Strengthening Community Response to Hoarding Among Older Adults: Findings from a Blended Workforce Training and Home-Based Intervention

Background and Purpose: Hoarding is a common and serious mental health and public health challenge with severe consequences (e.g., health and safety hazards) yet, personnel training and in-home support for hoarding are deficient. Personnel from various domains (e.g., mental health, housing, senior care) encounter hoarding yet few have received training in evidence-based practices and community responses for hoarding. An Area Agency on Aging and University partnered to develop and implement capacity-wide training and programming focused on hoarding and clutter among older adults, utilizing an innovative “blended” approach to enhance knowledge, skills practice, and community provider networks. The purpose of the study was to evaluate the effectiveness of a “blended” training and an in-home decluttering intervention program.

Methods: Community personnel (N=112) completed this unique “blended” training including an online interactive self-paced course and in-person” practice-based training sessions delivered by a hoarding expert as well as pre-training and post-training surveys that included. Participants identified as 26% white, 22% Black/African American, 32% Asian, 19% Hispanic, 87% women, and 51% were ages 25-40. The majority of participants identified as a Case Manager (32%) or Geriatric Support Service Coordinator (31%). About 20% reported having a high school diploma/associate’s degree/some college, 57% had a bachelor’s degree, and 16% had a graduate degree.

Several agency personnel received specialized training on an evidence-based in-home coaching intervention. Six community-agency consumers participated in this individualized in-person home-based intervention. The majority of consumers were Black/African American (71%), women (85%), legally separated/divorced (71%), had a high school diploma/GED/associate’s degree (57 %), retired (71%), and on average 71 years-old.

Results:

At baseline 61% of participants reported being “not skilled”/“beginning skill” and 35% reported “moderate”/“advanced skill” for understanding strategies to support individuals with hoarding. Post-training, 73% reported “moderate”/“advanced”/“expert skill”. Across all competencies, paired t-test found that pretest to post-test competency scores significantly improved (e.g., developing and understanding intervention strategies (t(101)=9.19, p<.001) ; identifying intervention options and current treatment approaches with hoarding, t(102)=9.05, p< .0001). About 96% of participants agreed that this blended model will help them in their role for working with individuals with hoarding. Personal self-ratings of confidence (t(102)=4.02, p< 0.001) and comfort (t (101)=-3.03, p< 0.003) working with people with hoarding were significantly improved, from pre- to post-training. Pre-post improvement did not differ significantly by age or education.

Preliminary data for the coaching intervention show that at baseline, 57% of consumers rated their hoarding severity as extreme or marked. Baseline scores on the Hoarding Rating Scale was 24.3 and Saving Inventory-Revised was 56, indicating significant clinical levels. Results show 24% clutter improvement at post-test.

Conclusions:

This community-based research strengthens community capacity, promotes equitable participation and promotes dignity for older adults with hoarding, many of which are marginalized and stigmatized. This blended training approach provides opportunities for evidence-based interventions and enhanced community responses by strengthening local networks. Community personnels’ improved competencies and in-home decluttering support may enhance hoarding outcomes and mitigate health and public health risks.