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.
Darren Johnson, an inspector with the Orange County Fire Authority, and Mary Lewis, a city code enforcement officer, smiled encouragingly. They maneuvered into the woman’s townhouse, 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 woman’s home on the condition that she 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 percent to 5 percent of Americans suffer from hoarding, officially recognized as a disorder this month in a psychiatric diagnostic manual. But the impact of hoarding extends beyond the afflicted individual and relatives in the home: The behavior can also put immediate neighbors at risk by creating perfect conditions for explosive house fires and infestations of vermin and disease.
Across the country, local officials like Johnson and Lewis have begun grappling with hoarding as a serious public health hazard. More than 85 communities — from San Jose, Calif., to Wichita to Portland, Maine — have established task forces, hoping to stave off catastrophes and help hoarders turn their lives around.
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. “No one discipline has all the expertise needed.”
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.”
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. In 2010, a Chicago couple were found buried alive under years of possessions.
The possibility of a hot, hungry fire increases over time. First, utility bills become buried under snowdrifts of paper, so people forget to pay them. Electricity is turned off. Then residents use candles for light and gas burners for heat, inches from swaying towers of cherished trash.
In October 2011, a couple died in a fire in Dana Point, Calif. — a home that officials had tried for years to get cleaned up. Last October, a fire in Old Greenwich, Conn., destroyed a home that officials called inaccessible, leaving a woman critically burned.
In November, a Chicago man was burned, five of his dogs died and a neighbor’s home was scorched. Pat Brennan, a chief with the Chicago Fire Department, told reporters at the scene: “He was a hoarder. It impeded our progress.”
Task forces are also confronting another public health threat: infestations. After water is shut off, residents may urinate in bottles and defecate in the yard. Bacteria invade. Maggots feast. Vermin burrow.
In September, a woman who was trying to clean up a hoarder’s house featured on a reality TV show contracted a rodent-born hantavirus.
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.
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, the inspector, 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.
Another challenge is the stigma of hoarding, dissuading many from seeking help. Some task forces have considered renaming themselves. The Wichita and Sedgwick County Hoarding Coalition offers a “What a Mess Workshop” and a “Clutter Cleaners Club.”
While each municipality has sanitation and building codes, enforcement is discretionary and selective.
At the Yorba Linda townhouse, Johnson wondered whether 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.”