“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 charge on the quick.’”Murray, 2000 as cited in Castex, 2007
The care and disposition of the dead is both a mark of respect for the deceased and an issue of public health. As health care professionals, our role in ensuring this respect for those without resources for final arrangements is tied to what is offered by our local governments. Regardless of our care setting, we will, at some point in our careers, be called to support a deceased with no funds to bury them or family able to take on the charge. With traditional funeral expenses ranging from $7,000-$10,000, burial costs above $10,000, and 11.8% of Americans living below the poverty line, incurring such a debt can further the cycle of poverty in a family. It is important, when possible, to have early and open communication with the patient and their family about expectations and preferences for final arrangements. See the Funeralocity article on Assessing Resources and Managing Expectations for more information on having these conversations.
Each state and jurisdiction is responsible for having a policy on disposition of the deceased if there no funds for the family to do so. It is important to understand what is available in your locality by calling the Department of Social Service as support varies significantly. For example, in Maryland, the State Anatomy Board will cremate the deceased but only after they have been considered as unclaimed for a period of time, but the state may also provide up to $600 for services which do not exceed $2500. However, in Virginia, the amount of financial assistance available varies by and is distributed by the county. When paying for final arrangements privately, this will usually include 1-3 copies of a certified death certificate. Public funding may not cover this cost which is on average $30 each. The following website provides an overview of social assistance for funerals: http://www.us-funerals.com/funeral-articles/social-assistance-funeral-programs.html#.XZKUdEZKg_B. Additional information on state public funding can also be found here: https://www.funeralocity.com/blog/2019/08/01/the-complete-a-to-z-guide-to-getting-state-government-assistance-for-a-funeral/
Social Security provides a one-time $255 death benefit payment to the surviving spouse or children. This cannot be done online. Survivors can call 1-800-772-1213 or visit their Social Security office in person.
If the deceased is Native American, the Bureau of Indian Affairs offers financial support. Visit https://www.bia.gov/bia/ois/dhs/financial-assistance for more information.
Inquire if the deceased is a member of a fraternal or sororal organization or labor union. For example, groups such as the Masons or Eastern Star may have funds set aside to assist members with funeral costs.
Local, grassroots organizations may be available in your area to support specific populations such as children, homeless, incarcerated, or people who die of a specific illness. For example, the Kelly Ryan Foundation provides financial assistance for funeral arrangements resulting from pregnancy or infant loss.
If death was caused by a declared natural disaster, FEMA may assist with a portion of the costs if they are not covered by another government benefit and the family can show evidence of unmet expenses. There is an application process which requires a death certificate certifying the cause of death is directly related to the declared emergency or disaster. See https://www.fema.gov/disaster-funeral-assistance.
Depending on your state or jurisdiction, in order to access public assistance, you will need a next of kin to release the body. Many public options include cremation and will require a next of kin or legal representative to authorize cremation. Often in these situations we have no next of kin. Consult with your local Department of Social Services as well as your organization’s legal department to determine your obligations, options, and resources to find next of kin or otherwise legally authorize final disposition.
Regardless of finances, all persons have the right to a respectful final disposition of their remains. While some benefits may be easier to access than others, having good working knowledge of your region’s public benefits and how to access them will serve to benefit you and ultimately, the clients you serve.
Castex, G. M. (October 2017). Social workers’ final act of service: Respectful burial arrangements for indigent, unclaimed, and unidentified people. Social Work, 52 (4), 331–339. doi: 10.1093/sw/52.4.331
McManus, R., Schafer, C. (2014). Final arrangements: Examining debt and distress. Mortality, 19 (4), 379–397. doi: 10.1080/13576275.2014.948413
United States Census Bureau. (n.d.). Poverty. Retrieved from https://www.census.gov/topics/income-poverty/poverty.html
U.S. Funerals Online. (n.d.). Social assistance funeral programs: Financial help for a funeral. Retrieved from http://www.us-funerals.com/funeral-articles/social-assistance-funeral-programs.html#.XYf_aujYrnE
Social Security Administration (n.d.). Survivors: How you apply. Retrieved from https://www.ssa.gov/planners/survivors/howtoapply.html
U.S. Department of the Interior Indian Affairs. (n.d.). Direct Assistance (Financial Assistance & Social Services). Retrieved from https://www.bia.gov/bia/ois/dhs/financial-assistance
U. S. Department of Homeland Security. (n.d.). Disaster funeral assistance. Retrieved from https://www.fema.gov/disaster-funeral-assistance