In Asia, you would usually see a case about a hoarder which is a common reference for a person living in severe domestic squalor. In most cases volunteers would have gone in to help clean up the home only to have it return to the same steady state a few months after.
Image from Chinanew.com (Elderly resident in Qing Dao accumulates items that blocks the apartment entrance.)
With our high-rise living 2 recent cases caught my eye, a 78-year-old lady sleeping in a stairwell in Singapore for 3 months as a result of the clutter in her home and an apartment in Shanghai, whose entrance has been completely blocked as a result of a single resident’s collection of items.
A lot of the time, these situations leave us confused, especially after a big clean up, they continue to build up and reside in unsanitary and highly dangerous living conditions. It is not uncommon for colleagues or friends to say that the individual was well articulated and seemed well presented. So why do they continue to live in conditions that endanger their lives and others?
In a study by Snowden et al. (2012), one in 700 elderly living alone in the community may be living in these conditions. Research by Lee et al. (2014) in Australia found that people living in squalor were mostly living with brain damage that is impacting their ability to accept that their living condition was highly unacceptable in society. To answer the question about the well-presented individual, their research have also found that most of these individuals score well on the Mini-Mental State Examination (MMSE) indicating a level of capacity resulting in the ability to remain well-spoken and presented individual.
Having helped out in some of these activities, it was and still is in hope; that a lot of the residents who were residing in these living conditions did not have the physical means to clean up their homes. For many of us living in high-rise apartments with our parents and children, a lot of us tend to turn a blind eye and only start to care when it begins to affect our living environments. The usual situation is when we start seeing a rise in the number of cockroaches, a bedbug infestation, or the smell of rotting garbage. By then it is too late.
In addition to the community, Sutherland and Macfarlene (2014), touches the inability of psychiatrists to view this as a psychiatric issue and yet psychiatrist are the key individuals that can assess and prescribe appropriate strategies.
Sutherland and Macfarlane (2014) advise that in these situations practitioners really only have 2 options. To intervene against the wishes of the person in question or do nothing. People could argue that this is highly paternalistic, some may say prescriptive. However, when the situation may pose a risk of harm to the individual and the community living in these high-rise communities, can you really turn your back on the situation?
Some of us may risk inaction out of respect for the individual. We may not want our neighbours to “lose face”, we may want to be polite, to keep the peace or for some of us, we just haven’t had the time to look, and for a minority of us, we may not care. to contact our local MP or town council for help; we are in fact abandoning these individuals as a society and putting everyone’s lives in jeopardy, their lives and our own. These environments are a huge fire hazard, in addition to the contributing unsanitary conditions when we allow bedbugs, cockroaches and other insects to spawn when we could have acted early and provided the right care for our neighbours and reduce the risk of harm to everyone.
“Our services should act in the best interests of the person where possible while bearing in mind the interests of others. When capacity is in doubt, decisions about intervention may be debatable. It may be easier to do nothing. Recognising our responsibilities, even if they distress us, is necessary. If we find the job impossible, it is important to refer to people or services who can take on the case (Snowdon, 2014, p682).”
These individuals are who may be found with diminished capacity may be able to be managed by services such as home help/care and other community services (Sutherland and Macfarlane, 2014). The researchers also suggest that in extreme cases, guardianship may e necessary. The person could be cared for in a residential home with clinical care such as an aged care home.
In the event that we may have seen such a situation, we should contact our local MP or town council for help. By remaining inactive, we are in fact abandoning these individuals as a society and putting everyone’s lives in jeopardy, their lives and our own. These environments are a huge fire hazard (Pending Road), in addition to the contributing unsanitary conditions when we allow bed bugs, cockroaches and other insects (Eunos Cockroach Infestation) to spawn when we could have acted early and provided the right care for our neighbours and reduce the risk of harm to everyone.
By including the safety and lives of others in our daily lives, we include the safety of our family.
References:
Lee, S., Lewis, M., Leighton, D., Harris, B., Long, B., & Macfarlane, S. (n.d). Neuropsychological characteristics of people living in squalor. International Psychogeriatrics, 26(5), 837-844.
McDermott, S., Linahan, K., & Squires, B. J. (2009). Older People Living in Squalor: Ethical and Practical Dilemmas. Australian Social Work, 62(2), 245-257.
Snowdon, J., & Halliday, G. (2012). A study of severe domestic squalor: 173 cases referred to an old age psychiatry service. International Psychogeriatrics, 23(2), 308-314.
Snowdon, J., & Halliday, G. (2009). How and when to intervene in cases of severe domestic squalor. International Psychogeriatrics, 21(6), 996-1002.
Snowdon, J. (2014). Severe domestic squalor: Time to sort out the mess. Australian & New Zealand Journal Of Psychiatry, 48(7), 682.
Sutherland, A., & Macfarlane, S. (2014). Domestic squalor: Who should take responsibility?. The Australian And New Zealand Journal Of Psychiatry, 48(7), 690.
Designing for Aged Care 