Helping an OT client declutter her space and her mind.

I will be the first to admit it; but I can be a bit of a hoarder. It is the bane of my husband's existence that I love to keep old editions of Women's Health magazine, store dozens of photo albums in our living room, and collect memorabilia from every trip we've ever taken. I like to think it is even a little practical of me to have that many memories handy, for reminiscing over on a depressingly rainy day or to eventually collage into a frame and hang up as art.

That being said I am also a functional, productive adult. I work full-time as a home health occupational therapist, keep up with my Facebook friends and also take care of our dog Bob. I am a faithfully contributing to my 401K every month and am trying to plan our next travel adventure, to charter a sailboat in Maui.

I went on an unusual home visit that made me stop and think about how my own hoarder tendencies might be affecting me. I was evaluating a patient who had returned home from the hospital after a bout with pneumonia. The doctor wanted to make sure she was safe and had all the help and equipment she needed. The first part of the assessment went fairly well, she had a tub transfer bench, grab bars, help with managing her medications.and then I saw her bedroom.

It was like stepping into a scene from the A&E reality TV show Hoarders. There was stuff everywhere. Clothes, stuffed animals, junk mail, used Kleenexes and newspapers took up every single surface of the room, with a small pathway from the door to the bed. And it was definitely affecting the patient, she was always sleepy, had more trouble with her memory, and daily tasks like basic hygiene were falling by the wayside.

Her husband no longer slept in the same room; he had his own living space downstairs which was clean and tidy, and he seemed hopeless when I commented on the state of the patient's living environment. So after some negotiating we struck up a deal to get the bedroom cleaned up. I had a good feeling that this positive change couldn't help but improve the patient's quality of life.

 Hoarding Symptoms

 Despite not being as excessive a hoarder as you might see on TV, this patient showed symptoms of the three issues that make up the Hoarder diagnosis: 1) collecting too many items; 2) difficulty getting rid of items; and 3) problems with organization.1 These three intertwining problems led to a significant amount of clutter, which was severely limiting the use of her living space, was a safety risk, and was also influencing her ability and motivation to participate in daily activities.

 She hardly ever left the house, even to shop, which is the most common way hoarders collect things, but she did save all the packing materials that came with food packages. Despite knowing that most of the items would be recycled or taken to Goodwill, she was still very reluctant to part with items that wouldn't have any worth to you and me.  

There were also things sprinkled in among the junk that most people would want to save, cards from deceased friends or family, family photos from the 1920's and medical information that could be stored in an organized way. Like many other people experiencing hoarding, my patient downplayed the seriousness of the situation throughout the whole process; even once we were done cleaning out her bedroom she maintained that she didn't really have that big of a problem.

Now I know you may be thinking, where do I fit into all this? With the increasing ease in which we purchase clothing, home goods and clothing, as well as how much junk mail we receive on a daily basis, people are having to deal with an unprecedented amount of stuff. In fact, one in ten U.S. households now rent a self storage unit, and these units make up more than 2.35 billion square feet in the United States alone. Other countries are starting to show signs of the same trend, as there are now 22 million rentable square feet in Australia and 20 million in the United Kingdom. 2

Also Online!

Positive Energy

Overcoming frustrations in the home health field.

If you type clutter or hoarding into the Google search engine, you will find dozens of articles, websites and books, all trying to help people deal with their stuff. There are now several TV shows that showcase extreme cases of hoarding. Because this has become such a widespread problem we have even created a new job - the professional organizer. People now have the option of paying someone to clear out and organize their stuff.

So all that being said, I would like to challenge all the therapists and health professionals out there to stop for a moment and think, are you practicing what you preach?

 Tips for Helping a Patient/Family De-Clutter their living space

  • Educate patients that having a clean environment can help decrease confusion, prevent falls and maximize the use of our personal spaces.
  • Educate on safety by having the patient retrieve items within their precautions or restrictions (spinal, weight-bearing or range of motion).
  • Before starting make sure to discuss basic ground rules about what items the patient will keep and why.
  • Educate patients on the incorporation and safe use of assistive devices (walker, cane or a grabber) and how to do this with potential hazards like oxygen tubing.
  • Instruct patients on energy conservation throughout the process; time how long the patient spends retrieving items on your first session and compare this to later sessions to show progress.
  • Keep the patient engaged by asking open-ended questions about the items they find: "What does this item represent to you?" or "What can this item provide you with?"
  • Prevent the patient from getting overwhelmed (especially on the first session) and encourage them at every turn.
  • Keep a sharp eye out for healthcare or financial information that will need to be shredded or saved.
  • Set the patient up for success; ask them to think about how they can prevent this from happening again.


1. International OCD Foundation Hoarding Center. Online. http://www.ocfoundation.org/hoarding/ Accessibility verified January 17, 2014.

2. "Self Storage." Online. http://en.wikipedia.org/wiki/Self_storage Accessibility verified January 17, 2014.


Megan Campbell, Bsc.OT,  graduated from the University of Alberta. She works as a home health occupational therapist at Providence Health & Services in Portland, Oregon.



How can I get involved in work like this? I am currently a contract COTA in the Orlando region.

Ashley Capozzi,  COTA/L,  Whole Sum TherapiesFebruary 05, 2014
Altamonte Springs, FL

I am sorry to admit I can relate to this too much. I keep myself so busy as well as come up with excuses why my office and bedroom at home stay so messy. I keep per serving though a couple times a year to set time aside to organize ice and declutter.

Angela ,  OTFebruary 04, 2014
Winter Park, FL

I found out that the mess my spouse lives in is nothing I can fix. Therefore we must regard this with more depth and public assistance or help to preserve the family unit.

As for mine, this constant garage of nonsense has destroyed our lives and marriage, I have to move as far away as I can to survive.

The impact that this behavior or syndrome has on family and friends is unimaginable. For me that means living apart for 6+ months alone in a strange place so that I can concentrate on my work. I love my family but I flat out refuse to live with this "mess". My daughter who was neat and clean until +-10 Years ago is now falling into the same trap. This is her stepfather. He refuses all and any help. This is a good man with a huge loving heart who has literally painted himself into his space.I have high BP and the stress proves unbearable. I have fallen too many times!

Sandy Marcelle Kristal,  DOR/CEO,  OwnJanuary 30, 2014
Jersey City, NJ


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