People in rural Maine seem to fit in one of these two categories. As I define them, an Accidental Hoarder is the more passive type. In this case it’s almost as if the house itself did the collecting. The years go by and the stuff is acquired as the family grows and changes. The children leave home but their stuff stays behind. The grandparents die and their stuff is added to the home. Then, perhaps there is a time of being a caregiver for a spouse or parent, and when that is over, the overwhelmed survivor becomes dimly aware that the home is over-loaded but the energy to deal with it just isn’t there.
Pack Rats, on the other hand, are enthusiastic collectors of stuff. They very likely still have things they collected in childhood. Every item has a potential new use. It might come in handy someday. You never know when someone might need an item.
For many years, either an Accidental Hoarder or a Pack Rat may manage okay, but then cognitive decline sets in. As much as people want to remain in their own homes, the circumstances that will end their stay are apt to be connected to their tendency to not deal with the stuff. When the home becomes a hazard a fall is more likely.
There are two considerations when working with people who need to downsize, whether or not they are moving.
The first consideration is the degree of attachment they have to their stuff. For some people their stuff is their identity and parting with any of it feels very threatening. It is human nature to want to avoid loss more than to seek gain.
The other consideration is the Accidental Hoarder ‘s willingness to receive help. It’s a little bit like the old joke about “how many psychologists does it take to change a light bulb?”. The answer is “only one, but the light bulb must be ready to change”.