If you have seen the A&E Show “Hoarders” and thought those houses are few and far between, that couldn’t be further from the truth. In fact, an estimated 3-5% of the population lives in severely congested environments no different than what you may have seen on TV.

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For those of us who specialize in compulsive hoarding and hoarding disorder, we can attest these conservative estimates downplay the reality of hoarding in our villages, towns and major cities. And for the tradespeople — plumbers included — who are inevitably called in to these homes to do everything from make small repairs to replace entire systems, conscientiously staying safe in this unsafe environment must be a top priority.


What is hoarding?

Let’s start with the word “clutter.” It’s politically correct, sensitive and a rather relative term. I could walk into anyone’s office or home and find clutter, and anyone who is the parent of teenagers knows clutter.

But the topic is not clutter here — it is severe congestion, or hoarding. Homes so tightly packed with stuff that the residents live in less than 5% of their homes or have erected makeshift housing outside their homes because the residence itself is inaccessible. These homes are also the most dangerous for the residents, homecare workers, emergency responders and the tradespeople called in to complete the work once the piles have been dismantled.

The following is a look at just some of the hazards that await tradespeople who answer the call to address the challenges of these residences.


Ammonia exposure

Urine is composed of 91-96% water, and the remainder can be broadly divided into inorganic salts, urea, organic compounds and organic ammonium salts. Of the feces and urine fractions, urine contains the largest proportion of Nitrogen at 90%. In combination with hydrogen also present in urine, we have ammonia (NH4).

Ammonia is dangerous. Although naturally occurring in nature, it serves as a fertilizer, cleaner and explosive in large, concentrated doses. Ammonia found at dangerous levels can often be smelled first, issuing the warning that the ammonia levels may be detrimental to human health.

The first signs of concentrated ammonia exposure begins with burning sensations of the nostrils, throat and, eventually, the lungs. Eyes and skin may also react to ammonia exposure with burning, tingling and tearing of the eyes.

Concentrated ammonia can also be ‘tasted’ in the air at lower levels, but do not assume that lower levels and tasting ammonia indicates a mask is not required; indeed, it is the first sign a mask (and other personal protective equipment) is needed. At higher levels and for individuals who are sensitive to ammonia, coughing and difficulty breathing may occur. Cases such as this warrant exiting the area immediately. 


The danger of feces

If you’re a plumber, you may have seen this: A toilet sitting unused for 6-10 years, filled to the rim and overflowing onto the floor, and resting quite precariously on not much more than the drain beneath it, especially given the flooring and subfloor have rotted way from over-exposure to urine and feces and under-cleaning with anything other than a dirty rag (if even that).

Now, add in cats, squirrels, mice, raccoons and other vermin. This is where the differences between human feces and animal feces become concerning.

The greatest concern for human fecal concentrations in squalid residential conditions is the bacterial count that is left thriving in the dark, moist environment that only fecal sludge can provide. As with all living organisms, a comfortable environment in which to grow, feed and multiply supports a population boom.

Let us begin our tale with a true story of a mother raccoon and her family that added to the hoard of other pests that invaded a war-time home. This family of raccoons, a large grouping of squirrels and untold numbers of cats and mice had taken refuge on this one property. Not only did these pests leave more ‘deposits’ than any major banking ATM, the hazards from their feces piles became readily evident when the local wildlife rescue agency arrived to relocate momma raccoon and her brood.

That day, I learned about Baylisascaris procyonis — a roundworm that can be harmful to people. Roundworm eggs are passed in the feces of infected raccoons, and people become infected by ingesting eggs. The most common route of ingestion is oral; however, these eggs can be inhaled, too. Baylisascaris larvae hatch in the human intestine and travel through the organs and muscles. Once swallowed and inside the body, eggs hatch into larvae, which then cause disease when they migrate through the liver, brain, spinal cord, and other organs. This is Larva Migrans Syndrome.

A home that has been neglected for decades, fallen into a state of disrepair, is packed with food sources and is an open access points for wildlife to enter and stay is also a home that is littered with potentially life-threatening bacteria, microorganisms and gaseous fumes that can leave even the healthiest tradesperson violently ill or in the ICU with an untreatable brain-eating parasite. Just a little food for thought — now go wash your hands.


Mold, mold everywhere

Mold is a common challenge for any homeowner, but add in years of neglect and the inability to locate sources of excess moisture in a hoarding situation and it’s a recipe for mold disaster, and tradespeople need to take precautions.

The conditions for mold growth are simple: a few mold spores, a dark and warm environment and moisture. Whether it’s the slimy black spots on the shower curtain, the fuzzy white patches on a basement floor or the slick orange film that forms around drains, mold is more than unsightly.

In small amounts, mold spores are usually harmless, but when mold has been left for years to grow, as in a highly congested home, it is dangerous. For people sensitive to mold, inhaling or touching mold spores can cause allergic reactions, including sneezing, runny nose, red eyes and skin rash. People with serious mold allergies may have more severe reactions, including shortness of breath. In people with asthma who are allergic to mold, breathing in spores can also cause asthma attacks.

Walls, floors, appliances, carpet or furniture all provide the food mold needs to grow. But the thing all molds need most is moisture, so it is most often found in damp places such as bathrooms, kitchens, laundry rooms, basements and crawl spaces. These areas, so congested with fibrous materials, are a haven for mold and breathing in the air barely circulating in these rooms is a serious health hazard that in some cities leaves the residents banned from residing in their own home due to such poor air quality.


Spoiled food is just the beginning

The expiration date, 1976, was marked on the bottle of fish oil my client stated was “still good” as she heartily swallowed back a large tablespoon hoping to prove a point. Her immediate retching and resulting illness showed it was definitely not still good. Everything expires eventually — medications become dust in the bottle, liquids become solids and solids become petrified.

Rotting food in sealed containers is of little threat to anyone entering the home, though the same cannot be said about food stored outside its container.

By the time we are disposing of food in a hoarding situation — food that “is still good” by their standards — it has long since expired and consists mainly of residue and mold. Some food molds cause allergic reactions and respiratory problems. The greater the concentration of mold, the higher the volume of mold spores free floating in the air.

Let us put this into context in a hoarding situation. On average, we remove upwards of 2,500-3,000 pounds of food waste from each residence. Most of this food has rotted through its containers, spilled over shelves and countertops, or has molded beyond recognition.

Moldy foods may also have bacteria growing along with the mold. Many forms of bacteria, such as Clostridium perfringens and Clostridium botulinum, produce heat-resistant spores as they multiply; cooking meat does not destroy these spores, even if the food is boiled. Clostridium perfringens causes diarrhea and abdominal pain. Clostridium botulinum — which can be fatal or take months of recovery — causes vomiting, diarrhea, blurred or double vision, respiratory muscle paralysis and difficulty swallowing.

The risks presented here are during food consumption, as little research exists on the dangers associated with inhalation of decomposing bacteria on food products. Safe to say, it might not be best to grill up that steak from 1984.


Bed bugs, cockroaches and more

Bed bugs are the bane of existence for many homeowners and property managers. These small insects feed on human blood and multiply quickly. They typically bite at night and often bite around a person’s face, neck, upper torso, arms and hands. There have been no known cases of bed bugs spreading disease to humans, and though bed bugs do not affect physical health, having bed bugs can be a source of stress and impact mental health and wellness.

Bed bugs are typically found in the corners and seams of mattresses or box-springs, in the cracks/joints of wooden headboards and bedframes, on bed sheets or pillows and in clothing storage bins, dressers, or other furniture.

Cockroaches have been an insect pest for about four million years. They rarely cause structural damage; however, they can contaminate food and spread disease by walking over, and excreting on, food or food preparation areas after having travelled through garbage and/or sewers. People with asthma may also have a negative reaction to their droppings (feces) and body parts.

Cockroaches will live in any area where food, water and shelter are available. They are attracted to the damp conditions offered by kitchens, bathrooms, basements and areas with plumbing. Roaches and their egg cases can snag a ride into your home on various objects — including used furniture, food items, empty beer and soft drink bottles, and even tool boxes.

To prevent the transmission of bed bugs, cockroaches and other insects from an infested residence to another home or office, plumbers and other tradespeople should keep tool boxes and supplies in their vehicles.


What’s in those piles, anyway?

In congested homes, the large quantities of stuff pose their own threat. Among the piles, it is not uncommon to find hazards such as uncapped syringes, broken glass vials, chainsaws, sharp tools, portable heaters stacked on flammable piles of small combustibles, fishing rods, lures, chisels and small kitchen appliances.

Avalanches or the accidental toppling of piles is always a concern for tradespeople entering these homes. The weight of these piles with dressers stacked upon dressers and 40-inch tube televisions somehow placed atop the second dresser is enough to crush anyone. Leaning on or placing weight near these piles is a no-go, as the floors have become soft and bowed under the massive weight of these possessions stressing the floorboards. Be careful what you step on — and what you step near. Feel for soft floors that indicate the piles could fall with added weight.

As a tradesperson bringing in heavy toolboxes (should spatial allowances even permit this), also be wary of where you lay your gear. Never trust a pile to hold the weight of your tools, and question whether the counter or cabinets can handle the weight of your body as you lean on them to enter smaller cabinet spaces.


Creative electrical ‘engineering’

Plumbers and other tradespeople expecting to be able to plug in power tools in a hoarding situation will likely find plenty of electrical cords in and around the piles in a hoarding situation — none of which they should trust. A common find in almost all hoarding situations is the stress marks and arching of outlets caused by attempting to draw power to the five or six power strips running 10 or 12 extension cords powering every portable device, lamp, small appliance, portable heating source and light source in each room.

What is on the end of this maze of cords is one outlet that is frequently broken or shattered, yet still in use — a fire waiting to happen. Once a fire begins in a highly congested residence, just run. Here in Canada, the speed at which the flames will ignite all of the items in this home and the temperature at which the fire will burn supports the provincial fire standard operational guideline of “body recovery only.”

If you cannot see the outlet, you cannot use it. Better yet, make sure you have fully charged batteries and portable tools so you do not need to rely on questionable electrical power supplied to the house.

Plumbers and tradespeople can help individuals in hoarding situations reclaim their homes — and themselves — from the very real physical dangers of this tragic mental illness. Staying safe in congested homes is of the utmost important, however, and taking the proper precautions in a severely congested home can help prevent unnecessary illness and injury.

And when you see a hoarding specialist like me speaking softly and gently smiling in hopes you can help, remember this article, be prepared and always know we understand your concerns, too. We are there to help you do the best you can do in some of the worst conditions anyone could ever ask of you.