People with dementia experience many changes, including memory loss, impaired judgment, and various behavioral changes.
At some point, your care receiver will lose the ability to housekeep and, after time, the living environment will become very cluttered. The person may feel a need to “keep things safe” or is afraid he/she may need the items one day. Usually, it’s extremely difficult for the person to throw hoarded items away.
What Makes a Person Become a Hoarder?
Hoarding is a complicated coping mechanism for someone with OCD or Obsessive Compulsive Disorder and it is surprisingly common. It is estimated that about 25% of people that suffer from OCD become hoarders. Hoarding is never an isolated behavior and develops alongside different mental problems, including dementia.
Essentially what happens in the persons mind who hoards, is that they become extremely attached to physical objects around them. In the case of dementia this can be anything from dirty clothes, food, boxes, string and rubber bands, to sugar packets, and papers. This is also accompanied with problems in decision making and they are often triggered by a fear of being robbed.
What makes the condition even more complicated is that the hoarding behavior is actually both the relief and the source of anxiety. While hoarding itself gives them some sense of safety and insulation from the “dangerous world out there”, it also isolates them from everyone else. Even the plain thought of throwing anything away can cause them overwhelming stress and even panic attacks.
How Do You Treat Someone Who is Hoarding?
As is any other type of OCD related disorder, hoarding is complicated to treat and difficult to manage. Mostly because the person himself does not see it as a problem. If the person doe not have a dementia, cognitive behavioral therapy and psychotherapy may help. However, if your care receiver has dementia, your best bet is to gently manage the behavior.
In addition to hoarding, people with dementia often hide their possessions, forget where they have hidden them, and then blame others for stealing them. Subsequently, the person may spend excessive amounts of time searching or rummaging through possessions and becoming upset while doing so. This could mean handling and turning over, again and again, the contents of an item. This behavior can be vexing for caregivers if the person is constantly taking things in and out of closets and cupboards.
How to Keep a Hoarder Safe
- Focus on fire prevention – Check for papers stored on top of or inside a stove or microwave, and near working radiators. Make certain the person has a working smoke alarm and arrange to have it tested each month.
- Focus on preventing poisonous ingestion – Be aware that people with dementia may not recognize that some things aren’t good to eat. Keep potentially dangerous materials such as cleaning fluids, plant soil, lotions, and medicines out of reach. Check the refrigerator regularly to make sure that rotten food is thrown away. Trade rotten food for fresh.
- Focus on fall prevention. Make certain that pathways are clear. Organizers like large plastic crates or wicker baskets may help if piles of newspapers and magazines are scattered about. Also keep in mind that some frail persons hold onto furniture while moving through the home. Observe how your care receiver gets around and make sure that any supports being used are stable. Also check for any slippery rugs that could cause falls.
How to Stop Hoarding Behavior
- Redirect the person’s attention to an enjoyable activity. Music, gardening, or kitchen activities can satisfy the need to be active and engaged. For some, repetitious activities, such as folding napkins or sorting colorful socks, scarves, or towels, can dramatically reduce rummaging behavior.
- Minimize the number of hiding places by locking or putting signs that say “NO” or “STOP” on places that you want the person to stay out of (unused closets or rooms).
- Provide easy access to some closet or drawers full of safe items, like dishtowels, scarves, and magazines for the person to rummage through.
- Limit the number of valuables or amount of cash that are within reach of the person with dementia, but be aware that your care receiver may become upset if he/she believes there has been a robbery.
- Keep the amount of junk mail to a minimum so the person has less to manage. If possible, arrange for bills to be sent to some one else for payment. Perhaps old mail with which the person cannot part can be better organized so it does not spill onto the floor.
- Remove nonessentials, such as out-of-season clothing, to lessen the clutter. Remember, however, that a person with dementia will experience increased anxiety if she/he believes that these possessions have been stolen.
- Buy two of those items that are constantly being searched for (glasses, hearing aids, keys, etc.). Have your care receiver’s doctor’s name on hand if duplicate prescriptions need to be filled.
- Look for patterns. If the person keeps taking the same item from you or someone else, give the person one of his/her own.
- Hire someone (or you) to help clean and keep things organized – the person cannot do this for him/herself. To view a list of creative ways to convince a person to accept help, click here.
How to Find Things Hoarder Has Hidden
- Learn the person’s hiding places. Items are often put in the same places, such as under carpets or mattresses and in shoes, handbags, pant or coat pockets, drapery lining, or drawers. Check wastebaskets for “lost” items (such as dentures wrapped in tissues or napkins) before they’re emptied.
- Choose bright colors for items that are consistently lost. For example, a key ring in a bright red stands out more on a cluttered tabletop. Or, if the person is willing, have him/her wear a brightly colored plastic coiled keychain around their wrist.
- Use a remote control item locator to find important items, such as keys, canes and purses.
How to Know What to Keep & What to Discard
- Remove only what’s necessary. If there are no safety hazards, begin by reorganizing (not throwing away) your care receiver’s possessions, even if you think the items are worthless. For example, if your care receiver insists on keeping large piles of rubber bands, junk mail, or sugar packets, organize the items in large baskets (supplied by you). Organize remaining clutter away from the walking path and other dangerous areas such as the stove, radiator, etc.
- Understand the coping mechanisms behind hoarding. For example, some people with dementia keep their belongings, including clothing, out in the open because otherwise they forget where they have placed them. There’s really no need to put their items away if this is helping them continue to function, especially in the beginning or middle stages of the disease. Other individuals may be willing to put their belongings away if large signs or labels, such as “Socks” or “Blouses,” help them locate their possessions.
- Be creative and negotiate! Keep a one year supply (not 20!) of a particular magazine or newspaper. Trade rotten food for fresh. Photograph belongings that the person will have a difficult time parting with; preserving the memories this way may help relieve the pain of parting.
- Declutter with or without your care receiver. If you declutter with the person, ask if you can help find something he or she is looking for or give the person a box with items for them to help sort through. Be sure to start slowly if you can, especially in the early stages of doing this, as short periods are generally better tolerated than longer ones. Some family members say it better to declutter without the person in the space, as long as only the essentials are removed and some “safe” clutter is left behind. But do realize that for some individuals, removing things without their consent can cause severe emotional upsetment. In either case, it’s always best to have someone available for psychological support (you, another family member, or even a social worker) after decluttering in the event your care receivers does become upset, and of course, have activities available to divert the person’s attention.
- Give a good reason to get rid of things. Some people will more readily give things up if told their belongings will be donated to charity, libraries, or needy relatives.
- Remove discarded items immediately. If you’re removing items from the home, it’s best to remove them immediately or the person may rummage through the garbage and bring the items back into the house. People have been known to drag heavy garbage bags back up the stairs, even late at night.
