Hoarding Cleanup Guide: A Compassionate Approach

Hoarding is one of the most misunderstood conditions in mental health, and hoarding cleanup is one of the most sensitive services in the home services industry. If you are reading this guide, chances are you are dealing with a hoarding situation involving someone you care about — a parent, a spouse, a sibling, or a friend. Maybe you are facing a hoarding situation yourself. Whatever brought you here, this guide approaches the subject with the seriousness and compassion it deserves.

This is not a guide about "decluttering." Hoarding disorder is a recognized mental health condition, and treating it like a simple cleaning problem leads to failed cleanups, damaged relationships, and relapse. Effective hoarding cleanup requires understanding the condition, respecting the individual, and working with (not against) the person affected.

Understanding Hoarding Disorder

Hoarding disorder is a recognized mental health condition in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), classified under "Obsessive-Compulsive and Related Disorders." It is not laziness, not a choice, and not simply a matter of having too much stuff. Hoarding disorder involves persistent difficulty discarding possessions, regardless of their actual value, due to a perceived need to save them and distress associated with letting them go.

Research suggests that hoarding disorder affects 2 to 6 percent of the population, making it far more common than most people realize. That means in a city the size of Portland, tens of thousands of individuals are living with hoarding disorder to some degree. The condition affects people across all demographics — every income level, every education level, every age group, though it tends to worsen with age.

Common Misconceptions

• "They just need to clean up." Hoarding is not a cleaning problem. It is a mental health condition. Cleaning without addressing the underlying disorder results in relapse in nearly all cases.
• "They are just lazy." Many people with hoarding disorder are hardworking and productive in other areas of their lives. The disorder is specific to the acquisition and discarding of possessions.
• "A good cleanout will fix it." Forced cleanouts — especially without the individual's consent — cause severe psychological distress and almost always lead to the hoard rebuilding, often worse than before.
• "It only affects older people." Hoarding behaviors often begin in adolescence or early adulthood but may not become severe enough to notice until middle age or later.

The 5 Levels of Hoarding

The Institute for Challenging Disorganization (ICD) developed a widely used five-level hoarding scale that helps professionals assess severity and determine appropriate intervention. Understanding where a situation falls on this scale is the first step in planning an appropriate response.

Levels 1 and 2 can often be addressed with professional organizing help combined with therapy. Levels 3 through 5 typically require professional cleanup services with specialized training in hoarding situations.

When Cleanup Is Needed

A hoarding cleanup becomes necessary when the situation creates immediate health, safety, or legal concerns. Common triggers include:

Health and Safety Triggers

• Fire hazard — Blocked exits, clutter near heat sources, non-functional smoke detectors buried under items
• Fall risk — Narrow pathways through piles, items stacked unstably, especially dangerous for elderly individuals
• Sanitation concerns — Rotting food, animal waste, non-functional plumbing, pest infestation
• Medical emergency access — Paramedics cannot navigate stretchers through the home. This is a life-threatening concern.
• Respiratory hazards — Mold, dust, ammonia from animal waste, poor air quality

Code Violations and Legal Triggers

• City code violations — Oregon municipalities can issue code violations for exterior hoarding, pest infestations, and unsafe living conditions
• Landlord requirements — Rental properties with hoarding situations may trigger lease violations
• Adult Protective Services — APS may intervene when hoarding creates self-neglect concerns for vulnerable adults
• Child Protective Services — CPS may intervene when hoarding creates unsafe conditions for children in the home

Estate and Life Transition Situations

• Death of the hoarder — Family members must clean out the property for sale or rental
• Move to assisted living — The home must be cleared for sale
• Property sale — A hoarded home cannot be shown or sold in its current state

For estate-related hoarding cleanouts, see our estate cleanout checklist for additional guidance on the property management aspects.

Working with the Individual

This is the most important section of this guide. How you approach the person with hoarding disorder determines whether the cleanup succeeds or fails, and whether the relationship survives the process.

Never Just Throw Things Away

The single most harmful thing you can do is clean out a hoarded home without the individual's knowledge and consent. Forced cleanouts cause:

• Severe psychological trauma — Comparable to the grief of losing a loved one
• Relationship destruction — The person will likely never trust you again
• Rapid re-accumulation — Studies show that forced cleanouts result in the hoard rebuilding within months, often to a worse level than before
• Increased anxiety and depression — The loss of perceived control worsens the underlying condition

The only exceptions are situations involving imminent danger to life (structural collapse risk, severe biohazard) or legal mandate (court-ordered cleanup, APS intervention). Even in these cases, involving the individual to the greatest degree possible yields better outcomes.

Involve a Mental Health Professional

Ideally, cleanup should be coordinated with a therapist who specializes in hoarding disorder or OCD-spectrum conditions. Cognitive Behavioral Therapy (CBT) adapted for hoarding is the most evidence-based treatment. A therapist can:

• Help the individual develop decision-making skills for sorting possessions
• Provide emotional support during the cleanup process
• Address the underlying anxiety and attachment patterns that drive hoarding
• Develop strategies for preventing relapse after cleanup

Communication Approaches That Work

• Express concern, not judgment — "I am worried about your safety" works. "This place is a disaster" does not.
• Acknowledge difficulty — "I know this is really hard" validates their experience instead of dismissing it.
• Focus on goals, not stuff — "Would you like to be able to use your kitchen again?" is more motivating than "We need to throw all this away."
• Respect autonomy — The individual should make the keep/discard decisions whenever possible. Your job is to support, not override.
• Be patient — Hoarding cleanup is emotionally exhausting for the affected person. Sessions may need to be short with breaks.

Professional Cleanup Process

Professional hoarding cleanup differs significantly from standard junk removal. Reputable companies that specialize in hoarding situations follow a structured process designed to be effective and respectful.

Phase 1: Assessment

A trained professional visits the home to evaluate the hoarding level, identify health and safety hazards, estimate volume, and develop a cleanup plan. This visit is typically free and confidential. The assessment should identify:

• Hoarding level (1-5) and overall scope
• Biohazard concerns (mold, animal waste, vermin)
• Structural issues (floor integrity, water damage)
• Items requiring special disposal (hazardous materials, medications)
• Whether the individual will participate in the cleanup

Phase 2: Phased Cleanup

Rather than attempting to clear the entire home in one session (which is overwhelming and counterproductive), professional hoarding cleanup typically occurs in phases:

• Start with the most critical areas — Clear pathways, exits, kitchen, and bathroom first for immediate safety improvement
• Work room by room — Complete each room before moving to the next, giving the individual visible progress and a sense of accomplishment
• Allow decision-making time — When the individual is participating, work at their pace. Pushing too fast leads to shutdown and refusal to continue.
• Multiple sessions if needed — Severe hoarding situations (level 4-5) may require multiple days or even multiple weeks of sessions

Phase 3: Sorting Protocols

Professional crews sort items into categories:

• Keep — Items the individual wants to retain (within agreed-upon limits)
• Donate — Items in good condition that can benefit others
• Recycle — Materials that can be diverted from landfill
• Hazardous waste — Items requiring special Oregon disposal (electronics, chemicals, medications)
• Dispose — Items that are damaged, contaminated, or have no remaining useful life

Biohazard Considerations

Level 4 and 5 hoarding situations frequently involve biohazard conditions that require specialized handling. This is not standard junk removal — it requires trained personnel with proper personal protective equipment (PPE) and disposal certifications.

Common Biohazards in Hoarding Situations

• Animal waste — Cat and dog urine and feces accumulation, particularly in multi-animal hoarding situations, creates ammonia and bacterial contamination
• Mold — Oregon's wet climate makes mold growth particularly aggressive in hoarded homes with poor ventilation and moisture intrusion
• Rotting organic matter — Expired food, deceased animals, and decomposing materials
• Human waste — In severe cases where bathrooms are inaccessible or non-functional
• Vermin — Rodent droppings and nesting materials carry hantavirus risk; cockroach waste exacerbates respiratory conditions

Biohazard remediation adds significant cost to hoarding cleanup but is non-negotiable when present. The health risks to cleanup crews and future occupants are serious. Professional biohazard crews use respirators, Tyvek suits, and follow OSHA bloodborne pathogen standards. Contaminated materials are disposed of according to Oregon DEQ regulations.

Oregon Mental Health Resources

Oregon has several resources specifically relevant to hoarding disorder:

NAMI Oregon (National Alliance on Mental Illness)

NAMI Oregon provides education, support groups, and advocacy for individuals and families affected by mental health conditions, including hoarding disorder. They operate a helpline and maintain a list of support groups across the state. NAMI Oregon can help connect you with therapists who have experience treating hoarding disorder.

County Mental Health Services

Oregon's county mental health departments provide or coordinate mental health services, often on a sliding-scale fee basis:

• Multnomah County (Portland) — Behavioral Health Division, crisis line available 24/7
• Marion County (Salem) — Behavioral Health Division, adult mental health services
• Lane County (Eugene) — Behavioral Health Services, comprehensive outpatient programs

Additional Oregon Resources

• Oregon Health Authority — Maintains a directory of licensed mental health providers searchable by specialty
• 211info — Dial 2-1-1 for a free referral to local mental health services, housing assistance, and social services anywhere in Oregon
• International OCD Foundation — Maintains a therapist directory searchable by location and specialty, including hoarding disorder specialists in Oregon
• Adult Protective Services — For situations involving vulnerable adults where hoarding creates self-neglect concerns

Costs and Timeline Expectations

Hoarding cleanup costs vary enormously based on the severity of the situation, the size of the home, and whether biohazard remediation is needed.

These ranges reflect the Oregon market and include labor, disposal fees, sorting, and donation processing. They do not include structural repairs, deep cleaning, or ongoing therapy costs. For level 4 and 5 situations, always get multiple assessments and detailed written estimates before committing.

What Affects Cost

• Volume of items — More stuff equals more truck loads, more labor hours, and more disposal fees
• Biohazard presence — Specialized PPE, disposal methods, and decontamination add significant cost
• Home size and layout — Multi-story homes, narrow hallways, and basement hoarding are more labor-intensive
• Pace of sorting — If the individual participates in every decision, the process takes longer (but produces better outcomes)
• Disposal requirements — Hazardous materials, electronics, and medical waste require specialized Oregon disposal channels

Ongoing Support and Relapse Prevention

Cleanup is not the end — it is the beginning. Without ongoing support, hoarding behavior returns in the majority of cases. A successful long-term outcome requires:

• Continued therapy — Regular CBT sessions focused on hoarding behavior, ideally weekly initially and tapering to biweekly or monthly as skills develop
• Support groups — Peer support from others who understand hoarding provides accountability and reduces shame. Online and in-person groups are available through NAMI and other organizations.
• Check-in schedule — Family or friends checking in regularly (with permission) to offer support and catch early signs of re-accumulation
• Organizational systems — Simple, maintainable systems for incoming items. A "one in, one out" rule can help prevent re-accumulation.
• Address acquisition — Therapy should address the acquisition side of hoarding, not just the difficulty discarding. Compulsive buying, excessive free-item collection, and "just in case" saving patterns need specific attention.

Legal Considerations in Oregon

Hoarding situations can intersect with several areas of Oregon law:

• Property code violations — Oregon cities can issue code violations for exterior hoarding, pest infestations, and unsafe conditions. Portland, Salem, and Eugene all have code enforcement divisions that investigate complaints. Violations can result in fines and, in extreme cases, condemnation of the property.
• Landlord-tenant law — Oregon landlords can issue lease violation notices for hoarding conditions that create fire hazards, pest problems, or damage to the property. Tenants have a cure period to address the violation before eviction proceedings can begin.
• Guardianship and conservatorship — In cases where hoarding is part of a broader cognitive decline, Oregon courts can appoint a guardian or conservator to make decisions about living conditions and property management.
• Adult Protective Services — Oregon's APS can investigate hoarding as self-neglect when it endangers the individual's health. APS has authority to arrange cleanup services in some circumstances, particularly for elderly or disabled individuals.
• Environmental regulations — Severe hoarding situations with hazardous materials, contaminated water, or other environmental concerns may involve Oregon DEQ oversight for proper remediation.

If you are navigating a hoarding situation that involves legal or safety concerns, consulting with both a mental health professional and a hoarding cleanup specialist is the best path forward. At Otesse, we approach hoarding cleanup with the discretion, compassion, and professionalism that these sensitive situations require.