Newspapers, boxes, and clothing are stacked in so many tottering piles that navigating through the house is nearly impossible. The kitchen is unusable; the counters, sink, and stove are covered with dishes, pots, pans, magazines, and empty food cartons. There is a narrow path to the bathroom and bedroom, but even the tub is filled now with various things that don’t belong in a tub. Ashamed and embarrassed, the person who lives in this house seldom allows any visitors, even concerned family members.

Hoarding is a complex mental health disorder characterized by excessive accumulation of items and difficulty discarding possessions. At its extreme, hoarding creates a significant safety risk for seniors. The clutter can interfere with mobility, is a fire hazard, can harbor insects and vermin, and even make it impossible for the person to cook, bathe, or sleep in his/her own bed.  Hoarding may also involve the accumulation of animals, such as cats, dogs, and other pets.

While the causes of hoarding are not fully understood, sometimes hoarding behavior begins after the person has experienced a stressful life event. Many people who hoard also show other signs of mental illness such as depression, anxiety, and obsessive compulsive behavior, or have a substance use disorder. Hoarding behavior may also develop when a person has dementia.

People who hoard often resist the efforts of family members or professionals to clean their homes or discard their possessions. Steps that concerned family members can take include the following:

  • Assess the seriousness of the hoarding problem, and encourage a medical/psychological evaluation. Are there significant sanitation or safety risks? A professional such as a geriatric care manager can assist families with an evaluation and make recommendations on how to address the problem.
  • Offer assistance with cleaning in a nonjudgmental way. If your parent is ready to tackle cleaning, make an agreement that he/she can keep a certain number of items. Encourage sorting of items to keep, donate, or discard.
  • A professional cleaning service may be needed depending on the severity of the situation.
  • If the person refuses help and his/her hoarding, family members may need to contact social services or other authorities to intervene.

A thorough clean-up, which may involve many people assisting, is just the first step. Often, the individual will need intensive and long-term medical and psychological treatment in order to address the root causes of the hoarding behavior. Individual and group cognitive behavioral therapy (CBT) has been shown to be effective, but behavioral changes may be moderate and slow.