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Social workers' final act of service: respectful burial arrangements for indigent, unclaimed, and unidentified people.

Although little discussed in the professional literature, social workers have long been involved in identifying resources and making final arrangements for clients who die without an estate or heirs to assume economic responsibility; who may have been institutionalized; who are unknown to the community; or whose body may be unclaimed for burial. This task can be demanding, if only because social workers must often locate resources quickly if they are to prevent a client from being buried with no ceremony of interment and frequently in an unmarked grave or in a grave marked only by a number in ground set aside for the burial of indigents--a "potter's field."

A person's respectful final disposition is important for the living, for the deceased, and, it may be argued, for the health of the larger society. Knowledge that respectful final arrangements have been made may offer psychological comfort to a client at the end of life, help a grieving family and friends during a time of sorrow and remembrance, and also mark the community's recognition of and respect for our common humanity. This article highlights the challenges faced by many social workers as they attempt to prevent undignified burials when requested to make final arrangements for terminally ill or deceased people, especially those who are indigent, unclaimed, or unknown. ("Burial" here refers to any form of final disposition: interment burial at sea, cremation, and so forth; "indigent" is a legal term often used in reference to people whose estates lack the resources to pay for final arrangements independently.)

Death is destiny for all of us; for most of humanity, there seems to be an almost universal impulse to attend the final mystery, the final journey, of death with ceremonies of respect and remembrance, implementing local traditions and commonly seeking religious or spiritual guidance and solace (Aries, 1974; Kastenbaum, 2004). Remembrances of the dead connect us to the past and honor the influence of those who have departed in helping us become what we are today. Observances of respect for the departed touch our common humanity; common sentiments such as "there but for the grace of God go I" and "as I am, so you will be" reinforce humility and empathy. In sum, as important as they are for emotional reasons, respectful death rites and burial practices are threads in the fabric of community that holds a society together.

Absent substantial policy reform at state and national levels, the need for "preventive" services to ensure respectful burials for all people may increase dramatically in the future. In part, an increase in indigent burials is a result of population increase, especially among the older-age cohorts. But the primary cause of an indigent burial is poverty at death.

Therefore, demography is only part of the story. Various social and political factors contribute to indigence at death; examples include the current financing of the U.S. medical system, which leaves 46 million people without insurance coverage (DeNavas-Walt, Proctor, & Lee, 2005); the political climate, which supports the diminishment of social safety nets; increasing numbers of incarcerated individuals with very long sentences, resulting in prison deaths; changes in family structure resulting in fewer offspring or other relatives available to make final arrangements; increasing numbers of immigrant residents who may have few social supports and no extended family in the United States; homelessness and all that it implies regarding lack of social attachments and unmet basic needs; and a system of payment for long-term care (assisted living, nursing, hospice, and so forth) that virtually guarantees the impoverishment of many people at death.

PRIVATE PAIN, PUBLIC BODIES

Every place where groups of human beings live will be faced with burying people who have no resources or friends or relatives to attend to their final arrangements or who may be entirely unknown to the community. The number of individuals who currently die in such circumstances in the United States is not well documented; no national data on indigent burials or unclaimed bodies are collected, and data collected at the state level are often erratic and incomplete (personal communication with M. Jones, public affairs specialist, National Center for Health Statistics, June 26, 2006). In 2004, about 2.4 million people died in the United States; in addition, there are approximately 26,000 stillbirths annually. The precise number of indigent burials in the United States, however, or of those who are unclaimed or unknown, is undetermined because the data are not collected (Centers for Disease Control and Prevention [CDC], 2003; Minino, Heron, & Smith, 2006; National Institutes of Health [NIH], 2003).

A hint of the number of indigent burials for the nation as a whole is, however, offered by extrapolation from the experience of New York City, which with 8 million residents makes up almost 3 percent of the U.S. population. About 3,000 (5 percent) of New York City's 60,000 annual deaths require some form of city burial assistance, of which about 1,500 adults and 1,000 or more infant and stillborn children are buried annually on Hart Island, the local potter's field (Corn, 2000; New York City Department of Health and Mental Hygiene, 2005). Extending New York City's experience to the nation, one might crudely estimate more than 100,000 potter's field burials annually (5 percent of the 2.4 million U.S. deaths)--perhaps too high a number, but there are at least tens of thousands of publicly assisted burials annually.

The limited state data available, and projections from a survey conducted by the Department of Veterans Affairs in 2003 (Schulman, Ronca, & Bucuvalas, Inc., 2003), suggest that even the 100,000-plus estimate may be reasonable: Michigan, for example, subsidizes 6,000 to 7,000 indigent burials each year, one-third of which occur in Wayne County (Detroit); Ohio paid for 2,000 in the year 2000 (Brickey, 2005); and Maricopa County (Phoenix), Arizona, pays for about 300 burials per year (Maricopa County Office of Management and Budget, 2000). Some regions face special challenges; for example, more than 200 immigrants died crossing the Arizona desert from Mexico in the fiscal year ending September 30, 2005, a third of whom will never be identified (Carroll, 2005; "Deaths on Border," 2005).

Although such examples illustrate the experience of a few jurisdictions for which data are available, it would be a mistake to view indigent burials as primarily a product of the anonymity or localization of poverty in urban environments. The need for social workers to provide burial assistance may arise in a rural county in North Carolina or Minnesota, perhaps for a migrant farm worker or nursing home resident.

Lack of assets at death is likely to become more common as members of the rapidly growing elderly population exhaust their retirement savings, as income distribution becomes increasingly skewed in favor of those who are wealthy, and as support for such a basic concept as social insurance faces increasing challenge. Thus, a social context that, perhaps unintentionally, promotes financial depletion at death increases the challenge facing a social worker seeking out resources to avoid a client's anonymous burial in a local potter's field, the lowest common denominator of indigent burial options funded out of the public purse.

RESPONSE OF GOVERNMENTS TO A SOCIETAL NEED

Funeral and burial expenses in the United States are customarily the responsibility of the estate of the deceased or of the deceased's family. However, there may be no estate or family or the family may be unable or unwilling to pay the final expenses. Yet, the remains must be disposed of, and some government entity must ultimately assume the responsibility of ensuring a proper disposal.

In other words, whatever the time and place, what of those whose families could not and cannot afford what they regard as an appropriate disposition? What of unknown or unclaimed bodies? Who takes responsibility for their burial? Any city and most villages, whether modern or ancient, had, have, and will have people die who are poor or unknown, and recognition of the undeniable need for communities to provide for their burial is ancient (Parkes, Laungani, & Young, 1997). In the United States, state governments have generally assumed this responsibility or assigned the task to local governments. In New York State, for example, Section 4200 of the Public Health Law mandates that "every body of a deceased person, within this state, shall be decently buried or incinerated within a reasonable time after death" (New York State Cemetery Board, 2001, p. 38).

Legal scholar Virginia Murray underlined the principle that in U.S. jurisprudence, most states have legislation guaranteeing that "all persons, including paupers and prisoners, are entitled to a decent burial. Sanctity of the dead is so basic a principle that it is referred to as 'a "right" of the dead and a charge on the quick'" (Trope & Echo-Hawk, as cited in Murray, 2000, para. 2). Even so, although the law recognizes that the living must pay to ensure the rights of the dead, no governing entity at the local, state, or national level has consistently been enthusiastic about assuming the financial burden of this responsibility.

Some jurisdictions go to lengths to discourage situations in which government burials might subsidize what many people would consider standard elements of a funeral. In 2001, for example, York County, Nebraska, clarified existing guidelines regarding county burials and explicitly banned independent arrangements by family members with mortuaries or cemeteries to provide additional services such as flowers, headstones, or clergy fees (Wilkinson, 2001).

Furthermore, state policies and regulations are usually implemented in piecemeal fashion by a patchwork of town, city, county, and state agencies. In many cases, state governments dictate what local authorities are required to do, creating what is all too often a partially funded or completely unfunded mandate to bury the dead. Confusion resulting from ad hoc local responses to a state mandate can be extreme: In New Jersey, for example, in 2003 the legislature had to step in and require that county governments, not municipalities, pick up the charges for indigent burials. Furthermore, the responsible county would be that in which the deceased person resided, not that in which he or she had died; certain counties with large, regional hospitals were in effect subsidizing the indigent burial expenses of other counties (Dressel, 2003).

State reimbursement to localities for indigent burials, when it exists, has rarely kept up with inflation. In 2001, the state of Ohio eliminated a $750 reimbursement to localities. The state of Washington did the same in 1993, although it requires that"[the county] shall provide for the final disposition of any indigent person including a recipient of public assistance who dies within the county and whose body is unclaimed by relatives or church organizations" (Brickey, 2005; Crumley, 2002; Revised Code of Washington, 1993, c 4, [section] 36.39.030). In other states, funeral homes must accept indigent burials at a loss.

POTTER'S FIELD: A PAUPER'S GRAVE

In the United States, people planning a funeral seem to have many choices when selecting a respectful final disposition. For example, one may be interred in the earth, buried at sea, cremated, or entombed; have a green (ecologically respectful) burial; be donated for scientific research; or be cryogenically preserved. One may or may not be embalmed; one's organs may be donated to others. Eventually, the final remains may be kept in a plot, crypt, niche, urn, or tomb. Objects commonly merchandized for funerary use include caskets, clothing, grave liners, guest books, flowers, memorial jewelry, balloons, grave markers, and so forth, depending on the customs and belief systems of the deceased and his or her family. The hallmark of the indigent burial is lack of choice and, all too often, the lack of respect and dignity.

Interment and the Classic Potter's Field

The term "potter's field" derives from a New Testament Bible story (Matthew 27:3-10) in which a plot of land owned by a potter outside the walls of the city of Jerusalem is purchased "as a burial place for foreigners" with the tainted 30 pieces of silver that Judas received (and returned) for betraying Jesus (New York City Department of Corrections, 1967). In time, however, the term took on other connotations: "Potter's field: A public burial place (as in a city) for paupers, unknown persons, and criminals" (Gove, 1976).

One of the most visually dramatic examples of the dehumanization of anonymous burials at a U.S. potter's field may be observed at City Cemetery on New York City's Hart Island, which was opened in 1869 and brings the efficiency and scale of the Industrial Revolution to the medieval pauper's grave. Every weekday will find teams of men who are incarcerated stacking unpainted plywood coffins, often of tiny children, eight or 10 deep in trenches These mass graves are then backfilled with earthmoving equipment until the ground is leveled, and backhoes move on to create the next trench (Hunt & Sternfeld, 1998; Risen, 2002). Even when faced with such images, however, the dehumanization of indigent, unknown, or unclaimed deceased individuals was not the intent of the architects of the original potter's field, or of any subsequent version.

Of course, most potter's fields in the United States do not operate on such an industrial scale. In Bradenton, Florida, for example, the 150 or so indigent funerals annually are handled by local funeral homes for a county fee of $400, with burial in a county cemetery and numbers on a concrete strip for a headstone. The newspaper reports on one such recent burial, of a 37-year-old woman who died of a heart attack after working a 14-hour shift as a short-order cook. Family and friends were unable to raise the $5,000 an average Manatee County, Florida, private funeral cost in 2005. The woman was buried at county expense in a particleboard casket sealed with duct tape. The funeral home did, however, generously donate a service complete with flowers, for which it received no reimbursement, before burial in the county potter's field (Cullinan, 2005).

Obviously, the Florida funeral and disposition was more respectful, and appears to have been more emotionally fulfilling for family, than burial in an anonymous trench on Hart Island. This difference illustrates the challenges facing the social worker advocating for an indigent client. There are no clearcut paths to a desired solution when values, norms, rules, regulations, reimbursements, and services offered can vary from state to state, town to town, and even funeral home to funeral home.

Burial Options, Costs, and Indigence: The Example of Cremation

One might assume that a key element in addressing the problem of indigence at death and respectful final dispositions would be a reduction in the cost of final dispositions. Although funeral costs have sometimes been criticized as excessive, this issue is separate from provision for the burials of indigent people. Respectful and inexpensive options exist, although options may be limited by the preferences of the deceased and prevailing customs or religious practices. Costs for modest burials are commonly trivial compared with the medical costs of a final illness. What constitutes a respectful final disposition, however, not only varies by community, but also may change over time for a community.

The key word is "respectful." Ensuring a final disposition will inevitably be assigned to an agency of the community, be that a parish in the Middle Ages or colonial America or a county government in the 21st century. Requirements or perceptions of common decency, health, and public order ultimately transcend the costs of particular burial practices. There will always be a need for intervention to ensure any final disposition, much less a respectful burial, for some clients.

Consider the option of cremation. The practice is certainly less expensive than interment, and cremations are increasingly regarded as respectful. In 2004, for example, about 30 percent of the final dispositions in the United States were cremations; interments constituted virtually all of the remaining burials, and there are predictions that the proportion of cremations will increase in the future (Cremation Association of North America [CANA], 2006). A change in burial practices favoring cremation will not in most cases, however, divert the road away from potter's field. Cremations cost less than interments, but most indigent burials involve people with, at most, a few hundred dollars in assets. The need for assistance will continue.

Although more inexpensive burial practices only marginally affect the volume of indigent burials, a social worker may be called on to intervene in a more subtle manner; a crematory may itself become a sort of potter's field. A survey conducted a decade ago by CANA found that 5.7 percent of cremated remains in 1996 to 1997 were never picked up, and 2.4 percent of cremated remains delivered to a cemetery were placed in a common grave. Of the remains that were never picked up, 46 percent were "placed in storage on the premises"; 32 percent were "disposed of in a proper and legal way"; and the remaining 22 percent were "placed in a permanent vault." Vague language leaves room for much interpretation in what, for crematory operators, are ad hoc solutions to a problem imposed on them (CANA, 1998).

Changes in burial practices are unlikely to substantially affect the larger policy issues regarding the final disposition of human remains. In addition, there may be an issue respecting religious diversity; some religious communities do not customarily practice cremation.

THE ROAD TO POTTER'S FIELD: THE GROWING NEED FOR SOCIAL WORK INTERVENTION

Although a lack of data obscures the absolute number of people who spend eternity in some form of pauper's grave in the United States, in looking at the total number of people who die, their ages, and their economic circumstances, one can quickly begin to piece together a grim reality. Social workers often provide services to those who are most vulnerable in society and most at risk of not having the resources to afford a burial, much less a funeral.

The social work community has always worked with members of groups such as elderly people, those who are incarcerated, newly arrived immigrants, homeless people, and so forth. However, a number of changes in the size of certain component groups of U.S. society appear likely to greatly affect both the number and the distribution of indigent burials. For example, the tripling of the population of those incarcerated for the long term--that is, over a 20-year period--merits special attention. Those 1.5 million prisoners will make substantial although often yet undetermined, demands on the social services delivery system in many areas, not the least of which will likely be provisions for final arrangements.

Poverty and age at death tend to be reinforcing. The group that will grow the most in numbers, elderly people, constitute the age cohorts most likely to die and those second most likely to live in circumstances of economic deprivation. Members of the cohorts with the second highest mortality, the infant children of (by definition) young families, have the highest rates of poverty, particularly if the family is headed by a single mother (DeNavas-Walt et al., 2005).

The dynamic interrelationship of demographic changes and family structure that reinforce poverty are, of course, exacerbated by a number of unrelated trends that also tend to impoverish these same clients. Especially significant are the reduction in the number of people covered by defined-benefit (fixed amount per month) corporate pension systems; rising medical costs combined with declining health and life insurance coverage for the most at-risk populations; the declining supports provided by family systems at all ages; and an increase in the poverty rate for children, whose parents may not be able to pay for burials or health insurance for all family members. Many social workers would add still more. All reinforce the likelihood that the financial resources of decedents will be exhausted at the time of death.

Age at Death

One's life may end on its first day, at age 25 in an auto accident, or during one's 100th year. The CDC reported that 2,443,908 people died in 2003 in the United States, and NIH reported that there are at least an additional 26,000 stillbirths annually (to be counted as a death by the collectors of vital statistics, one must be born alive; although as of 2007, NIH calls stillbirths "fetal mortalities," they still do not contribute to the total count of deaths) (MacDorman, Hoyert, Matin, Munson, & Hamilton, 2007). As is typical of people living in industrialized societies, most mortalities occur as stillbirths (26,000), as infant mortalities in the first year of life (1.2 percent, or 28,458 in 2003), or after 65 years of age (74 percent, or 1,803,827 in 2003). As a cohort group, the death rate in the first year of life, even excluding stillbirths, is not equaled until about age 60 (Hoyert, Heron, Murphy, & Kung, 2006; NIH, 2003).

Poverty and Age

In the United States, a large number of people are born into poverty, live in poverty, and die in poverty; many millions never have the opportunity to accumulate significant assets during their lives. Others are poor only at some point in their lives. In 2004, 12.7 percent of the national population, 37 million people, lived in poverty, officially defined as an annual household income of $15,219 for a family of three. The poverty rate rose to 17.8 percent of households with children that year, encompassing 13 million children plus their parents and caretakers. The poverty rate jumped to 28.4 percent if the family was headed by a single woman. A single mother is unlikely to be able save much for emergencies, retirement, or the final arrangements for a child (DeNavas-Walt et al., 2005).

For those age 65 and older, more than 6 million of 35 million people (17 percent) lived in households with incomes of less than $14,000 (about $1,200 per month)--about 25 percent above the official poverty threshold for this age group (DeNavas-Walt et al. 2005). The numbers of poor people with children and the numbers of elderly people who live in financially stringent circumstances are both quite large--these are households in which, by definition some members cannot work and are therefore likely to be financially challenged.

Some regional, racial, and ethnic groups also have poverty rates, and death rates, much higher than national averages. These are among the groups most at risk of indigence at death.

Incarcerated People

On July 1, 2004, there were 2,131,180 people--one in 143 residents--incarcerated in the United States. Of those, 1,410,405 were incarcerated in state and federal prisons, up from 487,593 in 1985 as prison terms have increased dramatically as a result of draconian drug laws, three-strikes laws, and the like (Harrison & Beck, 2005). Comparing 2003 with 1995, the greatest percentage increases in the inmate population were for people 55 years of age or older (85 percent), followed by those ages 45 to 54 (77 percent), with the two groups totaling about 251,000 prisoners (Harrison & Beck, 2004).

The release of death statistics lags incarceration statistics, but there were 3,311 deaths in state and federal prisons in 2001: 57 were killed by another person and 60 were executed. With an aging population of inmates, prison "nursing homes" are a current reality (Sourcebook of Criminal Justice Statistics, 2004,Table 6.76.2004). Inmates have long faced the prospect of having their unclaimed remains buried in prison potter's fields, often with no marker or ceremony,

SOCIAL WORK INTERVENTION

Before and After the Death of a Client

The role of social workers reaches beyond the significant contributions made to clients and loved ones in the process of assisting with the complex issues surrounding death and dying. In many cases, social workers may prevent an individual potter's field burial by implementing a range of interventions designed to secure a dignified and respectful final disposition.

Legal Requirements. Learn the legal requirements and local regulations and practices regarding indigent, unknown, or unclaimed bodies in the state and local community in which you practice. Although each state develops its own policies, responsibility has usually been passed on to some local entity, usually a county or city government. Knowledge of local practice helps establish the parameters of interventions. It is important to establish a time flame for action--how long do you have to locate family or resources before the deceased is removed for a potter's field burial?

Government Agencies. Contact the Social Security Administration, state or local human resources departments, federal and state Departments of Veterans Affairs, and other public assistance programs available in your area as soon as possible. At a minimum, almost every U.S. resident is entitled to receive a $255 social security death benefit.

VA Burial Benefits. A veteran is "a person who served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable" (U.S. Department of Veterans Affairs, 2003, para. 2). No veteran need be buried in a potter's field. The VA itself asks to be contacted to check whether any unclaimed person, male or female, qualifies for veteran's burial benefits; the VA checks identities against a database. All veterans are entitled to a variety of burial-related benefits, as in some cases are their spouses and even some dependents. So when contacting the VA, spousal information may also be helpful. Note that a man's spouse may be a veteran, even if he is not.

Collect and Revise Client Information. Collection and periodic revision of personal, financial, medical, and end-of-life information for a client might avoid later difficulties. Many agencies are using electronic documentation to facilitate this process, and gathering key information is already a standard part of the intake process for most assisted-living facilities, nursing homes, and so forth. Examples of pertinent information include death notification contact information; the location of wills; prearranged funeral and burial plans; segregated funds earmarked for burial expenses; wishes of the deceased regarding his or her care after death; information regarding cash, wages due or anticipated, income, savings, securities, bonds, insurance policies (including travel, auto, and credit cards), and retirement funds and accounts; client's real estate assets; vehicles owned; livestock; collections of potential monetary or emotional value; labor union membership (which may include death benefits); armed forces information (including spousal service for both genders); membership in professional, civic, or fraternal organizations; and legal residence status in the United States or other nations (U.S. citizens and residents may have accrued benefits on social insurance programs of other countries by living or working there; this is most common for refugees from Europe). Request and record all other names the client may have used--maiden name, married names other than the current name, nickname, birth name used before adoption, or name change as a result of an abusive relationship may be among the key information to be obtained.

Accessing Local Resources. Depending on where one practices, many organizations offer burial assistance for their members or for members of the public. Many religious organizations, such as the Jewish Federation and the St. Vincent DePaul Society, for example, have special programs for assisting coreligionists in need; professional and labor organizations, such as Actor's Equity, and fraternal and sororal groups such as the Masons, Eastern Star, and the Knights of Columbus may all have burial benefits for members and families. Local groups may also bury individuals with dignity, such as the Garden of Angels in Desert Lawn Memorial Park outside Los Angeles, which provides burial and funeral services for abandoned babies (Roche, 2000). In many communities, organizations that advocate for the most vulnerable residents compile and distribute publications with titles such as "A Guide to Burial Assistance"; these often serve as a helpful introduction to local resources and contacts at key government agencies.

Bureau of Indian Affairs. For those deceased clients who are, or might be, members of a legally recognized Native American tribe or Alaska Native community, social workers should contact a representative of the group's governing body, from which burial assistance might be available. For example, the Cherokee Nation may provide substantial burial assistance in a means-tested program; information is available from http://www.cherokee.org.

Foreign Nationals. If the client needing a place of eternal rest is an immigrant, it might be helpful to contact the consulate of his or her native country (if known). A consulate may be able to offer suggestions and concrete resources to assist in a burial or in contacting family members living abroad. For example, Mexican consulates have brochures available in English and Spanish offering detailed advice and suggestions to people assisting in the provision of final arrangements for Mexican nationals.

Scientific Identification Resources. Before an unidentified client is interred or cremated, try to ensure that key data necessary for identification--typically, photographs, fingerprints, DNA samples, dental records, and visual records--have been collected and preserved.

Posting and Seeking Information on Web Sites to Identify Unknown People. Many states, communities, and private organizations, through police departments or other government agencies, have a Web page with photos, drawings, or other unique markers or possessions, including dental information, of deceased individuals to aid in identification. The Mexican government is testing such a system for filing missing-persons reports in Mexico or in consulates located in the United States (Carroll, 2005). For example, one such well-established site is the Doe Network: International Center for Unidentified and Missing Persons (http://www. doenetwork.org), which also links to the North American Missing Persons Network. A social worker can assist by posting information about a missing person or in searching for loved ones or friends of an unknown person. These sites may also be very useful after natural disasters. In time, these types of registries may grow in sophistication, completeness, and importance in the search for missing people and in the identification of relatives or friends of unclaimed people or of unclaimed bodies.

Encouraging Community Generosity. Actively encourage the generosity of individuals, community groups, or other private, religious, or governmental groups who might donate goods and services or participate in fundraising for a particular burial. For example, on May 21, 2005, more than 200 people attended a funeral mass in Rockaway, New York, for an unidentified three-year-old child who had been found on a nearby beach with broken ribs and vertebrae. The child was named John Valentine Hope by the officiating pastor, who commented that the tragedy of a violent death was worsened by a "violence of silence" by the boy's parents, who never claimed him. "It's the violence of silence that makes this mystery continue," he said. The ceremony did offer comfort to the community, however (Kilgannon, 2005, p. 38).

FINAL THOUGHTS

Implications for Policy

Although advocacy for broad-based policy reformulation transcends the primary aims of this article, policy changes could alleviate future distress for clients and workers. Success in the profession's continuing efforts to address some issues--such as poverty, income inequality, and benefit levels--will help avoid some indigent burials. In addition, social workers could educate and influence clients, the general public, and policymakers by advocating on the following issues.

Acknowledgement and Discussion. Public discussion of indigent burials; the risks of an indigent burial for the individual; local, state, and national issues relating to indigent burials; and the scope of the numbers of people potentially affected may raise public awareness of the issue. Death and burial should not be veiled, entering public discussion only in times of crisis.

Increase the Social Security Death Benefit. Beginning in September 1960, the Social Security Administration allowed the one-time, lump-sum death payment of $255 to be assigned to funeral homes. The estates of all people who have met the qualifications for social security protection qualify for this payment, which has not been increased for more than 40 years (Social Security Administration, 2004). If the final payment had been indexed for inflation, the value of this lump-sum death payment would have risen to at least $1,000. Such a final payment would go a long way toward avoiding indigent burials (DeNavas-Walt et al., 2005, p. 30). Social workers could include death benefit entitlement among social security policy debates.

Veterans Benefit Enhancement. Although veterans are guaranteed a respectful burial somewhere, if they wish to be buried in a particular location, perhaps on a family plot in a private cemetery, the VA may subsidize the burial with a small amount of money (up to $600) and a marker or headstone. This subsidy, too, has not been raised in decades (U.S. Department of Veterans Affairs, 2003). Enhancement would facilitate burial in cemeteries close to family and friends.

Clarification of State and Local Responsibilities. Many laws and implementing regulations regarding indigent burials are obsolete and based on outdated assumptions. If proposals to clarify responsibility for final dispositions come before legislative bodies, input from social workers might support protection for future clients. At the least, unfunded mandates might be opposed.

Social workers have a unique opportunity to ensure a respectful funeral and burial for clients. Securing a dignified and respectful disposition of a person's body will in many cases allow family and loved ones the opportunity to grieve and mourn by having an identifiable permanent resting place to honor their loved one. Most of us "would want to feel that our loved one is 'all right' even though dead" (Kastenbaum, 2005, p. 6). Death marks both an ending and a beginning for family, friends, and community; our treatment of the dead also serves as a marker for our respect for the living. In earlier times, this observation would have been almost a truism. As William E. Gladstone so famously remarked more than 125 years ago, "Show me the manner in which a nation cares for its dead, and I will measure with mathematical exactness the tender mercies of its people, their respect for the laws of the land and their loyalty to high ideals" (Murray, 2000).

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Graciela M. Castex, EdD, ACSW, LMSW, is associate professor, Social Work Program, Lehman College, City University of New York, 250 Bedford Park Boulevard, West Bronx, NY 10468-1589; e-mail: graciela.castex@lehman.cuny.edu.
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