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Dead, in the red

 Street Roots - USA 21 November 2019

Grief was the first emotion to seize Sarah Jones after her sister died from advanced cancer earlier this year. Financial worry was the second, as the cost of funerals has soared. Services in the US report a rising number of people who can’t afford to bury their dead. (2247 Words) - By Stacy Brownhill

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Street Roots_Dead, in the red

The cost of funerals are rising in the US. Photo courtesy of Street Roots

From her trailer in rural Oregon where she lived with her brother-in-law, Jones called 211info with a nightmarish concern. The funeral home holding her sister's body had just told Jones she had twenty-four hours to come up with the $500 necessary for cremation. Otherwise, the funeral home said, they would put her sister's body in cold storage and, eventually, a numbered pauper's grave-a typical, legal process for indigent dead.

Like 14 million other Americans, Jones and her brother-in-law are unemployed. In the midst of the worst economic crisis since the Great Depression, many Americans are facing the painful fact that they cannot afford to bury their loved ones.

"There's not many alternatives out there for people in her situation," says Deborah Willoughby, special projects coordinator for 211info who received Jones' call. "If a community organization has $500 to spare, they're going to use it to house and feed folks, not spend it on cremations."

The issue of indigent deaths is becoming a "huge problem throughout the country," says Dr. Mary Ann Sens, president of the National Association of Medical Examiners.

This year, the number of indigent funerals for Multnomah County is already more than twice that of last year, and up more than 30% from 2009, according to the Multnomah County Medical Examiner's Office.

In Oregon, the number of indigent funerals is higher than ever - 317 so far this year, according to the Oregon Public Health Division. In fact, indigent funerals rose sharply after 2008, the year when the economy tanked, and the number has continued to rise. Across the country, reports have come to light of increasing numbers of indigent funerals and families struggling with funeral costs.

"The number of indigent burials is getting higher and higher," says Jackie Byers, research director for the National Association of Counties. While Byers doesn't have nationwide statistics, she says she's been seeing more reports of counties running out of money for indigent burials sooner than in past years.

"There's been an increase in families that are just struggling and can't afford to put together the money to bury their loved ones," says Sens. She believes the issue is most critical in large cities, speculating that rural communities may pull together and bury kindred better. She also believes the issue is more common when it's a distant family member, "like a cousin whom nobody's seen in a long time."

For the staffs at 211info, who serve as call-in, resource librarians for the city, Jones's plea was not unusual. 211info received 69 death-related calls for assistance this year, and staff members say the number of "cremation calls," asking for financial help cremating a loved one, is increasing.

Willoughby describes a failure in systems. "Traditionally, adult children will contribute to the funeral, grandma will bring the casserole, family and friends will divide the estate. But nowadays, people don't always have these systems. In this economy, people are more transient and often live in communities where they don't know anybody."

"More and more, we are getting calls from caregivers who've just seen an elderly client die. They are grieving, trying to manage the estate, and wondering about their future without a paycheck. On top of all that, they are at a loss for how to bury the body," says Willoughby.

The economy may not be solely responsible. "There's been better publicity around the indigent burial fund," says Christine Stone, communications coordinator for the Oregon Public Health Division. "It could also be due to better marketing - more hospitals and hospices may be telling folks about the indigent burial service."

So what happens when your neighbor can't afford to bury her grandfather? Or the homeless woman living outside your grocery store dies? Or your recently deceased coworker does not seem to have any traceable family?

"We get two types of indigent cases," explains Tom Chappelle, deputy medical examiner for the Multnomah County Medical Examiner's Office. "Either we cannot find the next of kin, or we find next of kin, but they are unwilling or unable to make arrangements." For instance, Chappelle says that this year, many families have abandoned deceased kin because they hadn't seen them in several years.

In Oregon, when an indigent person dies, a funeral home is contacted that is willing to cremate the body. In exchange, the state pays the funeral home a reimbursement, the amount of which depends on the number of indigent burial claims filed every month. The maximum reimbursement in Oregon is $650; in other states, it can be as much as $2,500, and may be paid for by the county or city. Oregon's indigent burial fund is managed under the Oregon Public Health Division and funded by death certificate fees.

For eligible spouses, Social Security pays $255 for funerals. For veterans who are homeless or have no family contacts, and were discharged honorably, the Veterans Affairs department offers "an appropriate burial and marker at the national cemetery," says Mike McAleer with the Portland Veterans Affairs Medical Center. McAleer estimates there's one indigent veteran burial per month in Oregon. Unclaimed indigents are listed in a searchable database back to 2000.

Chappelle's definition of indigent - from the current statutes which includes financially-strapped family members - is a topic of heated debate among "death care" stakeholders.

"The way the indigent burial laws are written and the way the funds are being used are two different things," says Randy Tjaden, principal of Crown Memorial Centers of Portland, Milwaukie, Tualatin and Salem.

"Some of these family members are not truly indigent and could really pay," says Tjaden. "Then what happens is the fund is depleted, our company carries the load, and truly indigent people still have to be buried."

"The indigent burial fund is not designed for people with family," says Lynne Nelson, interim executive director of the Oregon Mortuary and Cemetery Board, who says that they are seeing more indigent cases. "There is no program for the deceased whose family members don't have money. A lot of people are being taken care of from cradle to grave, and it stops at the grave."

In the late 1980s, Oregon offered state-subsidized burials for people on welfare, but abolished the program in the early 1990s when it became too expensive.

"The state came to the conclusion that welfare was to help living people," says Tjaden. Nelson admits "this may be something that needs to be looked at legislatively," but says, at this point, the board advises low- or no-income people to reach out to their communities and churches and shop around for less expensive funeral homes. "Cremation at one funeral home may be $995, and at another it'll be $400. Families may not know that," says Nelson.

"I would just as soon see the fund abolished so I could look a family in the eye and say there is no fund," states Tjaden, who says his funeral home company is losing money from "skyrocketing" indigent burials. "I feel sorry for the unemployed, but as an industry we can't be the ones to fix this. The family has to help us out."

So it might come as a surprise that Tjaden is furious at the state's 2009 decision to raise the maximum reimbursement from $450 to $650. Tjaden, who takes pride in his nine affordable facilities, confides that the actual cost of cremation is closer to $250. If a family truly cannot afford his price of $495, Tjaden says he will sometimes negotiate. But, other funeral homes, he says, will take the full $650 reimbursement without questioning whether the family is truly indigent.

As a result, the indigent fund can diminish during months with lots of claims, and become too small to cover costs. Lately, Tjaden has been receiving $128 reimbursements for indigent burials, which he calls his "community service."

Will the fund ever dry up completely? "No," says Tjaden, because if one thing is for sure, people will keep dying. Since the indigent fund is paid for by death certificates, and the annual death rate in Oregon is fairly constant (around 31,500 every year), the indigent fund is supplied with an estimated $179,550 per year.

"The fund has always struggled," says Tjaden. "Now times are tough, and there are people who really, truly need the assistance. But it's being misused."

Oregon Health Science University's Body Donation Program is one option for destitute families, and in fact, funeral homes are required to offer indigent bodies to OHSU before cremation. Until 2009, OHSU accepted indigents for use in medical study. But because of the liability associated with failing to track down relatives, and because of a 10-day waiting period prior to use of the body that rendered the bodies less valuable, OHSU changed the policy to require family or donor consent. Now, approximately half of OHSU's body donations are planned in advance by donors, and half are gifted by family members.

Overall, OHSU has gotten more body donations over the years, says Bill Cameron, director of OHSU's teaching institute and demonstrator of anatomy for the state. However, Cameron attributes the increase to boosted popularity of the program. "Oregonians are donating to our program largely due to word of mouth and an altruistic attitude perpetuated through generations," believes Cameron.

Companies like Biogift and MedCure offer a third, cost-free option. In exchange for a free cremation, Biogift and MedCure selectively remove organs and tissues for medical research and sometimes transplants. Heart valves, eyeball lenses, long bones and even deep skin tissue, for instance, are all particularly valuable body parts harvested for research.

Biogift staff says their numbers have gone up since they settled in North Portland in 2003. However, because they do not ask the motivations of donors, there is no way of knowing if the increase is due to financial struggles.

Finally, there are companies advertising discount cremation services, some more transparent about their services than others. One Denver-based organization called Ascension Catholic Funeral And Cremation Services goes by five generic names, takes calls 24 hours a day, and claims in newspaper ads that, "no matter what your financial situation we will help you!" The organization refused to comment.

Oregon has one of the nation's highest cremation rates, as opposed to many Southern states where casket burials are more common.  "Oregonians are not traditional people," says Cameron, who chalks up the difference to Oregonians' "greenness" and desire to leave a smaller biological footprint.

While cremations are generally less expensive than burials, both come with significant costs. The average price of cremation amongst three Portland funeral homes is approximately $3,000. The average price of a burial is $3,720. Local caskets can cost up to $6,495, and urns up to $3,695. Wholesale supplier Costco saw opportunity in the death care market in 2004 when it started selling coffins for $950 and urns for $99.

"There are different theories about why cultures have rituals to mark the death of their members," explains Jennifer Schuberth, assistant professor of religious studies at Portland State University. "Some theorists argue that it is because death represents a dangerous or precarious time for something like the soul of a person, as it moves from this world to the next, or perhaps to another body in the case of reincarnation. Other theories argue that the rituals are for the living so that the society, which has now lost one of its members, can reinforce its bonds as a community. In other words, death seems to threaten the social order, so coming together around death reaffirms that the community will live on."

"Funeral rites go with human individuation from the universe -- the place where we say Johnny really existed as Johnny, he was a real so-and-so (not like all the other so-and-so's), we will remember him, he lives on with us, and we hope that the same will be done with our memory," says Alan Cole, professor of religious studies at Lewis & Clark College. "In short, funerary rites mark the continuing virtual existence of the human personality in all its uniqueness."

Meanwhile, calls for funeral help continue to come in at 211info on NE 81st Avenue. Cara Kangas, community information specialist, describes a call she received two weeks ago from a woman who, until recently, had been the sole caretaker and friend of a senior citizen living by himself. The woman was at a loss for what to do with the body; the man had left no funds behind.

Kangas took a deep breath. She encouraged the caller to reach out to traditional sources of support: family, church and community organizations. She urged the caller to talk to funeral homes about financial need, or a hospital social worker about the indigent fund. She connected the caller to services that pick up items from an estate for free.

Most of all, Kangas assured the caller that she was doing the right thing. "She wanted to honor him," said Kangas.

"It's really hard for a person to say, 'I can't afford to pay to bury my friend or family member. I can't afford this basic rite,'" says Willoughby.

A name in this story has been changed to protect the subject's identity.

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