Using CARES Act monies for Hoarding remediation

Covid -19 Effected Housing Services

The need for in home supports and services especially in the wake of Covid- 19 has and continues to rise. Keeping our community thriving and safe in their home environments, while decreasing the call volume thus preserving the overall health and heightened safety risks of our 1st responders is crucial for the overall well-being and strengthening of a community.

With the pairing of a mental health clinician in the Framingham Fire Department, the strong partnerships among city departments and successful collaborations with outside agencies, a service model was created. This model has been in response to the overwhelming amount of mental health calls fire departments and other city departments now respond to now in the 21^st century.

This service model represents and supports healthy living and community integration with collaborations from city departments and outside service providers. This service model is utilized as a gateway to improving the safety and health of our community members in their homes. The City of Framingham and outside agencies will collaborate efforts to engage vulnerable community members and assess their homes for health and safety through the Framingham Heavy Content Task Force. The Task force is comprised of city departments and outside service agencies. The primary focus of this task force is to serve our most vulnerable populations that have been directly affected by sanitary and heavy content conditions in the home. Stemming from the Covid-19 pandemic these issues have increased the volume of clutter, sanitary and safety issues in the home.

Hoarding is clearly a public health issue. According to Bratiotis, Schmalisch & Steketee, 2011, “hoarding can lead to direct health and safety risks to the individual, their family and their neighbors and can create considerable costs for the community”. In 2000 the Massachusetts Department of Public Health reported in a survey of health officers in an area of 1.8 million residents, that four hundred and seventy-one complaints were filed due to concerns about sanitation, fire hazard, odor, odd behavior and three deaths due to fire- all likely related to hoarding behavior. Fires that begin in a hoarder’s home are more difficult to extinguish making them more likely to be serious and to spread to neighbor’s dwellings (Harris, 2010). As recently as March 2012 a Massachusetts’ elder perished in a fire because firefighters were not able to reach him in time due to the amount of clutter and hoarded items blocking their access. In addition, infestations are another hazard that hoarders and their neighbors face. Due to the enormous amount of clutter or possessions it can be nearly impossible to get rid of insects or rodents (Bratiotis, Schmalisch, & Steketee, 2011). A single heat treatment to remove bed bugs costs average $1,500 per unit. In a home or apartment treatment may need to be repeated several times to be effective. Cleanouts cost can range from $5000, to 25,000 or more and may need to be repeated after one year if the Individual has not received treatment for their behaviors (MassHousing Hoarding Resources, 2012).

Research also shows that individuals with hoarding behaviors are significantly more likely to suffer from chronic medical conditions and obesity (Bratiotis, Schmalisch & Steketee, 2011), which makes organizing and de-cluttering even more difficult for them. Additionally, having large amounts of clutter with increased dust, mold and pest infestation as well as instability of the structure of their living spaces due to excess clutter, makes for a very unhealthy living situation. They are also dangers of falling due to cluttered pathways especially for our older adults who are older at risk for falling down. As a result, hoarding and unsanitary conditions poses an elevated health risk to the individuals residing in these conditions as well as first responders.

Kelly Hagerty has worked as the City of Framingham’s Crisis Responder for the Framingham Fire Department for the last 5 years and previously began this work out of the City of Framingham’s Health Dept. 2 years prior. Kelly is now back in the Health Department as the Community Intervention Specialist and holds a bachelor degree in Human Services/Psychology, and a master’s degree in Social Science/Criminology. Previously, Kelly worked for the state of Massachusetts as a Social Worker for 15 years out of the Framingham Department of Children and Families and has extensive experience with case management, assessments and investigations for the populations identified. Furthermore, Kelly has obtained several certifications that compliments her work with Hoarding Disorder as she was part of the first training at the Hoarding Institute for Training with Mass Housing and began the last year to speak around the state on such issues outlined in this grant.

We are seeking support from this grant to institute the expansion of programming of the service model created here in the City of Framingham in collaboration with other city departments and outside service providers. Cost associated with this project are associated with issues and or barriers that Covid-19 pandemic has presented in this field of work. Currently, there is a lack of financial support to remedy these issues in our community thus presents addition barriers. The service models that provide in home care are crucial for our community members to live in healthy safe environments in their homes. At this time, there is a waitlist for in-home services as all in home visits that were abruptly stopped in the wake of the Pandemic starting in March of 2020. The repercussions of this have created many multi layered issues for individuals that were accepting, needing and wanting these services. These issues include both physical and mental health challenges or increased issues in the accumulation and acquiring of clutter in the home, sanitation issues, infestations, increase and or heightened risk for falls due to narrow or lack of pathways through the home and the structural safety issues due to the increase in volume of clutter, mold and other issues that could be present.

Services that will be implemented include cost for the following in the order in which the process begins and ends when addressing issues and barriers of health and safety in the home, they are as followed;

Dumpster rentals for the removal of “Heavy Content” (clutter), cost of labor for the instillation for home safety improvements measures, professional heavy chore and biohazards services sub-contracts for units that require bio hazard and heavy chore due to health and sanitation codes. Pest control will be utilized for units that require these necessary treatments to eliminate infestation once a unit is cleared of clutter and services to contract with vendors for the in-home support of professional coaching for sorting and discarding the needed items in a unit.

When dealing with the issues stated above, the amount can range widely as some home environments may not need all the services mentioned. Service delivery to the identified clients will be from the Framingham’s Intervention Specialist from the Health Dept. in response to referrals by firefighters on the front lines, the COA, Animal Control and all applicable city departments.

The Community Intervention Specialist will screen the subjects based on the criteria, the needs of the individual and the home environment of the individual/s. The Health Dept. will be responsible for the procurement of contracted services and will obtain no less than 3 bids per service item with the identified service providers and collaterals once an assessment is completed. The assessment that will be utilized to identify the needs in the home is the HOMES assessment. The Community Intervention Specialist and a Health Dept inspector will be responsible for the follow up inspections to ensure the service agreement was fulfilled in order to achieve the unified goal in keeping our community members safe and healthy while preserving their ability to remain in their homes.