YORBA LINDA, Calif. — Wet rag in hand, the older woman was trying to clean her filthy, packed garage to comply with a warning that she was violating city codes. As two officials approached to check on her progress, she proudly pointed to an open box in which she had placed two dead rats.
For maximum display, she had perched the box atop one of the garage’s many waist-high piles: bins overflowing with clothes and cans, a bicycle frame, a mildewed mop.
Darren Johnson, an inspector with the Orange County Fire Authority, and Mary Lewis, a city code-enforcement officer, smiled encouragingly. They maneuvered into the town house, its passageways blocked by the detritus of a troubled life.
Both are members of the Orange County Task Force on Hoarding, trained not to gag at the stench, even as their shoes squished on newspapers slippery with rat urine.
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Johnson, who with Lewis accompanied a reporter into the home on the condition the resident not be identified, shined a flashlight over tangled electrical cords and ancient magazines. If a fire broke out, he told the woman, “my guys would have a tough time getting inside.”
“So we’d have to get you out through the window,” he told her. “But it would be hard for you to climb through this stuff to get there.”
The fire inspector added softly, “Can you let us help you clean this up, to save yourself and not put everyone else at risk?”
An estimated 3 to 5 percent of Americans suffer from hoarding, officially recognized as a disorder in May’s release of an updated psychiatric diagnostic manual. But the impact extends beyond the afflicted individual and relatives in the home: The behavior can put neighbors at risk, by creating perfect conditions for explosive house fires and infestations of vermin and disease.
Across the country, local officials have begun grappling with hoarding as a serious public-health hazard. More than 85 communities — from San Jose, Calif., to Wichita, Kan., to Portland, Maine — have established task forces, hoping to stave off catastrophes and help hoarders change their lives.
A daunting mandate
The task forces on hoarding are finding their mandates daunting. With each case, officials must weigh when their authority to intervene trumps an individual’s right to privacy.
“The nature of the disorder demands multiple resources,” said Christiana Bratiotis, an assistant professor of social work at the University of Nebraska, Omaha.
The task forces typically include people from support as well as enforcement perspectives, added Bratiotis, a co-author of “The Hoarding Handbook,” an intervention guide. “There is value in the carrot-and-stick approach.”
Hoarding disorder is poorly understood, complex and often recurring. Over decades, cases wax, wane and become chronic.
It is distinct from cluttering or insatiable collecting. The self-soothing need to acquire, coupled with a paralyzing inability to discard, significantly impairs one’s ability to function.
Over the years, a hoarder’s health and hygiene become dangerously compromised. Because stoves, sinks and tubs are used for storage, cooking and bathing become impossible. Sleep becomes a relative term.
When the queen-size bed of a rocket engineer whom Johnson tried to help became buried under mounds, the man simply hoisted a twin mattress on top. In 2010, a Chicago couple was found buried alive under years of possessions.
Traditional methods for confronting hoarders are increasingly considered draconian and ineffective, creating new problems. Municipal cleanup crews or family members would throw the hoarded contents into a Dumpster as the homeowner watched, traumatized. Officials would seek civil or criminal penalties.
In extreme cases, a hoarder’s home — floorboards weakened, waste pipes neglected, mold growing deep inside walls — would be condemned. Evicted homeowners and tenants, mentally ill and often estranged from relatives, became homeless.
A pilot study last year led by Carolyn Rodriguez, an assistant professor of psychiatry at Columbia University, found that of 115 clients who sought help from a New York City nonprofit organization to avoid eviction, 22 percent had clinically diagnosed hoarding disorder.
Each task force is an amalgam of agencies and, depending on what resources they can muster, their goals may range from educating one another and the public to collaborating on cases.
Many task forces around the country use a standard checklist to rank homes. Those rated at levels 1 through 3 may need intervention but may not have descended into squalor.
“I’ve never seen a level 5” — the highest — “be cleaned up for less than $20,000,” said Johnson, who travels among 23 cities in Orange County and says he sees between 60 and 80 severe cases a year. In some cases, public funds may be available to help cover the cost.
After evaluating a home for fire hazards, he may call in pest control, social workers who specialize in older adults — whose hoarding may have gone undetected for decades — and cleanup crews affiliated with the county task force.
He will enter notes in a database for first responders, so that if there is a fire or other first-aid emergency at the home, they will be warned which entrances are blocked.
But even for a comprehensive task force, hoarding cases present harrowing, poignant obstacles, chief among them the homeowners’ fervent resistance to intervention.
Lewis learned of the woman in the Yorba Linda town house from the property manager, after a crew came to fix an interior leak that was making one of her walls collapse. To gain her trust as they inched their way through her home, Lewis and Johnson gently chatted her up.
Did she need food? Medication? Since Lewis had already extended the stick of code enforcement, they now both offered carrots for the cleanup.
Johnson had a friend at a vermin-control agency who could help. Lewis had a list of cleaning crews, mentioning that the woman might be eligible for a grant to defray costs.
Johnson wondered if he might stop by to install smoke detectors. The woman looked relieved. She promised to attend a therapist-led group in nearby Buena Park.
“I didn’t come into this world a hoarder,” she said. “I’m 76 now. I’m not leaving as one.”