Environmental Scan Shows How the Commonwealth Can Improve Supports for People Living with Hoarding Conditions

“As we age, we lose a lot of things- people, memories, health. My stuff is like a second operating system. When I touch an object, a cascade of memories come back. It’s a portal to another time, a reminder that I am still that person I was.” -Renee LaPlume, Certified Peer Specialist (CPS)

MHRN was established in 2025 to develop hoarding support and expand homelessness prevention for older adults in diverse communities across the Commonwealth. With support from a state Healthy Aging grant, MHRN led focus groups, key informant interviews, and an online survey to identify system strengths, gaps, and needs related to supporting people whose hoarding conditions create barriers to stable housing.

The scan centers the voices of those with the most intimate knowledge of hoarding conditions: people with lived experience, who shed light on the reasons people accumulate too much stuff and what helps people recover.

The scan noted the need for specialized and in-home support; coordinated systems; earlier and ongoing intervention, community driven support and access to information. Select recommendations include:

• Expand integration of assessment tools, such as the uniform inspection checklist to guide eviction prevention and the Clutter Image Rating Scale to create objective measurements for progress.
• Support the development of regional hoarding resource networks to better coordinate local responses
• Provide clinical training in approaches such as Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST); Cognitive Behavioral Therapy for Hoarding; and Acceptance and Compassion Therapy for Hoarding. These models combine training to improve executive functioning- --
• the ability to plan, sort, and make decisions -- with support to manage the distress caused by discarding objects.
• Expand use of peer support models, such as Buried in Treasures and Oasis Club.
• Recruit people with lived experience of hoarding in the peer workforce, including people from diverse backgrounds and communities.
• Promote co-response models, including having peer specialists and clinicians at housing court, public health/inspectional services and police departments.
• Promote older adult peer specialists as valued contributors within the aging and behavioral health service systems.
• Recruit diverse voices of lived experience to serve on local regional response networks and provide stipends to compensate people who attend outside of work.
• Elevate voices of lived experience through community forums and peer speakers, and use story telling approaches to help reduce stigma and cultural/linguistic barriers to care.

The scan emphasized the need for peed-led culturally and linguistically responsive support. MHRN’s consultant Lee Shuer piloted a training in peer support for clutter, leading to the first Cambodian Buried in Treasures group offered in Khmer through MHRN’s partner, the Northeast Recovery Learning Community.

Additional policy recommendations include:

• Advocate for increased pay for therapeutic heavy chore/homemaking through an enhanced service model to provide a career ladder and better invest in chore services for people with clutter.
• Promote training in professional organizations and support efforts to create pathway to billing. [JU1]
• Support statewide expansion of Behavioral Health Outreach for Aging Populations (BHOAP).
• Advocate for occupational therapy as a billable mental health service for older adults.
• Provide community-sponsored Clutter Amnesty Days, events to help residents who face physical or financial barriers to waste removal.

Perhaps most significantly, people need to know where to turn to access support. The scan recommended that MHRN and other organizations provide Information on where to go for help, including information about how to navigate existing services systems, who is eligible for services, and legal rights, including new initiatives such as eviction sealing. The scan also recommended broader dissemination of self-help tools such as Clutterers Anonymous, The Hoarding Disorder and Buried in Treasures Support Group, and podcast.