Should home care workers be cleaning the squalid residences of hoarders?

Home carer resident hoarder

A member of HelloCare’s Aged Care Worker Support Group on Facebook reached out, asking for their advice about how to handle this situation, explaining it’s one of the worst jobs she’s ever had.

She said the client won’t allow anyone other than her to help them clean the house.

However, the support group member has no cleaning training, and is concerned about working in such an unhealthy environment. She says performing the work is damaging her mental health.

Her client self manages his care, leaving the support group member trying to manage the situation on her own.

But is such heavy-duty cleaning the responsibility of a home care worker?

It’s not your job

Many members of the group responded with the advice that heavy cleaning is not the job of home care workers, and that ‘specialised cleaners’ should be used for cleaning up a hoarder’s home.

A number shared their experiences of cleaning whilst caring, as some of them have regular clients who are hoarders.

One member said she had worked as an industrial cleaner before working in aged care, and this was the type of work she did then. She said they are professionals.

One member of the support group said she focused on the kitchen and the bathroom, and clearing a space that allowed her to move through the house more easily.

A couple of members of the support group said hoarding in houses they had cleaned contributed to fires.

Some admitted they actually liked cleaning for hoarders, explaining it was hard work but rewarding.

​​Commonwealth Home Support Programmes provide specific plans for the job: one-off cleaning and linkages with specialised support services for “hoarding and squalor”.

Better monitoring and oversight of home care needed

This case demonstrates some of the problems plaguing the home care sector, as outlined in the Grattan report, which was released this week.

Home care assessment is not integrated sufficiently into care delivery or planning, meaning that consumers have trouble accessing information and finding the services they need.

“When older people get through the assessment process, many do not get enough support and advice to make informed choices to meet their needs,” the report stated. 

Older people are supposed to be able to choose and buy the services they need, “but in practice participants often report a lack of choice about the carers and other staff coming into their home”.

A “team-based” model of care is needed, combining in-home domestic and community support, among other types of care, the report’s authors recommended.

They also noted the poor conditions home care workers work under, with a casualised workforce and low rates of pay. The workforce is often dissatisfied and there are widespread worker shortages.

Hearing about this support group member’s situation, it’s not difficult to see why.

Workers should be able to choose

Mable, the online platform that matches customers needing home care with workers who can provide those services, allows recipients of home care services to ‘self manage’ their care, as is the case in this situation.

It has providers who offer services like “squalor cleaning”, and consumers who need those types of services. 

“The needs of a consumer are usually outlined in job posts, direct messages or the meet and greet process ahead of a support provider attending a home,” a Mable spokesperson told HelloCare.

“After discussing the needs, an agreement is entered into which outlines the terms and scope of the services to be provided.

“If a support provider believes there is a risk to their health and wellbeing or that of the client, they can lodge an incident report.”

The freedom to pick and choose work is one of the advantages of being an independent home care worker.

Home care workers can be specific about the kinds of work they want to do, and are perfectly within their rights to refuse work they feel is outside their capability, or that they simply don’t want to do.

Similarly, if they begin working in a role, they can choose to leave that role at any time. 

Hoarding is a complex disorder that will usually require specialised care, both psychologically and practically when it comes to cleaning. Most of the time, it’s better left to experts.

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  1. If you want coordination and a team then you need to have a service coordinator. 20 years ago all HCP automatically came with a case manager- nurse or social worker – who oversaw and coordinated care. Self managed packages ended this.

  2. “the client self manages his own care”…

    Then why in hell’s name is the taxpayer paying to clean the house?
    Home care has lost the plot altogether.

    Look after someones health needs is one thing but cleaning and gardening is really not the taxpayers problem. Worse, it appears that the good old taxpayers also pay the children and grandchildren to take grannie to the shop etc.

    Another government initiative poorly run and rorted by all.

    1. Anton sadly hoarding is a mental health condition and this is why as people age they need the age care help, if not helped then it possesses over health declines – falls risk ( broken hips/ bones- reduces mobility), there is also malnutrition- as many are unable to cook / store food. These and many more health concerns will increase risk of hospital admission – rehab and early admission to nursing home increasing the cost to health system e.g tax payers.
      The children and grandchildren are not able to be paid from age are packages for providing care or services to family.

    2. ‘self managing his own care’s means that the client is coordinating the care services he receives eg assistance with showering, shopping , cleaning.

      It does not mean that he is able to perform his own care. He will be coordinating who, when and for how long will provide the services he needs.

  3. I don’t know why we are taught about ‘holistic care’. To me, I understand it to cover all avenues of persons’ daily care…within reason and the safety of the carer. If a carer feels that it’s just not their job or whatever the case…just put a carer into that position who does not mind.
    We all just need to remember that we are all going to get old one day, and will also need help in our day-to-day living.
    How are we going to feel when slowly we are becoming disempowered….maybe our garden was our pride and joy…but with age, we just can not do the things we loved doing…just a thought.

  4. The issue becomes broader than should a Homecare worker do industrial cleaning?
    If the customer is self managed it is important for the financial intermediary to have the dialogue with the person can they adequately manage their package? Will they need advice?
    What role does ACAT play here? Surely an elder squalor hoarding matter should be auto referred to a specialist as you say the professionals in hoarding home care.
    This kind of situation should be avoided and the “independent “ home care workers on Mable rarely have the experience to manage such a complex client and work situation. The worker could make a targeted referral to a team and continue on as community access or other social role in the persons life.

    1. Very good point. These are the very sorts of clients who may not be suitable for self-management as they may have difficulty in understanding what they need. I am no expert but surely someone who is hoarding won’t always accept that they are doing this? They may even resist anyone who tries to assist them with the problem.

  5. This reads like an ad for Mable unfortunately.

    Another thing to note is that home care clients have an obligation to respect staff members’ rights to work in a safe work environment. Extreme hoarding may infringe that right.

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