Safety compromises: how do we balance the wish to keep elderly or frail people safe against their wishes for independence or their desire to remain in their home? This article uses a practical example to illustrate the difficulty of responding to unsanitary or unsafe conditions in the home of some people. Page top photo: the author's mother (right) with her care giver.

This article series explains special home safety concerns for the elderly and for disabled people, offering suggestions for safety inspections and for obtaining financial aid to perform necessary home safety or home accessibility improvements.

Balancing Safety for the Elderly with Individual Preferences, Fears, Desires

Reader Question: what to do about a very moldy home & unsanitary occupied by an elderly person

First off I should let you know that this is a house not an office building, just in case that makes a difference. I'll try and keep this as short as I can, the house belongs to my 88 year old grandmother, my cousin also lives in the house.

Over the years they had started keeping family members from coming to the house, they would come out but would not let anybody come to the house to see her. She recently got sick and had to have surgery on her legs and while she was in the hospital, some of the family members got into the house.

The mold smell was horrible, what we found were visible signs of mold, what type I don't know. Mold on carpet where water had run under a door for who knows how long, leaking sink drains with rotten wood below them, a room that had been flooded and not cleaned up properly, a basement that has a broken window and has allowed cats to come and go as they please with animal urine and feces all over the floor, another room that was so bad with animal feces and urine that we couldn't even go into it, reports of mice that had been running in the ceilings and had probably died, a leaking room and lastly a laundry room with leaking spouts that has soaked the wall and wood.

Although we have tried to convince my grandmother that the house if full of mold and she can't go back to it, she will not listen. We are trying to educate ourselves the best we can on mold and what we should do next. Any advice would be appreciated.

Reply: dealing with hoarding disorder, mold contamination, animal feces and urine, and probably other life-safety hazards where an elderly person is involved.

OPINION

You are describing a combination of several concerns: an elderly person who has a hoarding disorder and a building that is unsanitary due to animal feces (and probably urine), a high level of indoor mold contamination, and I fear that there are quite possibly other un-discovered life-safety hazards such as fire hazards, heating equipment ventilation and carbon monoxide hazards, and multiple trip and fall hazards: in my experience where someone suffers from a form of hoarding disorder, often there is a combined history of inattention to or lack of recognition of the other life-safety risks I name.

Balancing Respect & Concern for the Elderly with Immediate Life Safety Hazards

Where the building occupant is elderly additional sensitive issues pertain: working for the Red Cross in LA after the Northridge earthquake I was asked to advise a response for cases in which caregivers or family were balancing concern for the immediate life-safety issues that confronted an elderly family member against the risks to a fragile, frightened family member who was terrified at the prospect of having to stay in a shelter or being forcibly removed from their home.

There was no single "right answer". Some responders, fearing getting in trouble themselves, gave what they thought was an answer that was safest for themselves rather than best for the people involved. I did not always agree with that answer, but remain reluctant to ever judge the decisions of experts who are on the scene of a disaster.

Quickly Determine Immediate and Severe, Obvious Hazards, Mold or Others

Usually in the case of a building in the condition you describe, a visual inspection for the extent of visible mold and other hazards is more than enough to determine the safety of living in the space. Especially where most of the house is involved and contaminated, testing is not particularly helpful nor likely to be justified. (While there are some cosmetic molds, they don't appear on drywall, carpet, and many other surfaces.)

See HOARDING HAZARDS for a description of and research about types of hoarding in buildings and safety and health hazards associated with that behaviour.

Added to the mold contamination you mention animal urine and feces which in turn, in my experience form a bacterial and viral hazard.

Especially for an elderly person whose health is likely to be more fragile, such an environment is likely to be dangerous.

For purposes of bringing in an independent, credible expert, if your health department has people with experience in these hazards it may be sufficient to ask for a look and opinion from them. Explain your concerns and needs and expect cooperation.

For purposes of deciding what to do with the property and what can be economically salvaged, you need an onsite inspection by an expert. That inspection should focus on determining the scope of demolition and cleaning needed - thus the scope of work, and it should be performed by someone who has absolutely no business nor financial relationship with a cleaning company who may be hired to do the work.

Typically hard-surfaced items are easy to clean and salvage; wall to wall carpets, heavy upholstered furniture, etc. may be beyond economical salvage if those are moldy or urine/feces soiled.

Clothing and bedding (but not a moldy mattress or pillow) can be laundered or dry cleaned.

Take a look at ACTION GUIDE - WHAT TO DO ABOUT INDOOR MOLD  for a summary of the procedure for that topic.

The same cleaning, plus disinfecting, would be appropriate for animal waste soiling. Also
see ANIMAL or URINE ODOR SOURCE DETECTION

Even after that work it may be difficult to get rid of mold and animal odors without further demolition, cleaning, and sealing of remaining structural surfaces beyond that required just based on visible mold.

We can cross that bridge when we come to it.

I understand how badly your grandmother may want to return to familiar surroundings, and I've personally suffered through the issues around arranging care for a family member who vehemently wanted to be left alone.

Nevertheless, and recognizing that no one can accurately inspect a building by email, nonetheless, from your description I'd keep my grandmother out of such an environment.

Ethics & Elder Safety - References

In addition to the citations at x, here are some useful references on the ethics & issues of home safety for the elderly or disabled

• McShane, R., T. Hope, and Judith Wilkinson. "Tracking patients who wander: ethics and technology." The Lancet 343, no. 8908 (1994): 1274.
• Odenheimer, Germaine L., Marie Beaudet, Alan M. Jette, Marilyn S. Albert, Laura Grande, and Kenneth L. Minaker. "Performance-based driving evaluation of the elderly driver: safety, reliability, and validity." Journal of Gerontology 49, no. 4 (1994): M153-M159.
• Runciman, Bill, Alan Merry, and Merrilyn Walton. Safety and ethics in healthcare: a guide to getting it right. Ashgate Publishing, 2007.
• Ståhl, Agneta, Gunilla Carlsson, Pia Hovbrandt, and Susanne Iwarsson. "“Let’s go for a walk!”: identification and prioritisation of accessibility and safety measures involving elderly people in a residential area." European Journal of Ageing 5, no. 3 (2008): 265-273.
• Zhang, Guicheng, Andy H. Lee, Hoe C. Lee, and Michael Clinton. "Fire safety among the elderly in Western Australia." Fire safety journal 41, no. 1 (2006): 57-61.
• Zwijsen, Sandra A., Alistair R. Niemeijer, and Cees MPM Hertogh. "Ethics of using assistive technology in the care for community-dwelling elderly people: An overview of the literature." Aging & Mental Health 15, no. 4 (2011): 419-427.

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• HOARDING HAZARDS

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BALANCING SAFETY vs DESIRES at InspectApedia.com - online encyclopedia of building & environmental inspection, testing, diagnosis, repair, & problem prevention advice.

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Citations & References

In addition to any citations in the article above, a full list is available on request.

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