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

Problem Summary
11/18/2020 draft

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.

DEFINITIONS

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.

AUTHORIZATION

• 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.

PAYMENT

• 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.

RESPONSIBILITY

• 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.

SCOPE

• 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.

IMPACT

• 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 info@fcaemass.org