1. Let go of ideal notions of cleanliness. Your client may value items that appear to you as worthless or be rubbish. Parting with their belongings (even used paper cups) can cause severe emotional distress.

2. Listen to your client's ideas and plans for their belongings. Explore their hopes, both realistic and unrealistic, and accommodate them if possible. Clients have been helped to donate or sell their belongings. One woman even sent her "stuff" to relatives in her home country.

3. Work at the client's pace if you can. Start with short periods of time. Some clients cannot tolerate even a half hour in the beginning. Keep in mind, though, that a client's decluttering pace is usually slower than the eviction process.

4. Partner with a legal group, home care or nursing agency to find out what level of cleanliness your client needs to achieve in order to attain their goal, whether it be eviction prevention or home care services. You have to meet certain standards, but you don't have to exceed them.

5. Focus on fall prevention. Create pathways free of debris, loose cords or slippery rugs. Some frail clients hold onto furniture or other items while moving through the home; ask how your client gets around and preserve their "props" until other assistive devices (canes, walkers) can be introduced.

6. Focus on fire prevention. Make sure your client has a smoke alarm and test it monthly. Red flags include newspapers stored on top of or inside a gas stove or near working radiators. Help relocate their belongings from a hazardous area to a safe place.

7. Be creative and negotiate. Perhaps the client can keep the previous year's copy of a particular magazine, but throw away the prior twenty years' collection. Consider photographing belongings, as this may help the client part with them and preserve memories.

8. Begin by reorganizing, if time allows. Start with a small corner of a room, a single table, or just a section of the table.

9. Ask your client what they would like to do that currently they cannot do because of the clutter. For example, "Would you like us to help you to figure out how you can cook again?" or "How could you do this differently so you can use the stove?"

10. Motivate your client by helping them be realistic. Some clients will declutter only if told they face eviction or cannot be discharged home after a hospitalization. Gentle but firm pressure is appropriate if a client's home or health are at stake.

11. Create a limited number of categories for belongings. Large plastic crates or wicker baskets can help separate items into these categories.

12. Be resourceful in finding workers. Volunteers and other informal supports have been used with success, such as hired high school students who pack up agreed upon donations.

13. Have a social worker present during a major cleanout, preferably one who already has a supportive relationship with the client. Clean-outs can be overwhelming to people with severe hoarding behavior. Have a back-up plan in case emergency psychiatric services are needed.

14. Discuss how to safeguard valuables in the cleaning process. Have a written contract. Agree on what to do with valuables that turn up, such as money, jewelry, checks, bonds, stock certificates, collectibles.

15. Call the ASPCA if you need help finding a temporary or permanent home for pets while the cleanout is being conducted.

16. Consider relocating an individual to a new apartment if the clutter is the result of physical or mental frailty. A new environment can provide a fresh start and enable the client to receive needed services sooner.

17. Encourage the client to participate even during a major cleanout. Get them involved so they can be part of the process and have some level of control. Ask them if you can help find something they might be looking for, or give them a box to help sort through.

18. Plan for a carefully orchestrated clean-up which can result in decreased client anxiety. Make sure you make arrangements

• with the building for entrance and egress when removing possessions and trash
• for use of the elevators
• for cost, rental and removal of dumpsters (Do not leave a dumpster or trash bags on the property after a cleanout, even overnight)
• for storage if needed, including cost of transportation to storage facility

19. Communication is Vital. It is important for the client to communicate with the cleaning crew - making their concerns known. If the crew doesn't speak the same language as the client, there should be a supervisor/translator/advocate present so that the client can make his/her needs known and can feel as if he/she has some control over the situation.

20. Plan for on-going maintenance and supervision to maintain a decluttered environment.