Guidelines for field staff to assist people living in ... - Housing NSW

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SECTION 1: Introduction1.1 BackgroundDuring 2004, the Department of Ageing, Disability and Home Care (DADHC) fundeda review of the services provided to people who live in severe domestic squalor. Theaim of this review was to develop Guidelines for personnel who are asked tointervene in cases of severe domestic squalor, particularly staff providing Home andCommunity Care (HACC) funded services.The development of Guidelines is an initiative of the (then) Partnerships AgainstHomelessness (PAH) Committee. The project was auspiced by the Central SydneyArea Health Service (now the Sydney South West Area Health Service) andcoordinated initially by a Reference Group 1 , comprising representatives withexperience in assisting people living in squalor. Professor John Snowdon, apsychiatrist with a special interest in the area, was appointed Chairperson of theGroup. A consultant was recruited to conduct a review of the evidence relevant tosqualor, to consult stakeholder groups and to write a report. Based on this report,these Guidelines have been developed.1.2 Purpose of the GuidelinesThese Guidelines are designed to assist field staff 2 of various government and nongovernmentagencies to constructively intervene, and improve the situation of peoplewho are living in severe domestic squalor. The intention is to improve the efficiency,speed of action and coordination of work between relevant agencies, resulting inimproved health and quality of life for individuals who have been living in severedomestic squalor.These Guidelines provide field staff with:• a step-by-step guide• simplified procedures to assist people living in severe domestic squalor• clear roles and responsibilities of agencies and service providers, to enableimproved coordination and integration of services• practical information regarding referrals and intervention options.These Guidelines include flow charts to summarise the processes involved. Includedin Appendix 8 are a series of case studies (prepared by Graeme Halliday), whichexplain the issues and current events arising in typical cases of severe domesticsqualor.1 A list of Reference Group participants and other people who contributed to the project appears at Appendix 12.2 The term ‘field staff’ is used to cover a broad range of front-line workers in government and non-governmentsettings who, because of dealing face to face with clients, come into contact with or are the first point of referralfor people living in domestic squalor.4
SECTION 2: Explaining severe domestic squalor2.1 Definition of severe domestic squalorDictionary definitions of squalor refer to conditions that are filthy, unclean or foulthrough neglect. Commonly, this results from a person’s failure to remove householdwaste and other rubbish including papers, wrapping, food products, cooking waste,containers and broken or discarded household items.Cleanliness varies between homes and between individuals and can be presumed to beinfluenced by multiple factors, including upbringing, peer and family expectations, livingarrangements, social and financial circumstances, cultural background and surroundings.Some people live in conditions so filthy and unhygienic that almost all observers, inwhatever culture, would consider them unacceptable.The term ‘severe domestic squalor’ was chosen in order to emphasise, firstly that thefocus is not on cases where people live in somewhat unclean surroundings, even if theyhave severe physical or mental disorders. The concern is for people who live indisgusting conditions. This word is used advisedly in order to make clear that theuncleanliness in relevant cases is extreme. Secondly, the aim is not to provide guidancein cases of self-neglect where squalor is not an issue, nor in cases of hoarding withoutsqualor, i.e., those cases where there has been an accumulation of possessions but in anordered, clean and manageable way. What is included are cases of hoarding where theaccumulation has led to the living environment being unclean, unsanitary or dangerous(e.g., because of fire risk).There is a range of types of squalor, including:• Neglect, involving failure to remove household waste and other rubbish includingpapers, wrapping, food, cooking waste, containers and discarded household items.• Multifaceted self-neglect, where the person fails to maintain aspects of their care,health and lifestyle, such as personal care, eating adequately or failing to takemedications as prescribed.• Deliberate hoarding and the excessive accumulation of items such as clothing,newspapers, electrical appliances, etc. This may involve hoarding of animals.For the purpose of these Guidelines, the term severe domestic squalor includes:• extreme household uncleanliness• hoarding, where the accumulation of material has led to the living environment beingunclean, unsanitary or dangerous, e.g., conditions pose a fire risk.The decision regarding whether or not a person lives in severe domestic squalor maybe influenced by the attitude, culture, exposure to unclean environments andpersonal living conditions of the person making the assessment. An objectiveassessment tool has been developed to assess the level of squalor (see Section4.4).5
Page 1 and 2: Guidelines for field staff toassist
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Page 7 and 8: If such persons do agree to speak,
Page 9 and 10: 3.3 Gathering resources for use at
Page 11 and 12: • If the person is from a CALD ba
Page 13 and 14: availability of essential services,
Page 15 and 16: 4.6 Initiate referrals to address c
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Page 27 and 28: SECTION 9: ConclusionsThe key point
Page 29 and 30: ENVIRONMENTAL CLEANLINESS AND CLUTT
Page 31 and 32: J.SLEEPING AREA:0 1 2 3Reasonablycl
Page 33 and 34: APPENDIX 3: Impact of Squalor Check
Page 35 and 36: APPENDIX 5:living in severe domesti
Page 37 and 38: Aged Care Assessment Teams (ACATs)A
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Page 41 and 42: Department of Community Services (D
Page 43 and 44: APPENDIX 6:Organisations that can a
Page 45 and 46: NSW PoliceThe Police are often the
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Page 49 and 50: APPENDIX 8: Case studiesCASE 1An el
Page 51 and 52: CASE 3Ms D, who had been living in
Page 53 and 54: CASE 6Mr A. is a 70-year-old man wh
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would permit a psychiatrist to ente
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Non-GovernmentAssistance with Care
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APPENDIX 11:Further readingClark AN
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