Over 40 people participated in this Zoom meeting on November 18, 2020. Click the tabs below to learn about this meeting, and what was discussed. We intend to add follow-up information as it becomes available.
Announcements of this meeting were first published in newsletters of the two hosting organizations. Here is what appeared in FCAWM’s Fall 2020 newsletter:
Raising the Alarm about Bodies in Limbo: Delays in Indigent Disposition in Massachusetts
The Funeral Consumers Alliances of Eastern and Western Massachusetts (FCAEM and FCAWM) invite you to a virtual meeting (via Zoom) to learn about and help scope possible solutions to this complex problem.
What happens to the bodies of people who die without ties to family, supporting friends, or institutions? Who has authority, in the absence of next of kin, to make decisions about final disposition? Who has responsibility for the body? Who pays for storage, transportation, permits, cremation or cemetery plots?
Passage of a well-intentioned but incomplete state law (An Act Relative to the Cremation of Certain Unclaimed Bodies, effective July 1, 2018) allowed boards of health to authorize cremation after thirty days, but didn’t solve where bodies are to be kept during that wait. In January 2020 the Western Massachusetts Public Health Association wrote to 160 state legislators asking for help; a lively discussion March 6 with a few legislators, police, health directors, funeral directors and FCAWM members stirred up more questions than answers, but was a good start. COVID-19 interrupted that process, while simultaneously making the problem much worse.
We must persevere. Do we need new legislation? Can we brainstorm other solutions?
Please join us on Wednesday, November 18, 2020 at 6:30 pm and help us restore a modicum of dignity to the indigent.
FCAEM created a Facebook Event page, and also sent out this email message in November:
“You are warmly invited to attend a meeting addressing the problems in Massachusetts with providing care for unclaimed bodies or bodies of those who were indigent. Here is your invitation to the roundtable discussion about these troubling issues as together we try to develop some solutions. You will need to register in advance. Please join us.”
- How FCAWM and FCAEM got involved
- Stakeholder Views and responses to FCA questions
- What have we missed? Input from attendees
- Possible solutions? Next steps?
- Closing and Thank you for coming
Our joint planning team* invited key stakeholders to come and answers questions. We aimed to have representation from each of these perspectives: local health agents, police, funeral directors, Office of the Chief Medical Examiner (OCME), the Dept of Transitional Assistance (DTA), legislators, and consumer advocates. The meeting was open to the public, with advance registration (via Eventbrite) required.
* The planning team consisted of these volunteers:
FCA of Eastern MA: Patti Muldoon, Kat Kimball, Heather Massey, Frank Singleton
FCA of Western MA: Cecile Richard, Jim Couchon, Joan Pillsbury, Sandy Ward
Behind the scenes Zoom management was coordinated by Bill Thompson of FCAEM, assisted by Patti and Cecile.
Patti Muldoon, FCAEM President, prepared a draft summary in advance, based on months of preparation. During the Nov 18 session, she listened to the input from others, gathering information to augment the report. In the weeks following the meeting, she collected evaluations and additional comments. The revised summary will be posted here. Meanwhile, here’s the problem summary draft as of November 18:
Disposition of Unclaimed or Indigent Bodies
Funeral Consumers Alliances of Eastern and Western Massachusetts
Disposition of unclaimed or indigent bodies is complex and is no single entity’s responsibility. Delays in final disposition concern hospitals, long term care facilities, local health authorities and police, funeral homes and funeral consumer advocates. However, the problems are largely invisible to the general public.
Massachusetts’ law requires the State to provide a decent burial or disposition for anyone on or entitled to welfare (MassHealth eligible) if the decedent, their surviving spouse or parent of a minor child cannot afford it.
Those with low income (indigent) qualify for final disposition benefits paid by the State (cremation usually). They are not abandoned and there is next of kin or someone with right of disposition. Another group, which may overlap with the indigent group, has no one with right of disposition. These are considered unclaimed or abandoned bodies.
- Funeral directors can’t take bodies without authorization (if not by next-of-kin then by local health authority), which can be difficult to get.
- A 2018 law gives local health boards the role of authorizing cremation of unclaimed bodies after 30 days to search for next of kin, but apparently some boards are unaware that this has become their responsibility. A few have been unwilling to authorize disposition or have caused long delays.
- For the last 38 years the amount that Dept. of Transitional Assistance (DTA), the burial agent of last resort, is allowed to pay according to state law has remained unchanged — up to $1100, with a $3500 cap on all funeral expenses. DTA may not pay the full amount or may reject claims outright.
- Payment by Mass. Veterans’ Services for veterans’ funerals has recently risen to $4000 with a cap of $5000.
- The Office of the Chief Medical Examiner offers an additional $1000 for bodies it handles, but OCME only takes bodies that have a suspicious cause of death.
- If the payment is reduced by DTA, this leaves Funeral Directors (FD) as the collection agent, without ability to access bank statements or to require payment from the designee after service is provided.
- DTA has been taking a very long time to pay (up to a year) as they track down and examine bank statements from the deceased and next of kin. However, Massachusetts Funeral Directors’ Association (MFDA) reports the expediency of the payment system has improved lately.
- DTA has been reported to be sometimes reducing payment in cases where others who are not legally liable contribute to additional funeral services outside the purview of the FD. MFDA also reports that DTA no longer considers the assets of next of kin who are not legally responsible.
- Municipalities, which are responsible for the final disposition of its residents, rarely have “paupers fields” any more in their cemeteries and determining residence of homeless people can be its own challenge. (Note: the deceased’s residence, not location of death, determines which town or city’s health dept. is in charge of disposition authorization.)
- No one is responsible for picking up a body from houses, nursing homes, etc. Local police may have to stay with the body for hours while they and the public health agent try to find a funeral home willing to take the body. We have been told that the OCME used to take care of these cases, but now they restrict their services to those who died of suspicious causes.
ADDITIONAL EXPENSES & REGULATORY ISSUES
- State regulation requires funeral directors to embalm a body after it has been held for 52 hours or the body must be refrigerated at 34-39°. Embalming does not help protect public health, but fills the body with chemicals that are often toxic and will be at least partially released into the air or land. Some bodies arrive at the FD already decomposing and are unable to be embalmed. Embalming bodies that will never be viewed and will be cremated is an unnecessary (and sometimes impossible) monetary and environmental cost.
- The OCME may waive its (recently doubled) fee for examining unclaimed bodies. However, FDs do not report this occurring.
- We don’t know how many unclaimed deaths have occurred in our state. The Bureau of Vital Records & Statistics reports that there are no systematized records identifying abandoned/unclaimed bodies.
- DTA has agreed to assemble the data we requested on both indigent and on unclaimed bodies.
- How many indigent applications do you receive per year?
- How many applications are approved?
- What factors are required for approval?
- Of approved applications, how many were “unclaimed” or no family/responsible person?
- What factors lead to denials?
- Flow chart of application process and approximate length of time?
ISSUES WITH UNCLAIMED BODIES DIFFER FROM INDIGENT DEATH CARE
- It appears that just a few funeral homes across the state handle most of the unclaimed bodies, but that most funeral homes will at least occasionally take indigent cases.
- Northeast Funeral Professionals conducted a survey earlier this year, which was released In September. The following is from the Massachusetts-specific section. The total survey response represented 285 of the 498 funeral establishments in the Commonwealth.
- Question: Does your firm accept DTA funded services?
- Response: 41% Always, 52% Depends upon case, 7% Never accepts.
- The situation of abandoned bodies puts a strain on local public health officials, police and the facility where the death occurred. Most localities don’t feel there is a problem until there is a case in their community and then due to the infrequency they are unsure about the process.
- The death rate has gone up during the COVID-19 pandemic; the issues related to indigent and abandoned bodies may be getting worse. MFDA noted that potentially there are federal funds available for pandemic-related funerals. Massachusetts, like most other states, has applied for this funding as part of a bundled request but funding has not been released by the federal government.
Summary by Patti Muldoon
Send any comments/corrections to email@example.com
FCAEM President Patti Muldoon promised to send the Meeting Minutes to all attendees of the Zoom meeting held on November 18, 2020. We thank FCAEM Secretary Kat Kimball for preparing the written record of this meeting, which ran from 6:30pm to 7:59pm. We apologize for the delay in getting the minutes edited and sent out.
We will report followup meetings and steps toward solutions here. If you’d like to be notified via email, please sent a request to Patti Muldoon via info@firstname.lastname@example.org .
Here are some relevant sources of information, including those mentioned during the November meeting:
2018 Massachusetts legislation that permitting local Health agents, after 30 days, to authorize cremation for an unclaimed body: AN ACT RELATIVE TO THE CREMATION OF CERTAIN UNCLAIMED BODIES
The Oregon Indigent Disposition Program provides licensed funeral establishments with reimbursement for the costs that they incur while taking care of the final disposition of unclaimed indigent bodies. See overview.
Caitlin Doughty’s video: “Should This Funeral Director Be Forgiven?” (13-min.) Caitlin Doughty, well-known for her “Ask A Mortician” series on YouTube, visited funeral director Peter Stefan at his funeral home in Worcester in February 2020 and interviewed him about the difficulties he has encountered with indigent burials. She uses his case to highlight what is really a nation-wide problem, a puzzle that needs solving.