The Five Levels of Hoarding

Two different tools get referred to as "the hoarding scale" and they are not the same thing. The Clutter Image Rating, developed by Randy Frost and colleagues, is a set of nine photographs per room type, and a person selects the image closest to their own room — it is a clinical assessment aid. The Clutter Hoarding Scale, published by the Institute for Challenging Disorganization, runs Level I to Level V and assesses the property rather than the person. The five levels below are the ICD scale, which is what remediation companies and public health officers generally work from.

Level I is a household that is cluttered but functional. Doors and stairways are accessible, there is no odor beyond the ordinary, housekeeping is up to standard, and any pets are properly cared for. Most homes described as "messy" sit here, and no intervention is needed.

Level II shows the first structural signs. One exit may be blocked, one major appliance may have been out of service for some months, there is light odor, some pet waste is present, and light mildew appears in kitchens or bathrooms. Housekeeping has slipped noticeably.

Level III involves visible clutter outside the property as well as inside — items accumulating in the yard or on the porch. One bedroom or bathroom is unusable. There is noticeable odor, evidence of rodents or insects, excessive dust, and soiled surfaces. At this level the property has begun to affect the household's health rather than just its comfort.

Level IV is where a property crosses into remediation rather than cleaning. Structural damage is present, possibly extending back years. There is sewer backup, hazardous or flammable material, rotting food, and significant mould. Pets may be in poor condition, and there may be more animals present than the household can care for. Bathrooms and kitchens are typically unusable.

Level V is the most severe. There is no functioning electricity, water or sewer. Human and animal waste is present. Rodent or insect infestation is heavy. Fire hazards are serious, and the structure itself may be compromised. Properties at this level are frequently condemned or subject to enforcement action, and the occupants often cannot safely remain during the work.

The important thing the scale captures is that the higher levels are not simply "more stuff". Levels IV and V involve biological and structural hazards that need containment, protective equipment and regulated disposal — the same protocols as any other biohazard remediation. That is also why the cost curve is not linear: the jump from Level III to Level IV is a change in the kind of work, not just the amount.

It is worth saying plainly that the scale describes a property, not a person. Hoarding disorder is a recognised mental health condition, and clearing a property without clinical support in place has a very high rate of recurrence.

Two scales, often confused

The Clutter Image Rating, developed by Randy Frost and colleagues, is a set of nine photographs per room type. A person selects the image closest to their own room, which makes it a clinical assessment aid focused on the individual.

The Clutter Hoarding Scale, published by the Institute for Challenging Disorganization, runs Level I to Level V and assesses the property rather than the person. This is the one remediation companies, public health officers and fire officials generally work from, and it is the scale described below.

Level I — cluttered but functional

Doors and stairways are accessible. There is no odor beyond the ordinary, housekeeping is broadly up to standard, and any pets are properly cared for. Most homes people describe as "messy" sit here.

No intervention is needed at this level, and describing a Level I property as hoarding is unhelpful and usually inaccurate.

Level II — first structural signs

• One exit may be blocked or difficult to use
• One major appliance out of service for some months
• Light odor present
• Some pet waste present, and light mildew in kitchens or bathrooms
• Housekeeping noticeably below standard

Level III — visible from outside

Clutter has begun accumulating outside the property as well as inside — items in the yard, on the porch, or in vehicles. One bedroom or bathroom is unusable.

• Noticeable odor
• Evidence of rodents or insects
• Excessive dust and soiled surfaces throughout
• Narrow but navigable pathways between rooms
• Light structural damage beginning to appear

Level IV — remediation rather than cleaning

This is the threshold where the work changes character. Structural damage is present, sometimes extending back years and hidden beneath accumulation.

• Sewer backup or plumbing failure
• Hazardous or flammable materials stored
• Rotting food and significant mould
• Pets in poor condition, or more animals present than the household can care for
• Bathrooms and kitchens typically unusable
• Bedding and soft furnishings contaminated

Level V — the property is unsafe

• No functioning electricity, water or sewer
• Human and animal waste present
• Heavy rodent or insect infestation
• Serious fire hazards, often with blocked egress throughout
• Structural compromise to floors, walls or roof
• Occupants frequently cannot safely remain during the work, and the property may be condemned or subject to enforcement action

Why the cost curve is not linear

The important thing the scale captures is that the higher levels are not simply "more stuff". Levels IV and V involve biological and structural hazards requiring containment, protective equipment and regulated disposal — the same protocols as any other biohazard remediation.

That is why pricing does not scale with volume. Two properties with the same amount of material can differ by a factor of five if one has crossed into biohazard conditions and the other has not. The jump from Level III to Level IV is a change in the kind of work, not just the amount.

It also affects sequencing. A Level IV or V property frequently needs pest treatment, plumbing repair or structural work interleaved with the clearing rather than after it.

A caution about the scale

The scale describes a property, not a person. It is a useful operational tool for scoping work and for communicating with enforcement officers, and it is not a diagnosis.

Hoarding disorder is a recognised mental health condition, and clearing a property without clinical support in place has a very high rate of recurrence regardless of what level it started at.

How professionals use the scale in practice

The scale is a communication tool as much as an assessment one. A remediation company, a fire inspector, a housing officer and a social worker can each say "this is a Level IV property" and mean the same thing, which matters when several agencies are involved in one case.

It also drives practical decisions. Level I to III properties are generally cleared with standard equipment and general waste disposal. Level IV and V require protective equipment, containment, and a regulated waste route, and frequently need other trades — pest control, plumbing, electrical — sequenced into the work rather than following it.

Where a property is being assessed for enforcement, officers tend to focus on specific hazards rather than the overall level: blocked egress, accumulation near heat sources, absence of working sanitation, and evidence of vermin. Those specifics are usually what a notice cites.

Animal hoarding is assessed differently

Properties involving animal hoarding do not map neatly onto the scale, because the volume of possessions may be modest while the biohazard conditions are severe. Ammonia concentrations from accumulated urine reach levels that cause genuine respiratory injury, and floors are frequently saturated through to the subfloor.

These cases also involve animal welfare authorities, and the animals themselves usually need removing before any clearing can start. Recurrence rates are substantially higher than for object hoarding, and specialist clinical involvement matters more rather than less.

Common questions

Related service: Hoarding Cleanup