Massachusetts Department of Developmental Services Risk Management 

Subject:	Hoarding

What is it?  
Compulsive hoarding or pathological hoarding (disposophobia or fear of disposing of possessions) is the excessive acquisition of belongings and failure to use or discard them even if the items are worthless, hazardous, or unsanitary. It is not clear whether compulsive hoarding is an isolated disorder, or rather a symptom of another condition, such as obsessive-compulsive disorder. 

What risk does it present?

Compulsive hoarding impairs mobility in a home therefore increasing the possibilility of falls and injuries. Hoarding interferes with basic activities of daily living, such as cooking, cleaning, preparing meals, showering, and sleeping. There is often a risk of infection from vermin and insects due to a lack of basic cleaning of the environment due to the clutter. This condition is increasingly seen as a mental health issue. 

How is it assessed and managed?

This problem often comes to the attention of an Area Office or provider due to complaints registered by neighbors or family related to the individual’s dwelling. In an effort to prevent a person’s home from becoming uninhabitable, a simple assessment of the environment can be conducted by caregivers to provide a baseline for further investigation by appropriate professionals

The HOMES Multi-disciplinary Hoarding Risk Assessment Tool  measures the level of risk in a hoarded environment.  It is intended as an initial and brief assessment to aid in determining the nature  of the problem and to organize a plan for further action-- including immediate intervention, additional assessment or referral. It is recommended that a visual scan of the environment in combination with a conversation with the person(s) in the home be used to determine the effect of clutter/hoarding on Health, Obstacles, Mental Health, Endangerment and housing Structure. The Family Composition, Imminent Risk, Capacity, Notes and Post-Assessment sections are intended for additional information about the environment, the occupants and their capacity/strength to address the issue.

Where and to whom do these recommendations and protocols apply?

This assessment may be used by anyone interested in the housing environment of individuals supported by the Department of Developmental Services

Where can I find additional help?
•	NAMI- www.nami.org
•	OCD Foundation- www.ocfoudnation.org

HOMES® Multi-disciplinary Hoarding Risk Assessment
q Health
	qCannot use bathtub/shower		qCannot prepare food		qPresence of spoiled food			qPresence of insects/rodents
	qCannot access toilet			qCannot sleep in bed		qPresence of feces/Urine (human or animal)	qPresence of mold or
qGarbage/Trash Overflow		qCannot use stove/fridge/sink	qCannot locate medications or equipment		     chronic dampness 	
Notes:______________________________________________________________________________________________________________________________  
q Obstacles
	qCannot move freely/safely in home		qUnstable piles/avalanche risk				
	qInability for EMT to enter/gain access		qEgresses, exits or vents blocked or unusable
	Notes:_____________________________________________________________________________________________________________________________  
q  	Mental health  (Note that this is not a clinical diagnosis; use only to identify risk factors)
	qDoes not seem to understand seriousness of problem	qDefensive or angry		qUnaware, not alert, or confused
	qDoes not seem to accept likely consequence of problem	qAnxious or apprehensive				Notes:____________________________________________________________________________________________________________________________ 
q 	Endangerment (evaluate threat based on other sections with attention to specific populations listed below)
	qThreat to health or safety of child/minor		qThreat to health or safety of person with disability	
	qThreat to health or safety of older adult		qThreat to health or safety of animal	
	Notes:____________________________________________________________________________________________________________________________ 
q 	Structure & Safety
qUnstable floorboards/stairs/porch 	qLeaking roof   		qElectrical wires/cords exposed  	 qNo running water/plumbing problems
qFlammable items beside heat source    	qCaving walls      	qNo heat/electricity     		 qBlocked/unsafe electric heater or vents    
qStorage of hazardous materials/weapons  Notes:____________________________________________________________________________________________________________________________ 

HOMES® Multi-disciplinary Hoarding Risk Assessment (page 2)
Household Composition 

# of Adults ____________ ___________________ # of  Children ____________________________   # and kinds of Pets _____________________
    Ages of adults: __________________________        Ages of children: ______________________        Person who smokes in home  Yes     No
Person(s) with physical disability______________________________________________ Language(s) spoken in home_______________________

Assessment Notes:_________________________________________________________________________________________________________   ________________________________________________________________________________________________________________________

Risk Measurements
q Imminent Harm to self, family, animals, public:_______________________________________________________________________________
q Threat of Eviction: _________________________________________ q Threat of Condemnation:_____________________________________

Capacity Measurements
Instructions:  Place a check mark by the items that represent the strengths and capacity to address the hoarding problem 
q Awareness of clutter
q Willingness to acknowledge clutter and risks to health, safety and ability to remain in home/impact on daily life
q Physical ability to clear clutter
q Psychological ability to tolerate intervention
q Willingness to accept intervention assistance

Capacity Notes:______________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________

Post-Assessment Plan/Referral_____________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________

Date: ____________     Client Name: _________________________________________________ Assessor: ___________________________________________