“We saw a large increase in people needing the program. COVID had such a major impact on [people’s] mental health. We really saw people deteriorate and need [the Extreme Cleaning and Hoarding Supports program] more than ever.”
The Extreme Cleaning and Hoarding Supports (ECHS) program, which CMHA Toronto took over from VHA in 2019, assists seniors aged 65 and up, or 55-plus if there is a mental health condition, at no cost to them. The program serves people in the Greater Toronto Area and throughout the Central Region of Home and Community Care Support Services, from Mississauga in the west to Scarborough in the east and as far north as Lake Simcoe.
Andrea Ferkranus, who manages the ECHS program, explains that most service users are not existing clients of CMHA Toronto, but come in through self-referral or from community services such as fire departments, municipal bylaw officers, or public health, and sometimes directly by landlords, concerned neighbours, or loved ones.
Regardless of the referral source, by the time people are referred to the service, they are in dire straits, often facing eviction.
What clients find, when they begin to interact with the program, is a supportive, non-judgmental, trauma-informed service that meets them where they are and helps address problems that may have been festering for years.
A unique service staffed by people with lived experience
One of the program’s unique features is that its cleaning team members are all existing or previous CMHA Toronto clients. This gives them a unique understanding of their clients’ issues. All the cleaners “have accessed support through CMHA Toronto so they're very understanding. They understand that mental health piece because they have that lived experience, which is really helpful. They're deeply compassionate to [the clients that use the service],” said Andrea.
Another benefit is that the service offers the cleaning team a competitively-paid employment path. “It's a great way for us to help find employment for our clients if [this type of work] is what they're looking for,” Andrea said, adding that many of the cleaning staff have been employed in a similar capacity with CMHA Toronto and have been with the program for many years. Cleaners receive extensive training, including a two-day workshop on the mental health issues that those needing the service may be experiencing, and always have the support of their own case workers and managers should they need it.
Shima Sharifi, one of two hoarding support workers with the CMHA Toronto program, works directly with clients and the seven-person cleaning team. For Shima, it is deeply meaningful to be able to help seniors with mental health issues as well as offering employment to people who need it: “I see how it is helpful for the seniors and for the cleaners too. It is kind of being in a position to keep everybody happy,” Shima said.
The EHCS service helps put – or keep – in place some of the most critical social determinants of health for its clients and the cleaning team, too. Preventing seniors from losing their housing and connecting them with community supports for ongoing care can help them recover health and well-being that has been in decline. The cleaners, who could be at different stages in their own recovery, gain the advantages of inclusion and rewarding work with a regular salary and benefits.
“When you finish the job and see that someone is not going to get evicted, that is a really good outcome.”
Always client-centred and trauma-informed
Shima explains that most of the seniors she meets “[usually] get to that point because of depression or dementia. Hoarding may be a part of it, but often the main reason is depression.” She adds that dealing with clients with depression versus those who are hoarding “is completely different because the person with depression, they know that they need the help. They try, if they can, to help us do the work. The people with hoarding issues, they are in a situation that they have to accept us but they don't want us there at all,” said Shima.
“That's why it's so important to come at this from a trauma-informed lens,” said Andrea. “We know that for people who experience these hoarding issues there is a high probability that they have been through some kind of a trauma at some point in their life.”
Both Andrea and Shima underscore that the program is always client-centred. “It's not like the show Hoarders where we go in and say we're removing everything. It's led by the senior,” said Andrea. “The main part for me,” said Shima, “is talking with them, asking ‘okay, what do you want from us?’ Because if we go in and say, ‘I want to do this’ or ‘we want to help you with that’, that won't work for them. I put it on their shoulders to tell us what they want us to do.”
Still, “there are times we need to have tough conversations and say if we don't do this, you're at risk of eviction. [We have to tell clients that] if they don’t let us in to do the work, there are consequences,” said Andrea.
It is a testament to the program’s success that, so far, they’ve only had a single client who could not “follow through with us supporting them and ended up losing their housing,” Andrea said. “Other than that, everyone has maintained their housing. So that's something that we're really proud of,” she added.
COVID shutdowns made things much worse
Because of COVID, clients “haven't seen any visitors, no family members. Some don't have any family members, but they had annual visits by the fire department or the bylaw officers – they didn’t even have those [visits]. So they got to the point that they were in a really bad situation by the time a landlord or someone noticed what was going on,” Shima said.
Shutting down the service during COVID “was devastating for some people,” said Andrea. “We stopped services for at least six or eight months [in 2020]. It was a long time. We're still recovering from that and trying to go back to serve all those people that that were put on hold.” The time between Shima’s assessment and when the cleaning team can do the work is now around three to four months, almost back to pre-COVID levels.
While it’s still a long wait for clients, the relationships and reputation that Shima and her team have built with community resources in many cases can prevent the eviction from happening. “The fire department and bylaw officers, I love them and they know our team,” said Shima. “Sometimes I call them and let them know, okay we have this one, we're going to get there. When they know we are involved they will put the case on hold.” Andrea confirms that “the relationship-building that Shima has done with people in the community, that's a big part of [the program’s effectiveness]. It might be two months after the eviction date, but we can say we’ve booked them in and they’re okay with that. We've built that trust, which is really important.”
Slow, steady, compassionate care
The program offers support for as long as needed at the outset of the case. “We can go back if, a year later for example, people are finding that they're starting to struggle again,” explained Andrea, emphasizing that it’s a process for people to regain the capacity to maintain their home.
Shima’s first task is to do an assessment, and that means working gently but persistently with seniors who may not have allowed anyone into their homes for years – even if community services or CMHA Toronto has been involved. “There are lots of case workers who are not actually able to meet their clients in their homes. They may meet outside in, for example, Tim Hortons. The seniors don’t want anybody to see their situation because they feel shame, they feel they will be judged,” Shima said. “And even PSWs [personal support workers], if they go inside, it’s just cooking or light cleaning. It’s important but it’s not enough,” Shima said.
Shima starts by assuring the client that she is not going to judge them. “I feel so bad seeing them in that situation. I reassure them that this is my everyday job, I see many different places. I let them know that their place is not that bad,’” said Shima.
She’ll spend as much time as necessary to get the client’s permission to enter their home. No one on the ECHS team seeks to make a diagnosis – that is not what they are qualified or called in for. But, as Shima says, “it is completely clear going into these places that there was [or is] a really big problem in this house.” Shima encourages the senior to share their story, gaining an understanding of their situation while also gathering the information she needs to estimate how long an assignment might be and how many cleaners will be required.
Shima’s goal in her first meeting with the client is to ensure that they are comfortable with her and with the program, and she lets clients know that they will find a similar non-judgmental and supportive experience with the cleaning team. “The second point [when clients feel] relieved from being judged is when they meet our cleaners. It is interesting seeing how our cleaners talk with them,” Shima said. She says she has witnessed how quickly the bonds can form between the cleaners and the clients and attributes it to their shared experiences as CMHA Toronto clients.
“It’s our job to work with clients to make it as slow as they need it to be, slowly but continuously to make progress. We want to make it so they’re not going to go back to that bad situation any time soon. That is the ideal thing.”
Some cases are harder than others
Shima and Andrea emphasize that, while these good outcomes are almost always possible, it can be a difficult path for the client. “We have some really hard clients. Sometimes it is really hard working with them,” Shima said, giving the example of working with a client with dementia: “Every five minutes we had to explain to her why we were there. We had lots of conflict between the client and the cleaners because she would forget why we were there. For example, she would forget that this bag belongs to the cleaner, would open it and start using the cellphone. So that was a big challenge.”
Shima shares that many clients are alone, without family or close friends nearby. Many people the program helps have lost a spouse and experienced “a really long depression, during which they didn’t have anyone supporting them. So they have, for example, a room full of memories of their husband or wife which they don't want to throw out or donate. Everything is piled up and, as I always say, it is piling up on their minds, too. Those are hard ones to work with because we can’t tell them, okay, just throw out all those memories. But at the same time, we want to help them to clear space in their minds as well as their homes,” Shima said.
Situations of hoarding are also challenging, because “it is like going around in a circle. We work and work and work to move a little bit, then the client becomes overwhelmed so they can't continue. When we come back, we have to start over again,” Shima explains.
One of her most challenging situations was of a client who was hoarding for many years. “She was by herself in a large house [that had been left to her by her mother]. She had a sister coming to support her, but it wasn't the kind of support she needed. It always ended up in fighting between two sisters. We had some really bad experiences, very traumatic. [The client would yell and] throw stuff at the cleaners – it wasn’t safe and the cleaners would have to leave. Every time, [the client] called afterwards and asked us to come back. She would say, ‘I’ll be calm, I tried to cooperate, I promise to be calm.’ That was heartbreaking for me seeing how much she needed our help and that she wanted the help. She had no connections in the community, no case worker, she had been on her own struggling like this for many years. Her mom was a hoarder too; we found rooms in the basement that even she didn't know were there,” Shima said.
“So that was a really bad situation. But at the end we finished that job and that was amazing. I remember that the fire department and the city came to do their assessment and they were really excited. [The client] was so happy, too,” Shima said.
“Everything is piled up and, as I always say, it is piling up on their minds, too. …We want to help them to clear space in their minds as well as their homes.”
What the future holds
When CMHA Toronto took over the program, Andrea recalls that she had no idea how they were going to reach the targets the funder (the City of Toronto) set: “We had to serve 97 seniors, provide 5,000 hours of service. I thought, ‘how in the world would we ever serve that many people, that just seems enormous’,” Andrea said, recalling how incredulous she was at the target and adding, with some dismay, how easy it was to reach.
Even with the pandemic pause, the program has provided 15,624 service hours to 345 seniors by the beginning of 2023, and there is no sign that it is slowing down. “The need is so high, there are so many people that struggle with these issues,” Andrea added. “There’s huge recognition that this is a valuable and important service.”
Shima says that the city’s bylaw officers are often shocked that she and her team are the only ones offering such a service across such a broad area. “The first thing they ask is, ‘are you only one team?’,” Shima said. “They can’t believe we do so much as a single team covering such a large area.”
Steadily, patiently, and with great compassion, Shima and her team at CMHA Toronto’s Extreme Cleaning and Hoarding Support service will continue to offer kindness, connection, and professionalism to seniors who have few other resources to turn to.
“It’s our job to work with clients to make it as slow as they need it to be, slowly but continuously to make progress. We try to support them so that they do not go back to their previous situation. We may not completely stop it. But we want to make it so they’re not going to go back to that bad situation any time soon. That is the ideal thing,” said Shima.