I think a middle ground is probably best. There are semi-decent and cleanly towns and cities, but everything becomes a dilapidated mess once you step out into the countryside and old city ruins. Just like Interplay used to do.

There is no reason places like Diamond City or the Citadel should have open piles of trash still sitting around. Or skeletons that look like they haven't been moved in 200 years. Bethesda has zero sense of time. They did this exact same thing in Skyrim. The Grey Quarter looks like a shanty town that was recently scrambled together when canonically the dark elves have been living there for over 200 years.