A cluttered room. (Photo by Raining Rita / Flickr)

My mother was a meticulous housekeeper with no tolerance for clutter but a surprising acceptance of dusty surfaces (that came from living on a gravel road). My own standards are more relaxed, but not so much that I fear drop-in visitors will call the health department. And generally I have no trouble at all overlooking other people's messes. But sometimes it's hard.

One neighbor, in particular, really worried me. We could joke that we were friends partly because she made me look like a great housekeeper. But over the years, her clutter piled up and evolved into hoarding. At one point, I told her, “If there's ever a fire here, you will die in this house because there’s no way firefighters could get you out.” She thanked me for my concern. I offered help. She declined, but assured me she would work on it. She reported, several times, meeting her goal to haul one extra bag of trash each week to our rural transfer station. Eventually, she sold the place “as is” and walked away.

Rural neighbors have a lot of reasons to be anxious about people who hoard. These are not anonymous strangers easily labeled as lazy or dismissed as “someone else's problem”. We don't want to meddle in their affairs, but their situation can also impact the rest of us. What may start with piles of trash outside attracting rats, skunks and bears can progress to concerns about groundwater and impacts on the value of neighboring properties. And as with my neighbor, we may fear for their lives.

But what can you do? Sometimes, not much. But It helps to understand a bit about hoarding disorder when framing a plan to address a problem.

The disorder. According to the American Psychiatric Association, people with hoarding disorder have a perceived need to save items (regardless of their value) and persistent difficulty getting rid of stuff. Those with hoarding disorder report feeling indecision about what to discard, or fear the item will be needed in the future. Attempts to get rid of items can create considerable distress in people who may also have anxiety, depression or other mental health challenges. The alternative to that distress may be deciding not to get rid of stuff. Over time, the resulting clutter substantially compromises the ability to use living spaces as intended. According to the Anxiety & Depression Association of America, it's unusual for a person with hoarding behavior to make an independent, self-motivated decision to seek treatment for the disorder. Hoarding behavior begins relatively early in life and increases in severity with each decade.

Elders and hoarding. For most of us, the normal physical and cognitive changes that come with aging impact both our ability to decide what items to discard and the physical strength and flexibility to make them go away. Elders who are aging in place don't have to be hoarding for family members to be concerned about clutter contributing to falls or medication errors, or the time-consuming nature of having stuff in the way during activities of daily living. But with hoarding behavior, those concerns can escalate to include difficulty with self care, food contamination, poor sanitary and hygienic conditions, infestations of mold, insects, or rodents, and fire hazards (up to 25% of deaths by house fire may be related to hoarding). The most commonly hoarded items are everyday belongings including clothing, shoes, containers, tools and mechanical objects like nails and screws, household supplies, newspapers, mail and magazines.

Animal hoarding, a special type of the disorder, may begin with the best of intentions. But as an individual acquires more and more animals, the animals may be kept in inappropriate spaces, in crowded conditions that may become unsafe for both animals and people. Sometimes those conditions are visible to neighbors, such as inadequate pasture and feed for the number of horses present. Sometimes a rural mail carrier may suspect from the smell outside that many animals are kept inside a residence. Our volunteer fire department was called to one fire where the smell of cat urine was overpowering even through firefighters’ breathing apparatus. According to the American Psychiatric Association, people who hoard animals typically show limited insight that their situation presents any problem whatsoever.

Impacts within the household. That limited insight can also impact other members of a household, especially children, elders and disabled people living in the home. People with hoarding disorder may not recognize the dangers posed by the lack of clear pathways, the risk of falling, potential impediments to child development and care – even the impact of limitations on routine activities. The person with hoarding disorder may feel no need to address a problem they don't perceive – even when the accumulation of stuff means the family loses access to a place to prepare and eat meals, bathroom facilities, beds to sleep in, escape routes in case of fire. Members of a household who recognize the problem but are unable themselves to address it due to physical, cognitive or economic circumstances may feel stuck in an unsafe situation with no way out.

Shame and embarrassment. In situations where no problem is perceived, it's tough to offer help without giving offense or getting, “I'm working on it.” Those who do recognize that a problem exists may experience clinically significant distress at the prospect of getting rid of stuff, plus shame and embarrassment at their situation. Fear of being judged by their community can lead to social isolation and secrecy and prevent those who need help from seeking or accepting it.

Rebound effect. Well-meaning families, friends and neighbors may try to help by intervening with a big clean-up. But beware of potential consequences: Hoarders whose homes are cleared without their consent may experience extreme distress, become even more attached to their possessions, and be more likely to refuse help in the future.

Tough love. There are ways to help a hoarder. One is to stop contributing to the problem. For example, don't give them objects as gifts. Don't chauffeur them to garage sales. Don't store items for them. And if you regularly clean up for them, you may have to stop doing that. Otherwise, you're treating the symptom, not the problem. And it's easier to believe the problem isn't that bad when someone else is making it seem not so bad.

Is it hopeless? At some point, even rural neighbors who prefer to live and let live may be unable to overlook the impacts of hoarding. When that happens, you may be willing to risk everything – including cordial relations and the possibility of a reaction that leads to even worse hoarding in the future. One couple I know made repeated appeals to the township to require a neighbor to clean up their property, with little success. A rural municipality might send a strongly worded letter but lack the resources to hire enforcement – even if it has trash and (in the case of animal hoarding) noise ordinances on the books. And taking legal action against a hoarder is an expense that local government may be unwilling or unable to incur. That couple moved.

Legal action. There are circumstances in which legal action may be necessary. For example, a landlord may petition the court to evict a tenant when their actions violate a lease agreement. Bringing a civil suit against a hoarding neighbor is probably discussed more often than it's actually done – unless you can convince an attorney your hoarding rural neighbor is as rich as Howard Hughes.

Social services. The primary interest for rural social services agencies is generally the health and welfare of minor children, disabled individuals or elders in the home. If you suspect the health and safety of vulnerable residents are at risk, call your county social services agency to report your observations and concerns. Their actions will be governed by confidentiality laws so don't expect them to share with you what actions they may or may not take.

Public health. When hoarding has potential impacts on your rural water supply, attracts vermin, or poses another potential public health situation, your county health department may have resources to help. They can help you get your well water tested. They can also advise you on what local, state and other agencies you might contact with concerns like lack of egress in a fire, wildland fire fuel loads, hazardous materials storage, and more.

Animal welfare. Where animal hoarding is a concern, even budget-strapped rural animal welfare organizations can advise you on who to contact about helping possibly abused or neglected animals.

Law enforcement. Rural law enforcement officers and emergency service personnel see the worst of the worst situations. It's possible for hoarding behavior, including animal hoarding, to fly under their radar – or to seem like it does. But you can bet there are addresses they keep an eye on – in particular, where large quantities of debris may suggest meth cooking or other illegal activity. It may take time to build a case that can stand up in court. And in the meantime, they are not going to report to you their progress or intended actions. But you elect the sheriff who serves your rural county. So you can ask them – respectfully – to hear your concerns. And by reporting suspicious activity, you may contribute to helping vulnerable persons in the home and other neighbors as well.

When our former neighbor sold her place as-is, we had concerns about what kind of people might move into a place so filthy, so packed with stuff. We imagined every nightmare scenario. Instead, what we got was a young couple willing to tackle a monumental clean-up.

Shortly after they bought the place, the former owner called asking us to ask them a favor. She had left behind an item of both financial and sentimental value, and hoped it could be found. In the midst of all that debris, they did find it and were kind enough to return it to the former owner. Because we all have things we treasure, as well as fears and anxieties. For most of us, those don't evolve into hoarding. But we can have some compassion when it does.

Donna Kallner writes from Langlade County in rural northern Wisconsin. She adds that adult loved ones of people with mental health conditions like hoarding disorder may find free, confidential virtual support groups through the National Alliance on Mental Illness.

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