Hoarding and the Holidays

During the holiday season, we have occasion to interact with friends, neighbors and family members that we may not see very often. These holiday visits may reveal problems that we were not previously aware of. A problem that often goes unnoticed or overlooked is hoarding. According to the medical staff at the Mayo Clinic, hoarding is the excessive collection of items, along with the inability to discard them. While it is not uncommon for older adults to hold on to items that we would usually discard, when this tendency becomes excessive, and interferes with their ability to function and threatens their health, it can no longer be ignored. The home of a hoarder is unmistakable – there are piles everywhere and often only a narrow path remains to get around the house. Hoarding animals is a commonly example and the person may have as many as a hundred pets that are kept in conditions that are unsanitary.

Hoarding is often associated with an anxiety disorder called Obsessive Compulsive Disorder (OCD); however, some individuals who hoard do not have OCD. Therefore it may make sense to understand hoarding as a separate condition that has its own characteristics and treatment. Hoarding behavior appears to occur on a continuum ranging from mild to severe. Mild hoarding does not usually interfere with a person’s ability to function and is not usually identified as a problem by those who know the individual. Severe hoarding can lead to life threatening situations because of the unsanitary and hazardous conditions that typically exist in a hoarding environment.

It is not clear what causes hoarding, but it tends to run in families and the characteristics are usually first manifest in the early teen years. The behavior gets worse over time and that is why hoarders are usually only brought to the attention of authorities and the medical community when they reach their latter years. Other risk factors for hoarding include having a stressful life situation and it is more common in individuals who are socially isolated. Another identifying characteristic of hoarders is that they tend to be perfectionists and are very rigid about how things are done.

Just as the symptoms become worse with age, so the treatment becomes more difficult as a person gets older. Treatment is further complicated by the perception, by the hoarder, that there is nothing wrong with their basic need to collect things. They may concede that a specific situation is problematic, but they will not accept that there is anything wrong with the underlying tendency. How the person is approached can be pivotal in the success or failure of an intervention. A person who hoards will need reassurance about how their belongings will be handled and that the treatment staff have his/her interests in mind. Treatment is most likely to succeed if the ostensible focus of the treatment is something that the hoarder wants to change (i.e., something they subjectively experience as a problem). The inclusion of a trusted other can aid treatment. Attempts to treat hoarding have met with mixed success, but the most successful interventions combine psychotherapy (counseling that is aimed at understanding behavior and changing thoughts and behaviors) and medications (usually medications that effect serotonin levels in the brain).

Hoarding presents real and increasing danger to those who are afflicted and, because it tends to get worse over time, the earlier the person gets help the better. As family and friends of those who hoard, we may be in the best position to help the person understand that there is a problem and that treatment is needed. In cases of severe hoarding it may be necessary to get the authorities involved and for those over age 65 years county aging services may be the best place to start.

Help Your Parents Enjoy the Holidays - 6 Tips for the Season

The holiday season is a great time to get together with family to rekindle warm feelings and recall fond experiences from the past. However, family gatherings can also be stressful if we are not prepared or if we have expectations that cannot be met. As you prepare to gather with family this year, the staff of Helpwithmyparents.com offers some suggestions that will help you and the older members of your group have the best possible experience.

1- Be considerate
Remember that the older members of your group may not be able to maintain the same level of activity as the younger members, so plan activities that are suitable for all of the group. If an older family member suffers from memory difficulties avoid embarrassing them by asking them to recall an event from the past.

2- Be Prepared
If you are hosting the family gathering make sure that your home is accessible to older family members who may have limited mobility. Older members of your family group may not be as able to tolerate the noise and the strain of an extended gathering and it may be necessary to prepare a quiet room where they can rest.

3- Be Aware
If an older family member needs transportation make sure that it is arranged well in advance and that a suitable vehicle is available. If the older family member needs to take medication during the event make sure they bring it with them. Some medications will interact poorly with alcohol and it may be necessary to monitor the alcohol consumption of an older family member particularly if there is some loss of cognitive functioning.

4- Be Understanding
As we age our abilities and interests may also change, if an older family member cannot or does not want to engage in activities they may have engaged in in the past avoid attempting to persuade them to do so.

5- Be Open
Going into a holiday family gathering with expectations that are too rigid or inflexible will likely lead to disappointment for all, so try to open to the experiences as they occur and allow those present to be themselves.

6- Be…
Most importantly if we can relax and be our most warm, open and accepting selves, the holiday gathering can be a wonderful experience for all who attend.

Companion Site Launched

This week we decided to launch a companion site of HelpWithMyParents.com called HelpWithMyKids.com. In many ways this decision feels premature to me - the site still needs a lot of work on the topic pages and we have just begun to list providers who serve children and their parents. Nevertheless, the need is there, and the decision to publish the site now will spur us to action. It will also provide the opportunity for others to contribute as they see fit. The site is very similar in structure to the HelpWithMyParents site - it is in a wiki format so that those with expertise can contribute and providers of services can list themselves on the site.

Those of you, like me, who have young children and aging parents will quickly see why both websites are necessary. This point was brought home to me recently as I spoke at a conference on Multiple Sclerosis. I was demonstrating the information on the HelpWithMyParents site and a woman in the audience said that she thought the information was helpful, but that she would not have found it on her own because it was her child she needed help with not her parents.

I look forward to working with those of you who share my commitment to provide comprehensive and easily accessible information to people who are in need of services throughout the life span.

My Committment

In late 2006 after a visit from my good friend and colleague John Bowling I decided to start Helpwithmyparents.com. John and I have both worked for many years in the senior care industry - at first together as psychologists and later separately. John went on the work as an administrator and corporate officer for Silverado Senior Living and I operated outpatient psychiatric programs for seniors. John is now at Southern Oregon University where he continues to advance the cause of senior services and I am running a small outpatient mental health clinic in Salt Lake City.

When John and I get together we spend a lot of time talking about ideas and solutions to problems that we perceive. During that visit in 2006, one of the things we discussed was the difficulty the children of aging parents have finding comprehensive and coordinated information. It was shortly after this that I started working on Helpwithmyparents.com. My goal was, and remains, to provide a single website that can provide comprehensive informative content and information about all of the providers of services to seniors across the whole country. I want a person who lives on one side of the country to know all of the options that available to them, as they search for help for their parent(s), who may live on the other side of the country. I also want them to be able to access information about any situation, circumstance or illness that their parent may be dealing with.

This is an enormous task and it was two years before I felt ready to publish the site to web. The thing that finally allowed me to feel comfortable doing so was the decision to make all of the content pages into wikis (pages that can be edited by users), and to allow service providers to submit their own information to the site. In the 10 months since we launched the site we have made steady progress, but there is much that still needs to be done. Brent Pace has contributed significantly to the design and function of the site and Jeremy Rasmussen has worked wonders on the technical side. We are also now fortunate enough to have Carolyn Hunter whose knowledge of senior issues is proving invaluable to our ongoing efforts.

I made a decision early on that a website like Helpwithmyparents.com is only useful if it can provide free comprehensive and unencumbered access to users. Therefore we do not require people to log in to use the site and we do not charge providers to be listed on the site. I feel strongly that having free unencumbered access is the strength of Helpwithmyparents.com. My commitment to those who use the site is that we will never charge people to use the site and we will never charge businesses and organizations to be listed on the site.

It is my hope, and expectation, that we will be able to generate enough revenue through the banner ads that are available on the site to continue to fund the ongoing development and maintenance of the site, and that users will contribute to the content and provider information available.

The Critical Incident – Are you Prepared?

Most of us who have aging parents go about our daily lives without much thought about what our parents might need if they suddenly became incapacitated or severely ill. Our parents are relatively healthy and self-sufficient, but as they continue to age the likelihood that a critical incident will create a sudden need for us to intervene increases. At HelpWithMyParents.com we think of a critical incident as any event that rapidly changes the circumstances of an older adult, or couple, requiring rapid intervention by family or other concerned persons. Some common critical incidents include: a fall that results in significant injury, a death that exposes significant vulnerabilities in the surviving spouse, the onset of an acute illness (especially if it leads to a delirium). The critical incident may also result from an unexpected reaction to an elective surgery.

When these critical incidents occur, the need for action on the part of the adult children, and other caregivers, is often immediate and significant. The time and resource demands placed on loved ones can be very disruptive to their daily lives leaving them feeling overwhelmed. HelpWithMyParents.com was started as a response to the unmet need for a place that the adult children of aging parents could go to get all of their needs met when they are called to action.


There are several things that can be done to mitigate the impact of these critical incidents before they occur. The first thing is to make sure that there is a current set of advance directives. Beyond advance directives, it is also helpful to have a plan for who in the family (and non-family support system) will take on specific responsibilities. This type of planning may seem like a low priority when everything is going well, but a plan can be put together fairly quickly and the benefits down the road are significant for all involved.


If you would like to put together a plan to prepare for a critical incident but feel like you need help to do so contact us at helpformyparents.com and we will assist you.

Eden Alternative - Some Brief Thoughts

I recently spoke at a conference for nursing home staff with Brent Pace and our topic was how to apply the principles of the Eden Alternative within nursing homes. I really like the idea of the Eden Alternative and the wisdom in the principles as they are outlined. However, anyone who has been in a nursing home knows that it is no easy task to apply these principles in a meaningful way. Many are underfunded and understaffed and even more resist the fundamental change that would be necessary to really incorporate the ideas of the Eden Alternative. Although you may see some plants and even some animals you rarely see the spirit of the Eden Alternative being applied in nursing homes.

As we worked through some ideas about change with our audience, which was mostly social workers, we heard some good ideas from people who had made the effort to effect change in their facilities. One of the most profound things I heard was from a social worker who said that we need to make the environments more like homes where nursing takes place rather than the other way around. I really like this idea because I think it gets at the heart of the problem with most nursing homes – they don’t pay enough attention to the individual needs of their residents. I understand that it is easier and more efficient for the staff if all of the residents do things the same way (if they eat the same food and bathe the same way and even if they are all in wheel chairs so it is easier and quicker to move them around), but this forced homogenization does not make for good quality of life. When this issue is raised there is the common refrain – we do not have enough staff to do things differently.

While I think the problem is more complex that just under staffing, I do think that many facilities are understaffed in the social service and recreation areas and this often leads to programs that are designed so that everyone can participate. These programs are often very simple and of little interest to the higher functioning residents. One possible solution to this is to get more people in from the community to help. I offer three possible sources of extra help 1- university students – find students that have to have service learning hours as part of their classes and get them to into the facility to get those hours 2- family members – many family members have special skills that could be put to use in the nursing home (teaching crafts or other skills – musical performance) and 3- the unemployed – work with the local agencies to get people who are unemployed to volunteer in the nursing home while they are looking for a job – it will be a great service and could keep them from feeling unproductive.

What is a Neuropsychological Evaluation

A neuropsychological evaluation can be an important tool in helping your parent’s doctor diagnose conditions that impact cognitive (mental) functioning. It can be used to help refine the diagnosis of memory problems by distinguishing between normal age-related memory loss and dementia. It also distinguishes between dementia and temporary memory problems caused or affected by emotional disturbance.

Neuropsychological testing can also assist in differentiating between different types of dementia, and is an effective way to monitor progressive decline and to provide important feedback regarding the efficacy of cognitive enhancing medications.

There are many causes of dementia, including degenerative diseases, vascular disease, infections, traumatic brain injury, or combinations of these conditions. Some dementias are progressive, whereas others are not.

A neuropsychological evaluation provides a comprehensive assessment of cognitive (mental) functions including attention and concentration, memory, language, motor functioning, reasoning, and executive functioning. Alzheimer’s disease, strokes and trauma each produce different patterns of dysfunction.

A thorough neuropsychological evaluation provides the necessary information needed to identify the actual cause of the symptoms, or what is referred to as a “differential diagnosis”.

When ordered by a physician, neuropsychological testing is covered by Medicare and paid at 80% and most private insurance companies will cover the 20% copayment. An evaluation with a focus on memory loss and suspected dementia typically involves a one-hour diagnostic interview and approximately 6 hours of testing.