Engagement: Build trust. Reframe your role in terms of meeting the person’s perceived needs. Home visit: Beforehand, obtain information to identify safety issues. Environment/symptom severity: Assess the degree of hoarding/squalor and document it – take photos if the person permits, or use validated tools such as the Environmental Cleanliness and Clutter Scale (ECCS), Clutter Image Rating Scale (CIRS), Hoarding Rating Scale (HRS). Contributing conditions: Assess the factors underlying hoarding/squalor and possible comorbidities: Physical health problems. Cognitive problems: Executive function should be assessed. Mini Mental State Exam alone is insufficient and may be normal. Mental health problems: Assessment and usual treatment of comorbidities may need to be undertaken before or simultaneously, as they may interfere with addressing hoarding. For example, treatment for anxiety may assist with interventions to discard items. Function: Screen for impact on daily activities. For example, does the person: sleep in their bed have somewhere to sit have a place to prepare food and a place to eat use their toilet, shower, appliances/utilities e.g. fridge, water move throughout the home safely if there was a fire or a need for an ambulance, are the hallways clear? Potential for harm/safety risks: Assess the consequences of hoarding/squalor: risks to the person themselves (e.g. risk of self-harm/suicide, imminent safety hazards like fire or falls, acute medical illness, ability to receive emergency services in the home) risks to dependents (e.g. children and young people, adults in the household with a disability or frailty, pets) risk of eviction/homelessness medication safety. Legal and ethical issues/capacity: Assess the person’s decision making capacity in relation to hoarding/squalor. Are there other legal considerations? For example, does the council or another organisation have the power to override the person’s wishes? Consider the person’s readiness for change, and the safety risks, and capacity to refuse treatment in relation to the risks. Collateral history should be obtained.