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Pilot Project Provides Long-Term Social Work Assistance to Hoarders: An Interview with Jane Nathanson by Loree Cook-Daniels

From Adult Abuse Review, Volume 1, Issue 3, 2002. Reprinted with permission.

The Hoarding of Animals Research Consortium (HARC) was established in 1997 to "investigate the problem of animal hoarding from an interdisciplinary perspective." Based at The Center for Animals and Public Policy, Tufts University School of Veterinary Medicine in North Grafton, Massachusetts, HARC's membership includes Massachusetts professionals from the fields of psychiatry, sociology, social work, psychology, epidemiology, veterinary medicine, and the Massachusetts Society for the Prevention of Cruelty to Animals' animal protection division.

One of those professionals, Jane N. Nathanson, is currently heading a pilot project that allows her to provide long-term social work services to selected animal hoarders. Adult Abuse Review interviewed Ms. Nathanson to learn more about her project.

AAR: How did this project come about?

Nathanson: One of the purposes of the Hoarding of Animals Research Consortium [HARC] is to develop the data and the diagnostic criteria about animal hoarding that we need to make grounded recommendations about intervention. But these cases scream "NEED!" at you, and I didn't feel it was a prerequisite to have the research all in place before you provided some crisis intervention and remedial services. I felt that there was enough information from clinical and service experiences with related populations of persons at risk that some of the premises could be transferred to this population.

For instance, take self-neglect. In these cases, we see medical non-compliance, resistance to services, reclusiveness, and a lack of attending to one's personal or home care, or health and cleanliness standards — all characteristics we frequently see with animal hoarders. There's also a great body of experience with crisis management of cases of a broader nature, that may be transferable.

So in 1999, I wrote up a proposal for intervention. I reviewed Randall Lockwood and Gary Patronek's literature on animal hoarding, and applied what I knew from specific counseling approaches, case management, and what I've seen work in rehabilitation and social work practice to come up with a construct of intervention. It was funded later that year, under the sponsorship of the Massachusetts Society for the Prevention of Cruelty to Animals [MSPCA]. I also at that point became a participant in HARC. Until then HARC members were primarily researchers and academicians; I brought in a view from the outside, as someone who was a direct service provider and consultant for individuals and families. I offered HARC insights from that point of view.

AAR: What is the background you bring to them?

Nathanson: I have experience in both the public and private sectors of social service and rehabilitation. Although I was in education and training for many years, for the past 26 years I've specialized in social work and rehabilitation counseling for elders and persons with disabilities. In 1987, I expanded my private consulting to including human/animal bonding and loss issues. In 1990, I began a pet loss support program for MSPCA. In 1993, I was hired for the state's elders-at-risk program and worked there part time for about three years. I've also consulted with veterinary staff on client communications and relations related to human/animal bonding and loss.

My experience with the elders-at-risk program had a lot to do with this pilot project. There is a tendency for such adult protection programs to "disown" animal hoarding as a problem for their intervention, largely because it's most often considered to be either an "animal" issue, or the elder is considered to be competent and have a right to self-determination. But I think the piece that's been overlooked is that animal neglect is most often going hand-in-hand with human self-neglect. [The human and the animals] are sharing the same unsafe, unsanitary, substandard environment. But when adult protective services workers go in, there may be pressure, almost, to find that the elder is competent and desires the status quo, so that the worker can go out the door and close the case. And there's reluctance — and understandably so — to impose our own standards for how a person should live. So what happens many times is that there is a shuffling off of this kind of case, or closure before any kind of intervention can take place.

Yet we know that with elders at risk you are supposed to develop trust and rapport and a relationship prior to even attempting any change. But since there is a lot of pressure, given caseload size in these agencies, to open and close cases, just how long are you going to keep trying to develop trust and rapport? These are such challenging, hardcore, cases. It would be a gross oversimplification to think you can build the needed rapport in two or three visits. I understand that when you work within a bureaucracy, you may have constraints. But we need to at least address the fact that those constraints may be part of what leads to whether there's a successful outcome or not.

It's mind-boggling when you go into these scenes. But if you immediately suggest downsizing the animal population, you're out the door in a flash. Because of the pilot project, I am able to really develop the trust factor and work slowly, deliberately, minding my Ps and Qs, to be able to facilitate further communication and potential cooperation.

AAR: How do these cases come to you?

Nathanson: Right now in Massachusetts, a case of animal hoarding will likely first come to the attention of law enforcement. The law enforcement division of MSPCA will then go in and assess whether, indeed, the animals are being neglected or abused. If there is evidence of such, the law enforcement division has its protocol of intervention. In the worse case scenario, criminal charges are placed for removal of the animals. But over the years, all we've seen is an extraordinary rate of recidivism. Within as short a time as a month, or three months later, the situation is just as it was before.

With the pilot project, the person who is in charge of the law enforcement division of MSPCA, Carter Luke, the Vice President of Animal Protection, will review the report on the situation and determine if I should become involved. If so, I then proceed to try to arrange a meeting with the person in his or her home. Getting in can be an extremely difficult part of the whole problem.

Oftentimes these hoarders are adult children in their 40s and 50s who are caring for an elder in the home. We oftentimes get situations where the individual has been reported to adult protective services because there's a dependent elder, or child protective services for a dependent child. You often have layers of very serious things going on in these cases. In one of my cases, there were chronic reports. Every worker that went in to help with the elder — who wasn't the hoarder — reported my client. My client therefore associated the receipt of "help" with consequent trouble — she believed that "anyone who tries to help me, hurts me."

In general [humane society] law enforcement comes in and takes a low-key approach, if possible, and makes recommendations and suggestions for how to make things better for the animals. They might cite specific laws about the conditions of the animals. Then they'll say, "we'll come back in X amount of time and see if you are able to make the improvements we consider necessary."

That approach may prompt some change, but that doesn't mean the change will be maintained. If the person hasn't made the changes, law enforcement must then take a much stronger approach.

I could be referred a case at any point along the line — after animals have been removed, or in the midst of the crisis of the removal of the animals, or prior to the removal of the animals — to try to address the human/animal quality of life conditions.

AAR: After you get the referral, what's next?

Nathanson: It depends on who else is involved and what the person is facing. My intervention may be focused on trying to help them remediate the conditions so as to avoid whatever sanctions they may be facing potentially. For instance, public health may be trying to condemn the property, which means the person may be facing homelessness. The person may not be aware of what officials are doing, or care about what they're doing. Perhaps they don't think anything will ever happen.

Or the person may not know what is unsafe or unsanitary. There could be huge financial difficulties going on so that a person hasn't been able to meet their basic needs. There could be medical conditions, possibly related to the unhealthy environment, or physical or cognitive impairments that limit the person's capacity to respond. What I'm trying to address with the person is, what's in it for you if you cooperate? How can I help you avoid the problem? You may not agree, but if the authorities deem this a violation of humane or human laws, things are going to happen that you may not want. What can we do to prevent that from happening?

It may be that the person may be very proud of this domain that they've created. It's extremely important to recognize that the individual's home may well be his or her entire world. Oftentimes, there's a total exclusion of social interaction with one's own kind. What the person has [with the animals] is mutual trust and a sense of control in this domain. Some vehemently deny that conditions of the animals are poor and would be horrified to think that they were not actually providing a wonderful service to these animals. You may be calling it animal neglect, but these are people who consider themselves, in many cases, as having a very strong humane orientation. It comes to many of them as a shock that they are facing charges of neglect. While there are some individuals reported to humane law enforcement who don't give a damn, we do see so many animal hoarders who profess and demonstrate a great deal of love for their animals — each one named, each one individually adored and considered to be a perfect member of one's family.

The people where we're going to get the most potential acceptance are those who say, "Help me keep these animals. I don't want to give these animals up to a killing machine." What they are thinking about is that if these animals are brought to a shelter that practices euthanasia, they can be killed. Even if there's a no-kill shelter, these people say, "What kind of a life is that for the animal?" Many of these people pride themselves on keeping these animals from either unacceptable situation. They say, "If it were not for me, these animals would be homeless or dead." Even though the hoarder may cage the animals or have conditions that do not fulfill their basic needs, the hoarder may say, "These animals were unwanted. Any life is better than no life." Even those who are willing to acknowledge that the animals' current conditions are untenable will say, "At least they're able to live."

One thing we have to be careful of is what we are saying about the quality of the person's life. If they can't live decently, what are we saying? Are we negating their own acceptance of their own lives? You do want to bring improvement as you might see the need for it, but as a social worker you know we still must not impose our own standards. Social workers are constantly conflicted where they see or define human need, but the individual him- or her- self may not acknowledge need, and be adamant about being "left alone."

The biggest problem with all elders at risk is getting in and staying in long enough to effect improvement on mutually agreed upon goals. That's the kicker: how do we get to mutually agreed-upon goals?

AAR: So how do you get to mutually agreed-upon goals?

Nathanson: First I try to establish communication by way of cultivating a client-focused relationship. I recommend listening, listening, listening. That builds trust and rapport, which are essential to engaging in constructive dialogue. Only by way of attentive and thorough listening will the worker be able to learn what the individual's values, wants, and needs are — what will essentially motivate the person to change long-standing conditions. Listening also enhances the client's receptivity and responsiveness to intervention. Nothing is ever going to happen (in my way of viewing the world) unless this piece is in place. And just because you think it's in place, never take it for granted! Fundamentally, we are dealing with so much distrust. Even if you're minding your Ps and Qs, you can't slip up and can't hustle the person because you are so tentatively afforded his or her trust.

I've been working with one woman for over two years. And to this day, I can't count on her trust of me. These are very wounded people. Remember that having been hurt is one of the forces driving some people to gravitate to the world of animals, above and beyond the world of humans. The animals will not harm them. They will be their constant friends. They can be trusted implicitly forever.

So communication, trust, rapport, striving for their receptivity - that piece needs to always be there. That's the constant.

The next stage you add on is promoting the client's acknowledgement of problematic conditions. I utilize educational approaches concerning both human and animal health issues, which includes humane care and treatment of animals. I gradually approach issues of loss and grief. As needed, I provide crisis intervention and adjustment counseling.

You need to let the individual define what the crisis is in his or her own terms. Focus on the nuts and bolts, the things that they're ready to acknowledge about the crisis situation (i.e., the potential loss of their animals, home condemnation, financial hardship, consequences of utility shut-off for non-payment of bills) that they might want help with.

The second piece is to articulate a mutual acknowledgment of the problems to be addressed. I engage the client in the development and implementation of a mutually-agreed upon service plan. I've often found that written service plans are crucial. If and when disagreement or conflict develops, I am often able to go back to the service plans for the whats, whys, and wherefores. Write a contract. You need to give the person a sense of control. The individual needs to know you won't do anything without his or her permission. You say, "I will never contact anyone without speaking to you first about it. I want you to know what I'm doing every step of the way." Listen to the client and write his or her words into the contract; that helps the individual to feel in control, too.

If we're moving along all right, then I start to facilitate linkages with community-based resources or specialized services such as legal, housing, financial assistance. Animal hoarding intervention is a team effort — I can't go it alone! We need to find a liaison, a transitional force, to mainstream the person as much as possible. The elders-at-risk program can often help with this.

AAR: How does medical and psychiatric therapy fit in with your work?

Nathanson: One of the biggest problems I've faced in the last couple of years is coordinating the community resources and having them accept and be responsive to the advisory assistance which I can provide. Teamwork within and between agencies and individuals can be quite a challenge! Different agencies feel very proprietary, and there is often a very poor relationship between the different agencies. Take mental health workers: if they don't know what to do, they may not take the time or make the effort to ask for help. And that's a real problem.

Let's say you've worked a really long time to get this person medically and psychiatrically evaluated — when they agree to go, that's a huge leap you've taken! Let's say we get the person to a therapist; what is that therapist going to think about the relationship between the person and the animals? Unless the therapist takes that human/animal linkage into account — if, for instance, that therapist seems to talk to them like they've got a collection of inanimate objects — they're not going to make progress.

A number of my clients have already been in long-term therapeutic programs for conditions such as schizophrenia, severe depression, substance abuse, and manic-depression, and the providers never knew they were an animal hoarder. I don't believe animal hoarding is resolvable by simply giving someone medication, like Prozac for obsessive-compulsive disorder. When you're talking about the fundamental magnetic attraction, the compelling desire that that person has for animals, are you talking about, "Just give me another animal, I can't get enough," or are you also talking about this person's ethical and moral belief system that killing animals is wrong? When they say, "These animals are homeless, if I don't take them, who is?", is that resolvable by drugs? One may have delusions telling him or her to take these animals in, or compelling desires to continually add to one's flock, but what about the person with the altruistic orientation to this, whereby he or she feels that it is the moral and ethical thing to do? How can you medicate that away?

Because there is so much interaction [between animals and humans] that is so intensely pleasurable, sometimes people have to make the distinction between whether they are doing it for the animals or doing it for themselves. It's important for people, if they have the capacity for it, to see that they're serving themselves, possibly, at the price of the animals' well being.

I have this client who has hoarded cats for 20 years now. I bring the whole bailiwick of approaches to her: what's good for you, what's good for the animals, what'll keep you out of trouble. I told her, "What about if the animals created their own colony? There would be a certain point at which the animals 'refuse' to accept any more into the fold: they'd run them off or kill them, because there's competition for food and what have you." This client said to me, "I would think they would love the extra company, the new face, someone new to interact with." This woman is completely isolated from humans, and this expressed perspective was most illuminating about her own needs. It was one of the most extraordinary discussions I've had with her.

I'm not trying to show people they're being narcissistic, but rather trying to acquaint them with the idea that the animals may be serving the person more than they are being served. Did she accept the piece of humane education about how animals would create their own colony in the wild? I don't know. She is so impaired in so many, many ways: cognitively, with impaired judgment, poor abstract reasoning and capacity for insight, she has significant deficits that affect problem-solving and troubleshooting. She has a lot of these things going on. Sometimes she'll just be contrary to be contrary. You can't take anything for granted, whether it is trust between the two of you or whether some idea will be able to grow in one's mind or instead get bogged down by all the other undermining factors.

AAR: Can the interventions you're piloting here be used by agencies such as adult protective services?

Nathanson: We live in an exceedingly inhumane social service kind of bind right now. These are times of managed care not just in medicine, but in all of human services. The services are so grossly under-funded and the pressures on the workers are terrible. Some of the best workers just leave. Why should they stay when their caseloads get higher and higher, working with fewer and fewer resources? How much do we say the onus is on them to do things differently? I'm not going to be complacent about the horrific cutbacks. This happens in the field of education, too: we blame the teacher. We have a system that is failing. What do we do on that front? That's really what's going on here. Social service workers don't have the time to even learn the skills, develop and practice the expertise, that would ultimately be profitable and that would make their work easier. How do we get people who demonstrate a level of expertise or a special type of empathy to stay and thrive — and consequently have their clients thrive — when the emphasis is on the paperwork more than the outcome?

When I was working in the adults-at-risk system and we were being audited, we were told what the auditors would be looking at: how many days were there between the report and the contact with the referral or attempt to intervene? Was the paperwork completed within 24-48 hours of a visit? It's those kind of criteria that the human service auditors may be more focused on, rather than looking at what are the goals, what are the methods of intervention, were the goals reached, and if not, why not?

It is very stressful to work with such a difficult, difficult population, and I feel more workers are crumbling under the pressure of the paperwork and limited time for supervision and on-going training. I think what's also important is: are they getting positive feedback about their efforts? Do they receive some acknowledgement for having gotten in the door? Is there acknowledgement and praise for the little things that may be preliminary to bigger things potentially coming along the way as a result? Or are they raked over the coals because their paperwork wasn't completed within 24 or 48 hours? I don't know that you can have it both ways. And you can't look at serving these hoarders without looking at the system.

So these workers are all too often too busy to undertake some of these extremely complicated, complex cases with the amount of collaborative efforts that are called for. They just don't have the necessary time to spend.

AAR: Are these cases worth the cost and amount of time you are putting into them?

Nathanson: I think we need to ask what our moral obligation to the harder cases is. We tend to cream our caseloads, tending first to the compliant, pleasant ones. But what does that mean about our moral obligation to be of service to people?

In the long run, though, what would probably cut more ice with policymakers is, "What do these cases cost if untreated?" Let's say you've got a private home where this is going on. There is huge financial debt and they stop paying their bills or taxes. If utilities are shut off at an elder's residence due to non-payment of bills, the companies continue to provide the services — these are all costs to businesses, to communities, and to consumers. Someone (or many people) will be paying here. Furthermore, animal hoarding is a public health problem as well, and again there is a hefty price associated with the potential risks of safety, sanitation, and health. Consequently such situations become a drain on various public and private services. This is not an intervention and cost for animal organizations alone — effective means of resolving these cases must be pursued by way of a collaborative effort of community resources, or the price of "turning the other way" will be all that much greater.

Do I make progress? Yes, I do; I couldn't live without it. Even if it only comes slowly, sporadically, or in very small steps, I really appreciate the glimmers of change I see. These changes are so hard to make. These systems of behaving and living have been hard in place for so long…why should they change, especially when it's so hard and hurtful to do so?

Let me give you an example that may sound absurd: it took over a year before someone I was working with referred to themselves as an animal hoarder. That insight alone was progress! Any chipping away of the over-the-top denial that goes on in these situations is progress. When I hear, "I need help with that," or when a client says "thank you" to me, I find it so gratifying...especially when you're dealing with such hard core, resistant, sometimes intensely angry people, to have them genuinely say thank you. These things mean a lot to me; they keep me going.

I started out as a teacher, an educator. That orientation has never left me. It's my style of counseling, of doing interventions: to educate. I generally feel if a person has learned something, a tidbit — even if it is just that animals don't want to have urine and feces in their cage — it's a step. When individuals learn what an animal might need, they may be able to go on to figure out what they themselves might need or want...and proceed to fulfill that.

These cases just draw on every single ounce of personal as well as professional interest and commitment on my part. I love this work. I find these people so scintillating, so demanding of every bit of creative thought that I can exercise.

It's kind of like the thrill one feels when a hungry feral cat actually approaches to take offered food. I find that working with reclusive, resisting, hurting people has a similar dimension to it. When they are able to allow you into their world, you feel you've been given a privilege and a gift. People jokingly ask me, "Is it a privilege to walk knee-high into feces?" I say, "It's all in the way you look at it!"

Are these cases hopeless? No, they are not.

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