New toolkit addresses challenge of clutter and hoarding in home care


Whether they’re caused by a chronic condition like arthritis, an accident, or aging, mobility issues and fall risks are always a top-of-mind concern for workers and clients of home health care.

What if though, you not only had to navigate the room with a cane or walker, but also had to wade through broken furniture, mountains of clothing and towers of old magazines and newspapers stacked to the ceiling? This is the unfortunate reality for many people whose physical mobility limitations are further complicated by clutter and hoarding. It was also one of the challenges VHA Home HealthCare (VHA) wanted to address in its research and development of The Community Clutter and Hoarding Toolkit released in February 2011.

“Since there’s a strong connection to hoarding and other physical ailments—including arthritis, hypertension, chronic fatigue syndrome, fibromyalgia, and diabetes—it’s not entirely a surprise to encounter hoarding as a home care professional,” notes Catherine Chater, an Occupational Therapist (OT) with VHA who co-authored the toolkit with Emily Levitt, also an OT with VHA. “Going in to fit someone for a walker in a home full of clutter becomes almost pointless if there is no clear path for the client to walk along. It’s really a scenario where a fall is just waiting to happen.”

Chater suggests Fred*, an elderly man living in a two-story home, is a prime example of a person with hoarding issues, and of a client who benefited from clutter management support. “When he was younger, scavenging and keeping things was actually part of Fred’s job,” says Chater. “Then his wife died several years ago and his health started to decline. That’s when the clutter began to literally pile up,” she notes.

When Fred was hospitalized after a fall, a VHA OT was called in to do a home safety assessment. What they discovered was an obstacle course of piles. “Every newspaper was kept along with a myriad of books, paint cans, lamps from the garbage waiting to be repaired, instruction manuals, his wife’s old clothes, cardboard boxes, rubber bands, you name it. Fred kept anything that he perceived he might use now or in the future.” VHA worked on helping Fred develop an awareness of why he felt he needed to keep everything.

“Fred gradually began to recognize that, to him, his papers and possessions represented his own contribution to the world. So if he threw these out, it was like stating he had no purpose left in life,” says Chater. Through ongoing work with an OT and support from another community agency worker, Fred was able to get rid of all newspapers greater than three days old and clear out much of the clutter. He is also at a reduced falls risk because he can navigate his home with far fewer obstructions.

It takes a village

“While there are other resources that address clutter and hoarding issues, the toolkit is the first resource of its kind to take a community-based approach to the problem,” notes Barbara Cawley, VHA’s Vice President of Client Services. “Our team of health-care providers kept encountering people living with excessive clutter. At the same time, we were being approached by community workers and concerned family members, asking for our help. This toolkit came out of a pressing need we felt wasn’t being met.”

The toolkit is unique because it provides practical information and worksheets specifically geared to three different areas of support in the community; health professionals; housing and community workers; and “helpers” such as a friend, family member or neighbor.

“We believe this resource gives workers in the community who encounter hoarding on the job some really practical tools to help manage the situation,” says Cheryl Perera, Director of New Ventures and Community Programs, who also chairs the Toronto Hoarding Coalition. She notes VHA will be launching workshops this spring to reinforce toolkit contents and help all community sectors come together to deal with the issue.

With an estimated five per cent of the population affected by the condition, hoarding is a bigger problem than first thought. “These are people’s fathers, sisters, neighbours and friends. And when the clutter gets so out of hand, it can be a real safety hazard for falls, fire, and infestation,” says Perera. “We hope that by sharing VHA’s expertise and knowledge, we can really raise awareness and together help those who hoard reclaim their living spaces and lives.”

For more information on The Community Hoarding and Clutter Toolkit, please visit

*Name has been changed.