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If you’ve ever responded to a job and found yourself face-to-face with a wall of newspapers, a labyrinth of narrow walkways, or a kitchen that hasn’t seen a clean plate in years, you are familiar with hoarding. Hoarding changes everything.

Industry veteran Sandy Bowles of Horizon Consultants Inc. recently shared strategies for handling hoarding situations, particularly in restoration and remediation. With over 40 years in the industry and a pioneering reputation as the first woman to be IICRC-approved as an instructor, Bowles offered technical expertise and deep compassion.

One message was very clear: “We all have instant judgments,” she said. “Please put them aside.”

This wasn’t just about how to clean up a mess. It was about what hoarding is, what it isn’t, and how restoration professionals can approach these situations with the empathy and the planning they demand.

Defining the disorder

Hoarding, Bowles explained, isn’t simply about being messy. It isn’t laziness or poor housekeeping. It’s not even disorganization—though many hoarding environments might look chaotic. “It’s a psychological disorder,” she said, citing the clinical definition: the persistent difficulty in discarding possessions, regardless of their actual value, because doing so causes distress.

And hoarders don’t fit one mold. They can be wealthy or struggling, highly educated or not. “One of the worst hoarding situations I ever worked on was in a four-story luxury home filled with high-end antiques,” Bowles shared. “But you couldn’t walk through it.”

In many cases, hoarding stems from trauma, such as the loss of a loved one, a life-altering event, depression, or even dementia. And while it’s easy to think of hoarders as people you’d never know personally, the reality is often the opposite. “Chances are you do know someone who’s a hoarder,” Bowles said. “You just haven’t seen their home.”

The five levels of hoarding

Bowles recommended studying a scale developed by the National Study Group on Chronic Disorganization (NSGCD) to understand how to approach a hoarding restoration job. This scale categorizes hoarding behavior into five levels, each increasing in severity and risk.

������Level One, you’ll likely see a bit of clutter, but doors, stairways, and windows are accessible. There’s no strong odor. Pets may be present, but they’re well cared for. This level requires no special training or equipment for restoration professionals—standard procedures and maybe a pair of gloves will suffice. These are jobs we encounter all the time, even if we don’t call them hoarding.

But things can escalate quickly.

Level Two homes may have a noticeable odor. There might be at least one blocked exit, one major appliance out of service, and evidence of light pet accidents or rodent activity. The function of living spaces starts to change—counters aren’t clean, a couch might be buried in clothing, hallways narrow into footpaths. These clients need more than a friend’s help—they need someone professionally trained to work with chronic disorganization. For the cleaning crew, insect repellent and gloves are a must.

������Level Three, the clutter becomes overwhelming and spills to the exterior of the home. Multiple appliances don’t work. You might hear rodents scurrying in the walls. At least one room is completely unusable. There may be fire hazards, such as gasoline stored indoors and exposed wiring. Food preparation areas are visibly soiled. And perhaps most significantly, the emotional toll on both the occupants and the restoration team starts to take hold. “It’s not just about the junk anymore,” Bowles explained. “You’re dealing with someone’s entire sense of security—and you need to be trained to handle that.”

Working in a Level Three environment requires personal protection equipment (PPE), such as respirators, eye protection, and gloves. You’re protecting not just the property but also your team’s physical and mental health.

Then comes Level Four, where basic home functions have all but collapsed. Structural damage, sewage backups, broken windows and doors, and flea, rat, or even raccoon infestations may exist. Bedrooms are no longer usable. People may be sleeping on couches or makeshift beds on the floor. Mold is present. Rotten food sits on the counters. Stoves are used as storage and refrigerators house spoiled or non-food items.

Bowles stressed that it’s no longer just a cleaning job at this stage. Outside services are essential—pest control, trauma cleaning specialists, licensed contractors, mental health support, and often, charitable agencies. “One job took us more than a week just to find the floor,” she recalled. “By day two, we had to remove the homeowner. Watching us work was triggering such intense anxiety.”

Level Four homes are dangerous, both physically and emotionally. Full PPE is required, and your team needs trauma scene training. This is no place for guesswork.

Level Five is where habitability ceases entirely. There’s no power, no HVAC, no plumbing. Standing water might be collecting in the basement. Garbage is piled in every room. The bathroom doesn’t function, and human waste may be present in other rooms. Mice and rats don’t run away when you walk in—they live there like the occupants.

Some residents sleep in cars or in the yard. Others still sleep on chairs inside. “This is where hoarding becomes a multi-agency crisis,” Bowles explained. “You’ll need mental health professionals, building inspectors, social services, even legal aid. And before you start, you need a strategy, a contract, and a clear understanding of how you will get paid.”

These jobs demand extensive documentation, risk assessments, and collaboration with everyone, from landlords to the fire department.

The emotional weight

Hoarding isn’t about stuff—it’s about people.

For example, Richard, a gentleman who lived in a hoarded home for decades, was soft-spoken, thoughtful, and painfully self-aware. After the death of his mother, his collecting spiraled out of control. He crawled from room to room, slept on a commode chair, and saw his piles of newspapers as historical artifacts worth preserving.

“It almost makes me cry,” Richard said. “But you live like this for so long, it becomes your normal.”

The emotional toll of the cleanup on Richard was a sobering reminder: Clearing a hoarder’s home without their involvement can be traumatic. In one case, Bowles shared, a family cleaned out a mother’s home while she was away on vacation. When she returned and saw everything gone, she took her own life.

“Compassion is never out of place,” Bowles said. “Never look down on someone unless you are helping them up.”

Cleaning a hoarder’s home is never just about trash. It’s about rebuilding a life. And you’ll need more than your standard toolbox. You’ll need patience, planning, collaboration, and, above all, empathy.

Because in the restoration world, we don’t just clear damage. Sometimes, we help people start over.