Self neglect and hoarding

Self-Neglect

Recognising the early signs of self-neglect can prevent someone’s situation becoming a problem.

Self-neglect research by Braye et al. (2011) highlights the following early signs and indicators that professionals should consider. Some people may experience more than one indicator:

• Living in very unclean home environment e.g. build-up of rubbish, dirt or waste; property in disrepair; hoarding of items, vermin.  
• Physical or health needs not adequately cared for, causing health to deteriorate.
• Lack of self-care e.g. neglect of personal hygiene, nutrition, hydration.
• Not attending medical appointments and/or prescribed medication being declined.
• Inadequate diet and nutrition, which impacts on the individual’s health and wellbeing.
• Social contacts not being maintained, resulting in isolation .
• Finances not being managed and no assistance being sought.
• Refusing to allow access to health and/or social care staff in relation to care needs, health needs or property maintenance, or unwilling to attend appointments with services that could help.
• mistrust of professionals/people in authority.

Hoarding

The following signs and behaviours also provide some useful indicators of hoarding:

• Refusing home visits from professionals in favour of office-based appointments.
• Refusing to answer the door to professional visiting the home.
• Property is very ‘cluttered’ and rooms cannot be used for intended purpose.
• Collecting items that have little or no monetary value that the person is extremely attached to.
• Struggling to manage everyday tasks such as cooking, cleaning and paying bills.
• An individual’s physical appearance may appear unkempt and dishevelled due to lack of toileting or washing facilities in the home. 
• The property being a source of complaints by neighbours about vermin.
• Complaints by neighbours about excessive number of pets creating hygiene issues, smells and noise.
• Property is falling into disrepair and becoming a health hazard.

Where there is evidence of escalating risk, professionals should consider the six safeguarding principles as part of their risk assessment and planned response.

These principles also form the basis for applying Making Safeguarding Personal (MSP) approaches which recognise that adopting a ‘one size fits all’ to safeguarding does not work, but focuses instead on:

• Understanding an individual’s unique circumstances, strengths and support networks.
• Balancing the individuals’ human rights whilst working with them to identify the least restrictive solutions.
• Providing accessible information to help people make informed decisions about how to remain safe.
• Respecting their background, culture, lifestyle, personal histories, interests, and likes and dislikes.
• Communicating effectively with them to identify ways forward, including them in decision making wherever possible.
• Ensuring that they continue to feel in control of their situation.

Even if you’re not likely to play a major role in the person’s ‘support journey’, you can start to develop a good relationship with the person before brokering the next set of conversations with another service.  However, practitioners often find that the first contacts can be the hardest.

Past experiences may mean the person mistrusts services or authority. Start by establishing rapport and talk about interests, histories and stories, rather than focusing on immediate problems or enforcement. The aim is to try to build a relationship and engage with them to try and understand if there are underlying causes for their behaviours i.e. bereavement, trauma, significant events in their life or a physical disability.

Key things to consider:

• Find the right person: think about who is best placed to make the first contact and act as a bridge to help you develop the relationship (GP, housing contact, fire service).
• Start with practicalities: providing practical help with small tasks at the outset may help build trust (offer to help with a food parcel etc).
• Find something that motivates them: seek to understand the individual’s interests and history and make links with these.
• Work with family, friends or carers if possible, or get some advice from the Hoarders Helping Hoarders Peer Support group mcchshousingsupport@manchester.gov.uk

First Contact:

• Can you ask the GP to write a letter to say you will be visiting?
• Would they like to bring a friend or have a friend present when you visit?
• Can a family member or neighbour introduce you?
• Equally - be discrete, sometimes a person doesn’t want to lose face with their neighbours - don’t wear your work ID badge.
• Think about any other services who are likely to have contact with the person, such as the fire service, housing, utility companies, community nurse. Can you do a joint visit?
• Can you enlist the help of faith, voluntary or community support groups?
• Can you make an appointment by phone or letter, rather than just turning up?
• Can you build rapport on the phone before the visit?

First impressions count: 

From the first moment you enter someone’s home, every interaction is important and your reactions and responses matter.

Offer a compliment on entry, on anything; or ask a question to show interest and start a general conversation – make a connection, however small.

Small comments, looks, expressions and body language can be noticed by those you are visiting and make them feel that they are being judged or cause them offence – this can make a massive difference to how they feel and affect you ability to build a rapport.

If there are pets, it may be that the welfare of the pet is more important to the person than themselves - ask about the pet, show an interest.

Remember contact is about social interaction - if they offer a cup of tea etc, try and say yes, if you don’t drink what they offer perhaps ask for a glass of water instead.

Sit down wherever possible, it helps when having a conversation to be on the same level – standing can make it obvious that you feel it’s too cluttered or dirty.

Try not to make any judgement obvious, whatever you are feeling or thinking.

Other helpful resources include the TSAB Guide on Professional Curiosity

Five top tips to support you to have difficult conversations

1. Preparation – jot down key points in priority order in advance as this will act as a prompt when you are with the person – see the list of questions in the next section on Working With Risk.
2. Specifics are important – have one to two detailed examples of how support can be provided to reduce risk(s), take different formats of information which are accessible to support conversations.
3. Environment is important – the type of space you use to engage with the person can have an impact on how the conversation goes, consider alternative environments to have a good conversation i.e. ask they person where they feel most comfortable meeting with you or if they don’t want you to visit their home suggest alternatives likes local coffee shop or walk and talk.
4. Silence is golden – when you have provided the information then stop and allow the person to reflect and take it in. Don’t rush the conversation, take time to listen to what they are saying.
5. Put yourself in their shoes – how would you feel to hear the information you have provided to the person and more importantly remember what language you use, don’t use jargon.

Conversations about Hoarding 

Once you have made a connection THEN try to gently explore the person’s relationship with or attachment to their belongings.

For example:

• Start by asking the person to choose an item of great value to them (they define ‘value’ in any way they like) and something they would be extremely reluctant to discard or give away.  Ask them to tell you the story around the item.
• When you have developed that initial rapport demonstrate Compassionate Curiosity for example ASK: “What HAPPENED to you?” or “I’d like to hear a part of what happened to you in your life if you wouldn’t mind telling me please?” (or similar!)
• Ask the person to think back to a time before their environment became problematic for them and ask what they miss most – it’s another conversation starter but can give you and them some kind of a future ‘goal’ to aim for.
• Keep the focus on their personal strengths and opportunities as far as possible. Many will have shown real resilience coping with the circumstances that has resulted in their hoarding behaviour and will feel valued if this is recognised by those wanting to support them.
• Try to avoid using threats or the language of enforcement, these create negativity, anxiety and can lead to closed doors.
• The term ‘self-neglect’ can be a very stigmatising and emotive term – be careful how you use it.

Avoid setting goals or making plans until you have a shared/agreed understanding of the issues involved. Go at their pace - moving slowly and don’t force things; this may mean talking about other things until the individual is ready to talk about their situation. It may take several visits before they are ready to start thinking about goals.

This is also the key time to consider if there are risks to anyone else living in the property, such as young person and/or adult children, and to check if they are involved with any other professionals. See the section on Family, Carers and Advocates.

For more helpful information Tameside and Salford Hoarders Peer Support group have kindly consented to share their practical guide for people supporting or living with adults who exhibit hoarding behaviours TASPB-Tameside-Hoarder-Guide.pdf

The assessment and management of risk alongside an individual, their carer or advocate is essential to determining if the individual can see both the risks and benefits associated with the risk, and to inform their decision making. This includes understanding the risk to themselves and to those around them.

Risk Assessment

Risk assessment involves:

• The identification of known or potential hazards, circumstances, relationships
• Analysis of the impact/severity and consequences of the risk to the individual or others around them
• Analysis of the likelihood that the risk will occur

Contact other services to start a multi-agency risk management approach by sharing information to gain a full picture of all the risks and set up a Team Around the Adult meeting to develop a shared risk management plan.

Having a shared multi-agency understanding of the nature and degree of an individual’s risk factors, who is at risk, the likelihood of occurrence, the severity of impact of a risk, and the context in which the risk occurs, supports practitioners to hold informed conversations with individuals at risk.

Each agency involved with the adult should, as part of their own case management arrangements, maintain a chronology of key events and complete and document their internal risk assessment and management plan.

As a starting point it can help to think about the following aspects of the situation:

If there is hoarding in the property it may help to ask the following questions:

The Trafford Multi-Agency Risk Management (MARM) Practitioners Toolkit provides a range of practical resources, including a risk management template and guidance for chairing multi-agency meetings. 

Remember to work at the pace of the adult and don’t try to tackle multiple areas of risk in one go.

If the risk assessment highlights circumstances or risks which would be more appropriately dealt with under another process such as a Care Act Assessment or referral for Adult Safeguarding – please see the section on Referring to Services for more information.

Risk Enablement 

It is important to recognise that all risk cannot be removed, all harm cannot be prevented from taking place and that some risk taking can have positive outcomes. Working with risk can be very challenging for professionals working to balance an individual’s human rights and enabling acceptable risk with their professional duty of care to keep people safe.

Risk enablement should be a core part of placing people at the centre of their own care and support and consider:

• Individual strengths which may help to reduce risks.
• Balancing risk between an individual’s wishes and their human rights and the safety of those around them.
• Potential impact - the physical, psychological, and emotional impact to the individual of taking or not taking a risk. This includes the concept of positive risk taking to support the independence and autonomy of the individual at the centre of practice.
• Individual histories - the context including previous and current risk-taking behaviours, previous and current external sources of risk, the ability of the individual’s support network to cope with risk taking.
• Executive functioning - working proactively with the individual to look at patterns beyond the immediate crisis to understand wider executive functioning.
• Probability - considering timescales, external factors, and the significance of a potential outcome. Risk management plans should be flexible and responsive to changes.
• Risk minimisation – this is when the risk of harm in your mind is minimised due to factors such as burnout, unconscious bias, or compassion fatigue. Unconscious bias due to an individual’s repeated distressed behaviour can lead to a focus on select information rather than the whole picture. It is a very natural human trait and regular reflection, case discussion, supervision, peer, and managerial support are all there to assist practice.

Risk Management 

Risk Management should be a living process with regular reviews to consider changes in a person’s situation.

Multi-agency decisions, and the reasons behind them, should be clearly documented, with multi-agency meetings reconvening to consider progress and to review the plan. The Risk Management Plan should include details of all the relevant legislation being applied in the situation (see the section on relevant legislation). Where key agencies repeatedly fail to engage in the risk assessment and management process, the MARM escalation pathway (to be added) should be followed.

If someone chooses not to engage, agencies should not withdraw from supporting the adult without a formal multi-agency discussion and completing a risk assessment. Please see the section on Working with adults who are reluctant to engage.

Self-neglect and hoarding often involves situations where an individual declines support which could help to improve their situation. This can be due to previous experiences, past trauma or a desire to remain independent.

If an adult at risk of harm due to self-neglect and/or hoarding refuses support, it is important to understand what their concerns are and to be honest with them about the risks involved. In these circumstances the following should be considered:

• Professionals should try to engage with the adult as much as they can; be persistent without causing distress and understand their limits to intervention if the individual does not wish to engage.
• Where there are concerns about mental capacity a referral should be made to Adult Social Care for an assessment to be conducted.
• Where someone is assessed as not having capacity in relation to relevant decisions, actions should be taken in the persons best interests and in accordance with the Mental Capacity Act 2005.
• Where someone does not wish to engage with services, and has the capacity to make this decision, any actions should be proportionate to the risk and in line with Article 8 of the Human Rights Act 1998 and consider the safety of those around them.
• Understanding the individual involves trying to understand why the person is reluctant or unwilling to seek or accept support. See the section on Starting the Conversation.

When an adult refuses to engage this may require agencies to be flexible in their approach. Professionals should follow guidance set out in the TSAB Multi Agency Risk Management (MARM) Framework and consider the different legislation that can help depending on the situation – see the section on Legal Frameworks.

Before disengaging with someone who declines support or services:

• Identify any risks (or worries) that require immediate action – what is the duration and seriousness of the self-neglect.
• Consider if the individual has been provided with all the necessary information in a format they can understand.
• Assess the risk as far as is possible given the individual’s limited engagement. Be open and honest; share concerns about these risks with the individual self-neglecting.
• Consider if there are any wider protective characteristics that require reasonable adjustments or any cultural needs factors to consider. More information about protected characteristics can be found in this short video Protected characteristics.
• Check out your concerns with other relevant agencies, hold a strategy meeting where appropriate to discuss options for escalating to the Complex and High Risk Panel (link to be added) before considering closure.
• Consider who (whether family, advocate, other professional) can support engagement with the individual. You may not be the best person.
• Formally record decisions, actions, attempts to engage and the individual’s responses.

Resolving multi-agency disagreements

If there is a difference of opinion between agencies about the right approach or eligibility thresholds for support, the TSAB Escalation Protocol provides guidance for practitioners to help resolve or escalate a concern. More information can be found here Multi Agency Escalation Protocol.

Self-neglect and hoarding behaviours can impact on other adults or children who live in the same household. It can also impact on those who care for adults who are self-neglecting or hoarding and impact on the care of children or other adults at risk living in the property.

It is important that practitioners think family – and think household - when considering responses to self-neglect and hoarding behaviours.

Hoarding impact on children and young people

Evidence suggests that growing up in a hoarded property can put a child at risk by affecting their development and can lead to parental neglect, which is a child safeguarding issue.

It is important to assess the risk of harm or neglect for any others living in the property and where a child is at immediate risk of harm, call the police on 999, alternatively if it’s a safeguarding concern send a Safeguarding Children referral to Trafford Council’s First Response using the online referral form Trafford Children's First Response.

Even where there are no immediate concerns for a child living in the property, it is important to recognise that growing up in a hoarded property can also become an intergenerational issue, starting in the teenage years and becoming more acute as people get older.

Hoarding impact on adults at risk

An adult with long term care and support needs may also be at risk if they are living in the property with a person who is self-neglecting and/or hoarding.

There may be a safeguarding concern about the adult if they are at risk of harm due to the way the person who is self-neglecting or hoarding is choosing to live in the property. Referrals for the adult at risk should be made to Trafford Adult Social Care using the online referral form ASC Referral Form.

Hoarding and carers

If a child, young person or adult living in the property has a caring role (whether for an adult or another child), a referral should be made for a carer’s assessment to be completed by using the following link  Make a Referral.

Useful Contacts 

Some people who self-neglect or hoard may struggle to make decisions for themselves, and in these cases, professionals need to consider mental capacity.

The Mental Capacity Act 2005 Principles

The Mental Capacity Act 2005 is underpinned by the following five principles. The first three principles support the process of determining whether someone lacks capacity.

If it is decided that someone lacks capacity in relation to a specific decision, then principle 4 and 5 support the decision-making process.

1. A person must be assumed to have capacity unless it is established that he lacks capacity.
2. A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.
3. A person is not to be treated as unable to make a decision merely because he makes an unwise decision.
4. An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in their best interests.
5. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action.

Assessing Mental Capacity 

Mental capacity assessments must determine whether the person can:

• understand the information relevant to the decision
• retain that information (long enough to make the decision)
• use or weigh that information as part of the process to make a choice
• communicate their decision (whether by talking, using sign language or any other means)

Self-neglect is often characterised by a gradual decline in wellbeing so repeating and documenting capacity assessments that evidence the extent to which clients truly understand the future consequences of their decisions is extremely important.

Where the adult declines support and they have been assessed as having the mental capacity to understand the consequences of such actions, this should be fully recorded.

Professionals should also include a record of the efforts and actions taken by all agencies involved to provide support and confirmation that they have considered alternative means to help explain the consequences. There should be plans in place to monitor and review risks and reconsider actions should risks escalate.

Further information is available in the MCA code of practice.

Unwise Decisions

The Mental Capacity Act (MCA) states that a person is not to be treated as unable to make a decision or that they lack capacity merely because they make an unwise decision. Instead, the decisions should be considered alongside the risks and consequences as part of the capacity assessment.

Executive Functioning 

Executive functioning should be considered where a person gives clear answers to questions, but their actions suggest that they are unable to translate this into practice. Mental capacity involves not only the ability to understand the consequences of a decision, but also the ability to execute, or carry out, the decision.

A simple way to demonstrate this is to use ‘tell me/show me’ approaches. Ask the person to tell you how they would respond and then ask them to show you how they do it.

Here are some suggestions from practitioners about how this could be done:

• You need to observe the person’s practical ability to complete actions relating to a decision such as cleaning, shopping or cooking. For example, a person may say they are able to make meals, no problem, but you can’t see any evidence that meals are being prepared or cooking done. You could ask them to show you how they make a cup of tea, or a slice of toast.
• Sometimes, people have physical difficulties with completing an action. For example, a person may say they are able to take their medication independently. But when you look at the medication blister pack it is unopened. It may simply be that the person is unable to open the blister pack unassisted.
• A person may have the ability to self-medicate but make the decision not to take the necessary medication as they fear the side effects (such as frequent urination), or they lack confidence in its efficacy.
• In hoarding situations, a person may have the ability to clean up or order a skip, but that doesn’t take into account the related emotions – the value of their possessions to them, emotional significance of the items, safety, anxiety or guilt.
• Decisional and executive capacity may be difficult to test in some environments, such as hospital. ‘Testing’ decisional capacity may require there to be a level of trust that comes from a more established relationship.

Best Interest Decisions

For individuals who have been assessed as lacking mental capacity to make specific decisions about their health and welfare, the Mental Capacity Act 2005 allows for others to act in the person’s best interests.

In urgent cases, where there is a view that an individual lacks mental capacity (and this has not yet been satisfactorily assessed and concluded), and the home situation requires urgent intervention, the Court of Protection can make an interim order and allow intervention to take place. In such cases legal advice should be sought.

Learning from the Safeguarding Adult Review (SAR) for SAR James shows the importance of multi-agency information sharing as a first response where there is evidence of self-neglect and or hoarding behaviour. This can help to understand and assess the overall level of risk (low, medium or high) and identify the services best placed to offer support.

Stage 1: Multi-agency Risk Management

Multi-agency meetings to share information should be considered at the earliest opportunity to understand all the risk factors and the extent and impact of the self-neglect and/or hoarding. See the section on Working with Risk.

Where there are risks to an individual’s health and wellbeing:

• professionals should follow the Trafford Multi-agency Risk Management Policy and set up a Team Around the Adult meeting. TSAB Multi-agency Risk Management Arrangements can be found here Multi Agency Risk Management (MARM) Framework. 
• Share information to understand their history of how they came to be self-neglecting and or hoarding, and help to understand their worldview – what is their life like? Consider wider factors of trauma, bereavement, loss, divorce as well as any diversity issues that may be relevant.
• The MARM Framework can help to coordinate responses where there are multiple low level risk factors for self-neglect and/or hoarding or where there is a reluctance to engage with services.

Stage 2: Adult Social Care Assessment 

Where an individual has care and support needs as defined under the Care Act (more information can be found here Eligibility for adult social care | Trafford Council) and the effects of self-neglect and/or hoarding, pose a significant risk to their health and wellbeing:

• Referrals should be made for a Care Act Assessment to Social care support | Trafford Council or by calling the team to discuss on 0161 912 5199 (Monday to Friday, 9am to 5pm).
• The Care Act process will consider issues of mental capacity to make decisions, risks and the individual’s wishes to identify the most appropriate support.

Stage 3: Safeguarding

Where there is evidence of escalating risk or existing risks cannot be reduced through multi-agency risk meetings or care planning, or there is evidence of immediate harm to the person or those around them:

• An adult safeguarding referral should be made to the Trafford Hub Report a concern in line with the Trafford Multi-agency Safeguarding Policy and Procedures Link TBA.

Useful Contacts

Working with people who self-neglect, and building up a trusting relationship with them, can be a very slow, painstaking process. Consistency in terms of the worker who is involved and their approach to the adult is also very important.

However, this sometimes doesn’t sit well with timescales for closing cases and ending involvement. For social workers especially, there can be pressure to close self-neglect cases, particularly if a person is refusing to engage, and is deemed to have mental capacity. Yet often substantial worries remain about the self-neglecting person. Before closing a case, it may help to consider the following:

The quality of information as to the circumstances 

• The adult’s story and history – what have been major events in their lives, how have they been shaped by these and coped with them, what is important to them?
• Reliability and availability of information
• Existence of care and support needs
• Any changes to presentation, behaviour or routine
• The presence or absence of coercion
• Any previous family, community, housing or safeguarding concerns
• Awareness of the strength, availability and responsiveness of the adult’s personal and local networks.

The risks to the person, and to others 

• Seriousness of the circumstances
• Risk of death or major harm
• The nature and timing of the risk
• Has it changed over time?
• Does the risk affect others, such as neighbours or other tenants?
• Are there any children involved?
• Has a crime been committed against the person?
• Consider your ‘proportionality and perspective’ about the circumstances.

The likelihood of the risk actually happening 

• Immediate nature of the risk?
• Are all variables being properly weighed?
• Is there any objective or research evidence available?
• Consider the over-influence of the ‘protection imperative’ (“What’s the point of making someone safe if in doing so you just make them miserable?” (Munby, LJ, 2007))

Efforts made to engage with the adult 

• Efforts have been made to gain the person's trust and build a relationship and going at the person’s own pace. Have you done that?
• Support has been provided to help the adult to look after themselves. What has been provided?
• Encourage them to continue the conversation with other people who they trust
• Mental Capacity has been considered and where appropriate assessed. As has Executive functioning. How has this been considered?
• Other agencies have been informed and involved as necessary
• Consideration has been given to involving others (whether family, advocate, other professional) to support the individual.
• Support has been provided to help the adult to weigh up the risks and benefits of different options - Multi-agency Risk Management policy has been followed TSAB Multi Agency Risk Management (MARM) Framework
• The adult understands where they can go if they want to seek help in the future. How do they know?
• Record your reasons for not intervening

The strength of the adult’s views 

• What is the adult’s rationale for their views or opinions?
• Is it consistently stated, or has it changed or developed over time?
• Is what they want to happen possible, lawful and does it impact on other people’s rights?
• Is it legitimate or reasonable in the circumstances?
• Are they declining all support to help address needs, or just some?
• Can they demonstrate an ability to adapt to other changes in circumstances?
• The adult’s rights to privacy and family life could outweigh concerns. Consider the Human Rights Act. Different people give different weight to different factors or concerns – the person may simply not see the situation as being as serious as you do.

Final considerations 

• Could someone else have more likelihood of successfully engaging with the person, and achieving a good outcome?
• What are the real, known strengths, availability and responsiveness of the adult’s support networks? Can they be strengthened or expanded?
• Is there room for compromise, expediency, delay or better timing?
• Is there organisational capacity to monitor and review the situation regularly?
• Are you assured that they understand where they can go if they want to seek help in the future?
• Have other agencies been informed and are they involved as necessary? Check out your concerns with other relevant agencies, hold a strategy meeting where appropriate to discuss options for escalating to the Complex and High Risk Panel (link to be added) before considering closure.
• The frequency and duration of any ongoing contact and efforts to engage should be proportionate to the factors above.
• Formally record decisions, actions, attempts to engage and the individual’s responses and rationale for closing the case.

There will be times when the impact of the self-neglect on the individual’s health and well-being, their home conditions or neighbours' environmental conditions are of such serious concern that practitioners may need to consider taking legislative action to improve the situation.

The following legislation is a starting point to help professionals and should be considered in consultation with legal advice as part of a multi-agency intervention plan.

Additional legislation that may be relevant when supporting individuals with a hoarding disorder:

Hoarding can be a fire hazard, and occupants can be at greater risk of death or serious injury from fires in hoarded homes.

Often, blocked exits prevent escape from the home or access in the event of a fire, making fighting fires and searching for occupants far more difficult and responding firefighters can be put at risk. Also, those living adjoining to, or near to a hoarded property can be quickly affected when a fire occurs.

Where cluttered properties cause a fire risk to the person, family, wider community or responding firefighters, a referral for a Home Fire Safety Assessment (HFSA) must be considered. For individual cases where consent is unavailable, but the fire risk remains a concern, please seek advice from Greater Manchester Fire & Rescue Service (GMFRS) regarding potential alternative approaches to address the fire risk in a collaborative way.  Always consider inviting a GMFRS representation to any safeguarding strategy/MDT/Team Around the Adult meetings where fire concerns have been identified.

More information regarding GMFRS Home Fire Safety Assessments and how to make a referral is available here GM Fire and Rescue

Clutter Image Rating

For cases involving hoarding, the Clutter Image Rating, can be a helpful resource to support decision making. However, the images should only be considered as part of a wider, holistic consideration of risks that takes into account past factors, background, circumstances and the persons understanding of their current risks.

The Clutter Image Rating[LA2] is recognised nationally and endorsed by the National Fire Chiefs Council (NFCC) Person Centred Framework (PCF), which supports Fire & Rescue Services to deliver a standardised and evidence-based approach to Home Fire Safety Assessments, as well as being used further in the Online Home Fire Safety Check (which is utilised by Greater Manchester Fire & Rescue Service and other services across the country).

Conversations about functionality can also help to jointly assess risk. Functionality refers to the number of rooms or spaces that can be used for the purpose for which they’re intended. Asking questions such as “How do you get hot water and lighting in here? How do you manage to cook food and keep yourself warm, especially in winter?” can be useful conversation starters to understand how the person perceives their living arrangements and any associated risks.

For cases that considered to meet level 3 of the Clutter Image Rating a referral for a Home Fire Safety Assessment (HFSA) must be considered. See earlier information about consideration of a Home Fire Safety Assessment referral for all properties where  there is a fire risk to the person, family, wider community or responding firefighters.

Clutter image rating - how to use:

Select the photo that most accurately reflects the items in the room

• Level 1 (Images 1-3) - require no specialist intervention
• Level 2 (Images 4-6) - may require some support for the adult and should be considered as part of a wider, holistic consideration of risk factors, background and understanding of current risks.
• Level 3 (Images 7-9) - requires specialist intervention including multi-agency working and a safeguarding referral

Kitchen:

Bedroom:

Living Room:

Contacts for Services                          

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