Families, landlords and agencies often hear hoarding described in terms of levels or scales. These tools help professionals communicate about severity and plan cleanup. They aren't diagnoses, and different organizations use different systems. This guide explains how severity is generally assessed and what it means in practice.
Why severity scales exist
A shared description of severity helps:
- Plan cleanup: crew size, equipment, time and cost
- Prioritize safety: fire, structural and sanitation risks
- Coordinate services among families, therapists, code officials and protective services
- Track progress over time
Common tools
Several tools are used in the field:
- Clutter image rating scales use a series of photographs showing increasing clutter in rooms, such as a living room, kitchen and bedroom. The person or assessor picks the photo that best matches each room. These are widely used in research and clinical settings.
- Clutter-hoarding scales with numbered levels, developed by professional organizing groups, describe several levels based on factors such as structure, animals and pests, household functions, health and safety, and sanitation.
- Questionnaires used by clinicians assess difficulty discarding, acquiring and distress.
Different companies may adapt these tools or use their own descriptions. When you hear a level, ask what scale is being used and what it means for the work.
What assessors look at
Regardless of the tool, assessments consider:
- Access and exits: Can people move through the home and get out quickly?
- Use of rooms: Can the kitchen, bathroom and bedroom be used for their purposes?
- Structure: floor loading, water damage, roof and structural issues
- Utilities: working plumbing, heating, cooling and electrical systems
- Sanitation: spoiled food, human or animal waste, odors
- Pests and animals: infestations, number and condition of animals
- Fire hazards: combustibles near heat sources, blocked exits, electrical overload
- Health risks to occupants and visitors
General levels in plain language
While tools differ, severity is often described along a continuum:
Low: clutter is present but rooms are usable, exits are clear, and sanitation is adequate. Organizing support and gradual decluttering may be enough.
Moderate: clutter limits use of some rooms, pathways are narrowed, some sanitation issues or minor pests may be present. Cleanup and organizing with sanitation work are typical.
Severe: rooms can't be used for their purposes, exits are blocked or difficult, sanitation problems are significant, pests are present, and repairs are neglected. Professional cleanup with protective equipment is needed.
Extreme: conditions threaten health and safety, with human or animal waste, structural damage, non-working utilities, heavy infestation or mold. Professional remediation, coordination with agencies and repairs are needed, and occupancy may be unsafe.
What severity means for cleanup
- Crew size and duration increase with volume and hazards.
- Protective equipment increases with biological contamination, mold and pests.
- Disposal costs rise with volume and contaminated materials.
- Repairs are more likely in severe cases.
- Coordination with therapists, agencies and contractors becomes more important.
Limits of scales
Scales describe conditions in the home, not the person's diagnosis or capacity for change. Conditions can vary dramatically from room to room. A low rating in one area doesn't mean another area isn't dangerous. Use scales as communication tools, not labels.
Using severity to set priorities
In practice, many plans start with the most serious risks regardless of the overall level: clearing exits, removing spoiled food and waste, addressing fire hazards and restoring working bathroom and kitchen. That improves safety quickly, even before the rest of the home is addressed.
An example assessment
In a two-bedroom house, the living room has narrow paths but usable seating; the kitchen counters and stove are covered and the refrigerator holds spoiled food; one bedroom is filled to waist height; the bathroom works. Overall the home might be described as moderate to severe, with the kitchen as the priority because of fire risk at the stove and sanitation concerns. The plan starts by clearing the kitchen and exits, then works through the bedroom with the occupant's participation.
Reassessing over time
Severity tools are most useful when repeated. Rating rooms again after cleanup and periodically afterward shows whether conditions are stable or returning, and can guide when to schedule maintenance visits or additional support.
Frequently asked questions
Who decides the level?
Assessors, organizers, clinicians or code officials, depending on the tool and setting.
Does a higher level mean the person is worse?
It describes the home's conditions, not the person's worth or prognosis.
Can a home go down a level?
Yes. Cleanup, support and maintenance can reduce severity over time.
Does the level determine price?
It influences crew size, time, disposal and protective equipment, which drive cost. Ask for an itemized estimate.
Do code officials use these scales?
Some agencies use them; others rely on code violations. Ask which standard applies.
Do insurers use hoarding levels?
Insurers generally look at specific risks and damage rather than levels, but documentation of conditions can matter for claims or coverage.
Key takeaways
Hoarding severity is described with photo-based clutter ratings, numbered clutter-hoarding scales and clinical questionnaires. Assessors look at access, room use, structure, utilities, sanitation, pests and fire risk. Severity informs cleanup planning and costs, but scales are communication tools, not diagnoses, and the most urgent safety risks should be addressed first.
Sources
This guide is general information. It is not legal, medical, environmental or safety advice. Rules vary by state and locality. For a specific situation, consult the relevant agency or a qualified professional.