“Dealing with Domestic Squalor” Northern Sydney
Information Pack
Northern Sydney Severe Domestic Squalor Working Party
First Edition - August 2005
Dear Service provider
Dealing with Severe Domestic Squalor in Northern Sydney Information Pack.
Following on from the Domestic Squalor forum held in North Sydney during 2004 a working party made up of Local Councils, Government Agencies and Community Organisations was formed to research and coordinate responses to the emerging issue of people living in Severe Domestic Squalor in the Northern Sydney Area.
This information package is part of the strong commitment by those agencies in Northern Sydney to assist people who are living in severe domestic squalor. It is intended for all agencies that may have contact with people living in such conditions or because of frailty, disability or mental health are vulnerable.
The package provides details of key agencies that are involved in assisting people who are living in or in danger of severe domestic squalor or are in danger of becoming. It also provides a chart of possible scenarios that could arise when attempting to resolve the problem and at what stage the key agencies would be involved.
To assist agencies or individuals who are unsure about what constitutes domestic squalor a Living Conditions Rating Scale is provided. This scale will greatly assist in any initial assessment of an individual’s living conditions.
For organisations requiring further assistance, the details of a key contact in each sub- regional area of Northern Sydney is provided.
Finally as this is very much a first edition we strongly encourage feedback to further improve this information package. Please forward your suggestions to Chris Taylor C/o North Sydney Council PO Box 12 North Sydney 2059 Telephone 9936 8195 Email: [email protected]
Signed on behalf of the Northern Sydney Domestic Squalor Working Party
Glossary
Definition of ‘Squalor’
Dictionary definitions of a squalid dwelling or place (as opposed to clothing or appearance) refer to somewhere that is filthy, unclean or foul through neglect. With the exception of some very extreme examples, whether someone lives in ‘squalor’ is subjective and influenced be the attitude, exposure to unclean environment and personal living conditions of the person making the assessment. Some environments, furthermore, such as those that are cluttered and inaccessible may be more likely to be labeled as ‘squalid’ even though they may be no dirtier than other places where there is less property and possessions.
Adapted from published criteria: Macmillan D,Sahw P. Senile breakdown in standards of personal and environmental cleanliness. BMJ 1966:I:1032-37. Clark AN, Maniker GD, Gray I. Diogenes syndrome: a clinical study of gross neglect in old age. Lancet 1975:I: 366-68.
Acronyms
ACAT Aged Care Assessment Team DOCS Department of Community Services RSPCA Royal Society Prevention of Cruelty to Animals OH&S Occupational Health & Safety NGO Non-Government Organisations GP General Practitioners DADHC Department of Ageing, Disability and Home Care.
Resource contacts:
Mental Health Act: Section 27. www.legislation.nsw.gov.au/ Local Government Act www.legislation.nsw.gov.au/ Residential Tenancies Act www.legislation.nsw.gov.au/ DADHC www.dadhc.nsw.gov.au Guardianship Tribunal 2a Rowntree Street, Balmain 2041, Phone: (02) 9555 8500 or 1800 463928
Service Provider Handbook - A guide to Home and Community Care Providers in the Northern Sydney area. Copies available from: Northern Sydney HACC Development Project: Ph: 9415 4855 or email: [email protected] Acknowledgements
The commitment and time devoted to the development of this Information pack and from the following people who are involved with assisting people living in Severe Domestic Squalor is hereby acknowledged and appreciated
Karen Barfoot RNSH & Community Mental Health Team Sue Buckle Senior Coordinator, Community Support Services Mercy Community Care, Waitara Kirsty Chappell HACC Development Officer, Northside Community Forum Inc (Resigned May 05) Kristie Gibson Assertive Recovery in the Community Team, Chatswood Mental Health Service Catherine Hitchcock Coordinator Domestic Assistance, Lifelinks, Baptist Community Services, Anthea Johnson Senior Social Worker, Aged Care & Rehabilitation Medicine, RNSH Liz Kiel Aged & Disability Service Coordinator, Willoughby City Council Sharon Kilduff Community Worker, Northern Beaches Adult services, DADHC Roslyn McLoughlin Community Caseworker, Mosman Council Aged & Disability Services Jessica Özbay Community Support Worker – Caseworker, Crows Nest Centre Libby Palmer Northern Sydney Dementia Advisor, Community Care Northern Beaches Inc. Lyn Richards Nursing Unit Manager, Ryde Mental Health Service Chris Taylor Aged & Disability Worker, North Sydney Council Mathew Thomas Northern Beaches Mental Health Team
Special Appreciation
North Sydney Council Management & Board Crows Nest Centre Prof. John Snowdon, Psycho-geriatrician, Central Sydney Area Health Dr. Graeme Halliday, Psycho-geriatrician, Central Sydney Area Health
DIAGRAM 1: ASSESSMENT & MANAGEMENT OF PEOPLE LIVING IN SQUALOR
POSSIBLE C. TAKE IMMEDIATE RESPONSES: ACTION IF REQUIRED 1. For person (eg transfer to E. POSSIBLE hospital) INTERVENTIONS: 2. Dependents (eg refer to DOCS, RSPCA) • Individual support &/ or case management D. JOINT AGENCY CASE Comm. Support Workers CONFERENCE Community Services Convene meeting with delegates • Cleaning from relevant services to determine Commercial / B. HOME VISIT A. REFERRAL action plan, within context of: Forensic Cleaning F. CONTINUING 1. Assessment of • Obtain • Persons physical/mental health FOLLOW UP & • Level – squalor • Medical and background • Capacity SUPERVISION TO • psychiatric services information; Risk Does the person have impaired PREVENT • including Person decision making re • RECURRENCE. • Home services potential OH&S Dependents accommodation, service, health (Case management; issues • Capacity and or financial management. • Council Services NGO services; GP, 2. Engage and gain trust of • Acceptance of assistance Aged & Disability Worker Community Treatment Environmental Officers Order & Mental Health) person • Residential Care
• Families / friends
REFUSES RESISTS HELP ASSESSMENT or LACKS CAPACITY
PEOPLE WHO RESIST ASSESSMENT OR HELP (See Diagram 2)
Domestic Squalor Flowcharts Diagram 1 – Augsut 2005 DIAGRAM 2: PEOPLE LIVING IN SQUALOR RESISTING ASSESSMENT OR HELP
1b. Apply for a GUARDIAN to be Guardian can make decisions about appointed to make decisions INTERVENTIONS including about health & accommodation CLEANING & MEDICAL PEOPLE WHO (in consultation with case TREATMENT RESIST manager etc). ASSESSMENT OR HELP 1c. Use MENTAL HEALTH ACT to Mental Health to ACCESS HIGH 1a. ASSESSMENT compel treatment. RISK CLIENTS AT HOME WITH for capacity ASSISTANCE OF POLICE 1. NO, CONTINUING FOLLOW lacks capacity UP & SUPERVISION To prevent recurrence. 1d. Apply for FINANCIAL Financial Manager can make DO THEY MANAGER to be appointed. decisions about PAYMENT FOR HAVE SERVICES REQUIRED CAPACITY?
See contact list attached 2. YES, has capacity
2a. KEY WORKER / CASE MANAGER to continue to If unsuccessful 2d. USE 2c. ENVIRONMENTAL liaise & persuade & home owner APPROPRIATE HEALTH OFFICER person to accept or private rental LEGISLATION (FIRE BRIGADE, SUBSANTIAL (DETERMINED help. 2b. REFER RSPCA, POLICE) PROBLEM BY PROPERTY TO COUNCIL eg fire risk, 3. DON’T ASSESSMENT of OWNERSHIP) rodents, KNOW risks to neighbours to compel and community. infestation. owner/occupant to remove risk and permit 3a. CANNOT ASSESS CAPACITY BECAUSE PERSON cleaning. REFUSES TO OPEN DOOR OR SPEAK TO PEOPLE Consider: If unsuccessful • Relationships with others i.e. G.P, relatives & neighbours & public rental • Mental Health Act, Section 27 Assessment (if evidence of likely mental illness, apply to Magistrate for order to conduct assessment of patient in presence of police. • Council can order inspection (with Police) under Local DEPARTMENT OF HEALTH Government Act. POSSIBLE OR LANDLORD (See 2c, 2d & 3a) • Dept. of Health or Landlord can apply to conduct inspection under RESPONSES: Residential Tenancies Act. • Guardianship Tribunal for guidance and advice. Domestic Squalor Flowcharts Diagram 2 – August 2005 Northern Sydney Contact List Domestic Squalor Manly Warringah Pittwater Ryde Hunters Hill Case management: Individual support &/or case management: # Community Care (Northern Beaches): 9979 7677 Christian Community Aid Service Eastwood: 9858 3222 Cleaning: Commercial / Forensic Cleaners Gladesville Community Aid: 9817 0101 Council Services North Ryde Community Aid & Information Centre: 9888 3380 Manly Council Community Development Coordinator: 9976 1562 # Mercy Community Care: 9487 3022 Pittwater Council Community Development Officer: 9970 1199 Mid-West Community Care: 9898 0000 Warringah Council Community Worker Aged Services: 9942 2560 Cleaning: Commercial / Forensic Cleaners Aged Care Assessment Teams (ACAT): Council Services Manly ACAT, Manly Hospital: 9951 0330 Hunters Hill Council Community Services Liaison Officer: 9879 9419 Mona Vale ACAT, Mona Vale Hospital: 9998 0356 Ryde Council Community Project Officer / Access & Equity: 9952 8304 Community Health / Mental Health Services: Aged Care Assessment Teams (ACAT): Frenchs Forest Community Health Centre: 9452 4244 Ryde Aged Care and Rehabilitation Service: 9858 7782 Queenscliff Health Centre, Adult Mental Health Services: 9466 2500 Community Health / Mental Health Services: NSW POLICE – Local Area Commands Ryde Community Mental Health Service: 9858 7777 Dee Why: 9971 3399 NSW POLICE – Local Area Commands Manly: 9977 9499 Eastwood: 9858 5944 Gladesville: 9879 9699
Lower North Shore Hornsby Ku-ring-gai Individual support &/or case management: Individual support &/or case management: Crows Nest Centre: 9439 5122 # Mercy Community Care: 9487 3022 Lane Cove Community Aid: 9427 6425 Cleaning: Commercial / Forensic Cleaners Mosman Council Aged & Disability Services: 9978 4119 Council Services Mercy Community Care: 8425 7100 Hornsby Council Community Development Officer (Aged Services): 9847 6535 Hope Healthcare Community & Aged Care Services: 9903 8366 Ku-ring-gai Council Community Development Officer (Aged & Disability Cleaning: Commercial / Forensic Cleaners Services): 9424 0836 Council Services Aged Care Assessment Teams (ACAT): Mosman Council, Aged & Disability Services Development Officer: 9978 4129 Hornsby Ku-ring-gai Hospital – 9477 9525 # North Sydney Council, Community Development Aged & Disability: 9936 8195 Community Health / Mental Health Services: Willoughby City Council, Aged & Disability Services Co-ordinator: 9777 7975 Hillview Community Health Centre: 9449 9144 Aged Care Assessment Teams (ACAT): Hornsby Community Mental Health Centre: 9477 9520 Aged Care and Rehabilitation Medicine Royal North Shore Hospital: 9926 8705 Pennant Hills Community Health Centre: 9481 0022 Community Health / Mental Health Services: NSW POLICE – Local Area Commands Chatswood Mental Health Team: 9448 3250 Gordon: 9418 5399 Cremorne Mental Health Team: 9904 1700 Hornsby: 94769799 NSW POLICE – Local Area Commands Chatswood: 9411 0999 Department of Ageing, Disability & Home Care - Metro North Information, Intake and Harbourside: 9956 3199 Referral: 9450 7832. # If still unsure, for further information contact as marked in region.
Contact List for Domestic Squalor Diagrams 1 & 2 – August 2005
LIVING CONDITIONS RATING SCALE
The scale has 13 domains, totally 39 and each scoring 0 to 3.
0 = acceptability 3 = severely abnormal.
Ryde Community Mental Health Service found that a score of 11/39 required significant domestic assistance. We also considered that a score of 2 or 3 in any particular domain required assistance even if the total score didn’t reach 11/ 39.
Information for Scoring:
Interior of house Scale Accessibility Score according to ability to access eg 3 for completely unable to enter due to holes in floor/belongings piled up Odour Score 3 only if it is physically impossible to stay in the residence Lighting To score 3, no lighting/natural lighting ie very dark and unable to see without torch Floor/carpet Score 3 if unable to see the majority of carpet due to covering of newspapers etc Walls To score 3, the majority of the wall is covered with filth etc Furniture To score 3, there is only a mattress and no other furniture Kitchen To score 3, there must be no evidence of organisation, cleaning or rubbish removal over a long period of time; or no kitchen Food To score 3, there must be only minimal food/ poorly stored food Bathroom/toilet To score 3, there must be a blocked, or not functioning sewerage system; or no bathroom; and/or no toilet Disposal of excreta To score 3, human or large pet excreta (exclude occasional cockroach dropping) Hoarding To score 3, there must be a massive number of items stored in the home Clutter To score 3, there must be more clutter than accessible routes through the home Vermin To score 3, vermin must be visible on inspection
Adapted from published criteria: Macmillan D,Sahw P. Senile breakdown in standards of personal and environmental cleanliness. BMJ 1966:I:1032-37. Clark AN,Maniker GD, Gray I. Diogenes syndrome: a clinical study of gross neglect in old age. Lancet 1975:I: 366-68.
Living Conditions Rating Scale RCMHS CRT Organisation of Person who completed rating scale: Age of Client:………… Sex of Client: …………… Post Code……..... Dwelling: [circle those appropiate] single/shared/unit/house/group home/rented/privately owned/ other……………………… Age of Dwelling:…………………………. Interior of house Score Accessibilty 0. within acceptable standards 1. some difficulty entering the house or rooms 2. moderately difficult to enter the house or rooms 3. rooms or house inaccessible or impossible to enter safely Odour 0. within acceptable standards 1. slight unpleasant smell 2. moderate unpleasant smell 3. unable to spend any length of time in house due to the smell Lighting 0. within acceptable standards 1. poor lighting 2. most lights not working 3. no lighting available Floor/carpet 0. within acceptable standards 1. some rubbish, food stains, filth covering floor 2. moderate amount of rubbish, food stains, filth covering floor 3. thick covering of newspaper, cardboard, discarded packaging and stains on floor covering Walls 0. within acceptable standards 1. some filth, nicotine stains and grime covering some walls 2. moderate filth, nicotine stains and grime covering most walls 3. all walls covered with filth, nicotine stains and grime Furniture 0. acceptable amount of furniture (bed,table,chairs,white goods) 1. short of some necessary items (ie no couch or bed) 2. missing essential items (eg no fridge or stove but has a bed) 3. no essential furniture (ie mattress only) Kitchen 0. within acceptable standards 1. some unwashed crockery and benches left for a couple of days 2. most crockery unwashed and benches unwiped for some time 3. full of unwashed crockery, mouldy scraps evident, benches not wiped for months or more Food 0. acceptable amount of storage space and healthy variety of food 1. some storage problem (ie food not in cupboards) and reasonable variety of food 2. balanced diet only on pay days and /or shopping left in bags on the floor 3. little food in the house eg staple diet of tea, bread, biscuits, cakes and tinned food and/or inappropiate storage of food (ie frozen food not in freezer) Bathroom/toilet 0. workable sewerage system 3. blocked or non-workable sewerage system Disposal of excreta 0. no excreta noted throughout the house (include pet excreta) 3. excreta noted in the house ie on floor or walls Hoarding 0. within acceptable standards 1. some collection of singular items ie cartons, bottles,newspapers 2. moderate collection of singular items 3. mass collection of singular items Clutter 0. within acceptable standards (include clothing) 1. some cluttering of living space 2. moderate amount of clutter starting to affect living space 3. bags and boxes markedly reduce living space Vermin 0. within acceptable standards 1. some evidence of vermin present 2. moderate amount of evidence of vermin present 3. Rats/cockroaches are evident most of the time Total /39 If you have any clients living in domestic squalor please fill out the scale with non identifying details and fax or post to: Chris Taylor, Aged & Disability Officer - North Sydney Council ph 02 9936 8195 fax 02 9936 8177 PO Box 12 North Sydney, NSW 2060 [email protected]
Adapted from published criteria: Macmillan D,Sahw P. Senile breakdown in standards of personal and environmental cleanliness. BMJ 1966:I:1032-37. Clark AN,Maniker GD, Gray I. Diogenes syndrome: a clinical study of gross neglect in old age. Lancet 1975:I: 366-68.