A heart condition was the 76-year-old woman's chief medical problem. Another threat to her health was the "stuff" that cluttered every room of her home and even crept into the bathtub. She slept on her couch because she couldn't make enough room in her bedroom, said Dane County elder abuse investigator Brenda Ziegler, who withheld her full name to respect client confidentiality rules. She refused most offers of assistance until one day, she tripped over something on the bathroom floor and fell into the tub, unable to get out. Refusing help is common among hoarders, Ziegler said.

Madison usually gets about two hoarding reports a month, said Tommye Schneider, director of environmental health for the Madison-Dane County Health Department.

Schneider handles some of the city's most challenging self-neglect cases — elders who have filled their homes with items such as newspapers, old food, pets or even human waste. Sometimes, "people slam the door in our face," she said.

Occasionally, an elder opens a door to reveal a home where clutter or garbage leave only narrow paths linking rooms reeking of rotting food or animal waste.

Schneider remembers a case several years ago, when police responded to a call at an elderly woman's home and found layers of stuff covering the floors. "You had to walk on top of it," she said. "Your head was almost touching the ceiling."

Obsessive-compulsive disorders, the backdrop for many hoarding cases, are treatable with medication or therapy, experts say. When a filled house is cleaned, almost half will become cluttered again, if the resident gets no treatment, studies show.

Often, helping families or neighbors get frustrated and exhausted.

"The hardest thing is to have to make changes," Schneider said. "These are nice people. They're not doing anything bad. They're just living their lives alone, a bit apart from other people. We're disrupting someone's whole world here. That's hard."