Question: Our mother’s home has become dangerously cluttered, especially since our father died 18 months ago. Piles of newspapers and magazines fill almost every space, with small paths winding their ways through the various rooms. Mom’s bed is covered with papers except for one small spot where she sleeps, and the refrigerator is packed with rotting food. At last count, 16 cats wander through and above the maze. The odor is unbearable.

But Mother refuses to admit there is a problem here. The more we bring it up, the more defensive she gets. She has just barred my sister from going into her home. We tried to talk to Mom’s doctor, but his staff says medical ethics prevent him from talking to us. We’re worried that Mom could fall and hurt herself and not be found in time. Have you heard of a solution to this kind of problem?

Answer: “Hoarding” has been defined as a fear that if you throw something away, you might need it, might not be able to remember it, or might bring bad luck on yourself. At the same time, the build-up of newspapers and magazines results in discomfort, not to mention safety concerns, which are generally very disruptive to one’s life.

Folks who hoard find it difficult to organize and make decisions, and therefore, keep everything, could be suffering from a form of obsessive-compulsive disorder (OCD). Woven in are issues of control over an item – or many items—which, if thrown away and picked up by the garbage men, will be lost forever. Therefore, it is easier to justify the concept that “if I don’t throw it away, I won’t have to worry about looking for it or replacing it.” As a matter of fact, we have heard from readers whose loved ones save chewing gum wrappers and even wash, store, and reuse aluminum foil.

Some experts say that hoarding takes the place of family or friends who have died or moved away. Although psychotropic drugs are often prescribed for those who suffer from OCD, these medications are generally not effective in the treatment of hoarding. Nor is intervention by the court because the legal system is ill-equipped to deal with this issue.

While the solution to your problem is certainly not an easy one, take heart that you are not alone. The New York Times published “When Clutter Becomes an Illness” on December 31, 2003. In fact, there are so many “hoarders” in New York City that its own Task Force on Hoarding was established in 2002. According to this article, 12 or more similar task forces have cropped up around the United States, and a “Hoarding Fact Sheet” has been developed by the Los Angeles County Department of Mental Health, Older Adults Services Division. This information, which provides advice for those who are dealing with an elderly friend or loved one who hoards, can be found online by clicking here.

Question: After my mother fell, broke her hip, and had surgery, my husband and I moved into her home to help take care of her for nearly three years. My husband lost his job and, in turn, we lost our other home. Last month, Mom had a stroke, was hospitalized, and then was admitted to a nursing home, where she will remain. Her only income is Social Security payments of $790 a month; her only asset was her home.

I was told by a social worker at the hospital that because I had taken care of her for two years, Mom could give me her house without penalty, so I got a lawyer to prepare a deed that Mom signed. But when I applied for Medicaid, even though Mom met the financial and medical qualifications, she was hit with a 20-month penalty. Now I must mortgage or sell the home to pay for her care for 20 months, and my husband and I are out in the cold. Where did we mess up?

Answer: You probably “messed up” by relying on an inaccurate legal opinion from a hospital social worker. The two-year care stipulation you were told about, which is contained in both federal law and state regulations, exempts the transfer of a residence by a Medicaid applicant to a child who both (i) lived in the house with the applicant, and (ii) provided care that helped the applicant avoid placement is a nursing home for a minimum of two years.

While we don’t know all of the facts, it appears to us that while you may have lived in the home for more than two years, you probably did not prove that the care you provided to your mother was instrumental in helping her avoid going to a nursing facility. As an aside, had you left the home titled in your mother's name, it would have remained an exempt asset, meaning that your mother would have qualified for Medicaid. At her death, however, the property would have been subject to “estate recovery” -- that is, the right of your mother’s state of residence to seek reimbursement for the amount of Medicaid benefits paid to her.

Bottom Line: In these very complex situations, it is essential that no transfers be made without advice from a qualified elder law attorney -- not a social worker at a health care facility or, for that matter, anyone else. (www.naela.org)