and a concentration in Gerontology, I learned a valuable lesson from this case. The social worker with whom I was working made the necessary calls to family members and came up with a plan for the client. During this internship I learned to distinguish between situations where there is self-neglect—and therefore a need for social work intervention—and those where the behavior represents a life style decision rather than compulsive hoarding that threatens a client’s safety. In the field of gerontological social work, each client, without exception, has an extensive life history that social workers must understand and respect. My goal as a social worker is to maintain and improve the story of the clients with whom I work.
Sarah McKay is an MSW student at the Cleveland State University School of Social Work. She holds a BA from John Carroll University in Sociology with a Concentration in Gerontology. In 2005, Sarah was awarded the Susan Friedland Gerontology Award for dedication in field work on aging studies. Sarah will be interning at the Louis Stokes V.A. Medical Center in Cleveland in their geriatric assessment unit.
References
Pavlik, V.N., Hyman, D.J., Festa, N.A., & Dyer, C.B. (2001). Quantifying the Problem Of Abuse and Neglect in Adults-Analysis of a Statewide Database. Journal of the American Geriatrics Society, 49, 45-49.
Poythress, E.L., Burnett, J., Pickens, S., & Dyer, C.B. (2006). Severe Self Neglect: An Epidemiological and Historical Perspective. Journal of Elder Abuse & Neglect 18, 5-12.