USA > Massachusetts > Middlesex County > Somerville > Report of the city of Somerville 1953 > Part 12
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WELFARE DEPARTMENT
though the various Social Security protections do assuredly provide a real cushion against the full impact of industrial recessions.
While the multiplicity, diversity, and complexity of factors affecting "Temporary Aid" are not amenable to ready analysis, the upward tendency of the payroll during the last quarter seemed to be reflecting the rather generally conceded conclu- sion that the super-boom of the war era was over and that a perhaps painful period of adjustment was at hand. Several indices revealed the s.gnificance of the pertinent repercussions. The placement of job-seekers became more difficult, some of the handicapped who found employment in a tight labor market were being sloughed off, the curtailment of Saturday work and overtime pay were depressing allowances due to families from estranged husbands, and a number of those cus- tomarily on the verge of sufficiency were in actual distress.
At the end of the year we were studying all discernible trends critically. The employment picture was somewhat con- fused by post-holiday let-downs, inventory-taking, and seasonal shifting. While there were admittedly real reasons for anxiety, our experience especially in the main categories furnished no grounds for pessimism. Indeed, evidences of high optimism were not lacking elsewhere. Unprecedentedly high securities markets, stable commodity prices, the confidence demon- strated by business leaders planning large scale capital outlays for expansion, looming tax reductions calculated to unleash new consumer purchasing power, the promise of liberalized Social Security benefits and projected Federal and State public works, all of these appeared as powerful realities brightening the horizon of public assistance administration. Speculations about the future, always hazardous, need not detain us here. The actualities of the year past are being recorded. Unfortu- nately, the usual statistical tables scarcely suffice to reveal their real implications. Perhaps the accompanying comments will help to interpret their meaning.
OLD AGE ASSISTANCE
Old Age Assistance is the type of public relief available to citizens 65 years of age or over who meet the basic statutory requirements of need and certain qualifications pertaining to residence, real and personal property possessions, lack of ade- quate income and other specified eligibility conditions. Need is measured by determining "Standards of Assistance" estab- lished by the State Welfare Department.
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Old Age Assistance is not a standardized national or State pension as is sometimes popularly assumed. In this Common- wealth, United States citizenship is a prerequisite and the sons and daughters of recipients attaining stipulated income levels are held legally liable to contribute to the support of their professedly needy parents.
Moreover, the Law (Chapter 118A of the General Laws) makes mandatory the placement by the Bureau, of a lien on all the real property however negligible the valuation, of all re- cipients. According to the interpretation of the provisions of Chapter 801 of the Acts of 1951 (amending Chapter 118A of the General Laws) by the Massachusetts Department of Public Welfare which has supervisory jurisdiction, such liens may not be discharged by local Bureaus for any reason whatsoever, except on the condition that all assistance monies granted to the recipient since January 1, 1952, the effective date of the legislation, are repaid to the City. The preponderance of "recoveries" (i.e. reimbursements from individual clients) pres- ently received by the Bureau are traceable to the operation of the lien law. While the amounts recovered locally thus far may not seem very impressive in relation to the aggregate outlays, there can be no doubt that if the law remains effective, the reclamation of accumulated indebtedness over the years to come will result in substantial revenue. It must be remembered of course, that the number of recipients owning real property is percentage-wise small. Much more important than the matter of re-payment is the deterrent effect of the mandate. There is no doubt in our mind that it has proven a potent bar- rier to the (hitherto) mounting caseload. Therefore, the fre- quently projected argument that most of the reimbursed money must be returned to the Federal and State Governments which supplied it originally, does not diminish the cogency of the positive reasons for retaining the lien proviso. Our experi- ence indicates that it has encouraged many sons and daughters otherwise not inclined to do so to support their distressed parents whose family homesteads they are anxious to inherit encumbrance-free.
The Bureau of Old Age Assistance is by far the largest Division of the Welfare Department and during the fiscal year just ended its total expenditure of $1,911,660.44 represented 66.5 per cent of the entire spending of the Department which equalled $2,877,299.97. It is worth noting that of the cash assistance payments of $1,754,490.78 almost a quarter, or to be exact 24.3 per cent was disbursed for medical and nursing home care which combined, cost $426,061.40. Of this latter total, $197,244.17 went for medical care including hospital-
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ization, and $228,817.23 was distributed for nursing home care. The term "nursing home" as used here includes licensed "Boarding Homes for the Aged" but not commercial lodging houses.
The Old Age Assistance caseload fluttered around the 2100 mark without any startling variations, during the entire year, averaging 2082 monthly for the calendar period. The medical caseload averaged 799 monthly or 38.4 per cent of all. The nursing home caseload averaged 171 per month or 8.2 per cent of the entirety (2082). Interestingly enough of the $228,817.23 expended for medical care, $19,448.50 or almost exactly 8.5 per cent was consumed by nursing home cases.
While the almost quarter million spent for medical care for the aged needy appears enormous, if not exorbitant, upon detailed analysis it does not seem quite so amazing. If we divide the total sum of $228,817.23 spent by the universal caseload of 2082 we obtain an average medical outlay for the year of $109.99 per client, that is $9.16 per month per aged person. In the light of the fact that the average age of our recipients surpasses 75 years, and that the progressive and progressively disabling chronic diseases constitute a principal cause of dependency, the medical cost figure becomes at least understandable. Nevertheless the hard realities of the situa- tion also make clear that the control of medical costs remains a major problem for assistance administrators. Whether the new Medical Care Plan to be promulgated by the State Welfare Department in 1954 will effectuate the desired control despite the implications of the "choice of physician" privilege granted by statute, remains to be demonstrated. We doubt that the answer lies in increased paper-work.
Several objectives which should be of community-wide interest were accomplished by the Old Age Assistance Bureau during the year. Early in February, the Board of Public Wel- fare published in book form a comprehensive study on the "Hospitalization of the Aged" written by John J. Griffin, Supervisor of Old Age Assistance. The first such study ever published under the auspices of the Board of Public Welfare, the book (copyrighted by the author) contains a "Foreword" by the Members of the Board calling attention to the high valuation placed upon it even before publication, by the Amer- ican Hospital Association. Since its publication, it has received widespread national recognition and requests for copies have come to the Bureau, from hospitals, social agencies, libraries, universities, physicians, educators and other professional per-
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sonages from all over the United States, Canada, Europe and even Australia.
In order that the personnel of the Bureau might be brought up to date on the most recent developments in the broad field of Public Welfare, especially in respect to the important modi- fications contemplated in Social Security Legislation, Mr. Griffin, with the approval of the Board and Mayor John M. Lynch, attended the annual Conference of the American Public Welfare Association in Washington, D. C. in September. Upon his return he held a Staff Conference of the Social Workers and relayed to them his findings. In response to an invitation he also spoke on the subject to the Somerville Conference of Social Work in December.
For the past several years, the Supervisor of Old Age As- sistance (Mr. Griffin) has been serving (without compensation) as a Supervisor of Field Work students placed with the Agency for guidance by the Department of Sociology of Tufts College. The most recent referral to the Bureau by the College is a graduate student in Sociology, Miss Helen E. Beedem of the Faculty of Physical Education at Jackson College who is com- pleting a study of the "Leisure Time Activities of the Aged in our Institutions" under Mr. Griffin's direction. The present project is complementary and supplementary to the "Study of Recreational Facilities and Programs for the Aged in Greater Boston Communities" which Miss Beedem carried out last year under Mr. Griffin's direction. The 1952 research received con- siderable attention among professional groups and was referred to top officials in Washington by the Regional Office of the Social Security Administration. There are good reasons for hoping that these research projects will fructify in practical programs to supply the recreational needs of the lonely elderly in Somerville. We understand that the Municipal Recreation Commission is now planning to round-out its excellent regimen of activities by helping to establish Golden Age Clubs. Miss Beedem has graciously volunteered her services to stimulate interest in these Clubs and Mr. Griffin long since an advocate of the movement, has pledged his hearty cooperation to Charles C. Kelley, Superintendent of Recreation.
During the latter part of the year, Mr. Griffin was called into consultation by the Director of Urban Redevelopment for the Somerville Housing Authority in regard to the contem- plated Housing Project for the Aged which is being planned for construction on Highland Avenue. This will be a State- financed development and will have at least 40 dwelling units. A study on "Housing of the Aged" written by Mr. Griffin and
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published in 1950 in the Journal of Gerontology, was made available both to the local and to the State Housing Authority on request, and likewise to the new Somerville Planning Board.
The Statistical Tables which follow are designed to make graphic the work of the Old Age Assistance Bureau.
AID TO DEPENDENT CHILDREN
From the viewpoint of caseload and expenditures the Aid to Dependent Children Division (Mr. Ecio Luciano, Supervisor) is the second largest Section of the Welfare Department. During 1953 the Division expended a total of $456,887.68 which was some 16 per cent of the gross expenditures of the Welfare Department as a whole.
A. D. C. is intended to provide adequate assistance for needy children sixteen years of age or less, or if in school eighteen years or under, who are dependent by reason of the death, incapacitation, desertion, or imprisonment of parents or because of other defined circumstances. Like Old Age Assist- ance, A. D. C. is a three-tiered governmental program financed by the Federal, State and local governments. Unlike O. A. A. which is centered on the individual person, Aid to Dependent Children by its nature, is focused on the family as a unit - insofar at least, as the shattered or disrupted families in need have any solidarity.
While dependency due to the death or incapacitation of the bread-winner is not infrequent, problems caused by deser- tion, divorce, estrangement, illegitimacy of parentage, and other species of deviation are the constant preoccupation of A. D. C. caseworkers. It is for this reason that the Board of Public Welfare decided to establish with the approval of Civil Service, the position of Supervisor of Domestic Relations in which capacity Lawrence J. Crowley is now serving. Comments on the services of the latter's functions will be found later in this Report.
Although not suffering from the disadvantage of technical settlement laws like Old Age Assistance, A. D. C. it may be ob- served, in passing, constitutes a greater drain proportionately on local tax funds than does the program for the Aged. This is true because the formula for Federal-State reimbursement in A. D. C. is somewhat less generous than in O. A. A. Thus in 1953 as will be seen in Tables printed below, local funds represented 18.3 per cent of A. D. C. expenditures, while the
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local contribution to O. A. A. was but 14.2 per cent of the gross cost.
In Old Age Assistance the reimbursement formula calls for Federal participation by payment of $20. of the first $25. (of the monthly assistance grant) and one half of the next $30. up to $55. ceiling. The Federal government does not share in any part of a monthly O. A. A. payment exceeding $55. A simple approach is to say that the Federal share is one half up to $55., plus $7.50 - that is, $35. of the first $55. The State pays 2/3 of the portion remaining beyond the Federal share.
In A. D. C., the Federal share is one half (of the monthly assistance grant) up to $30. for the first child, one half up to $30. for the needy parent, and one half up to $21. for each additional child. The State pays one third of the total grant. In both O. A. A. and A. D. C the Federal Government pays one half of all administrative costs including salaries.
The Aid to Dependent Children caseload hovered around the 300 figure all during the year. The average medical case- load was 110 per month. The costs for medical care (includ- ing hospitalization), which can readily be isolated, equalled $25,470.34, or, approximately one eighth of the cash assist- ance expenditures which grossed $412,066.37. We refer to "costs which can readily be isolated" because since A. D. C. recipients do not have the "physician of choice" prerogative, they are serviced by the Staff of City Physicians, and the cost of maintaining the Municipal Clinic ($20,860.21 in 1953) can largely be attributed to medical care of A. D. C. clients who are its most numerous patrons. This Division moreover, deal- ing is it does with children, has no nursing home expenses.
The Tables which follow indicate the caseload and ex- penditure experience of the A. D. C. Division.
DOMESTIC RELATIONS DIVISION
In a report filed towards the end of the year upon request of the State Welfare Department, Mr. Lawrence J. Crowley, Supervisor of this Division pointed out that he had received approximately two hundred referrals from the various other Divisions of the local Department for action. These referrals result from problems concerned with desertion, non-support, illegitimacy, and marital difficulties of divers kinds.
Mr. Crowley works in partnership with Special Officer John Courtney of the Police Department. Most of the service
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rendered is given to the A. D. C. Division where the problems in question are said to affect some sixty percent of all cases. Supervisor Crowley's compilation of figures indicates that the cases closed by his Division have effected savings of $23,000 annually to the A. D. C. Bureau.
DISABILITY ASSISTANCE
Disability Assistance is a relatively new category of public relief having come into being as a result of the 1950 Amend- ments to the Federal Social Security Act and ensuing enabling legislation in the year following, in Massachusetts. The pro- gram was initiated locally in December 1951. Those eligible are the totally and permanently disabled eighteen years of age, or over, who meet the statutory requirements of need and other specified qualifications. Mr. William T. Casey is the Supervisor of this Division.
Like the other categorical groupings, the D. A. caseload wavered but little during the year, clinging closely to the 245 level.
Concerned as it is with the incapacitated, the Disability Assistance program entails medical costs far exceeding in ratio those of all the other categories excepting only General Relief. An analysis reveals that of the $235,176.16 paid out in cash assistance to clients, the sum of $77,381.80 or 32.8 per cent of the whole was expended for medical costs including hospitalization and nursing home care. This fact becomes more impressive when we remember that many of the recipients, especially those who previously were on the General Relief rolls, continue to request the services of the City Physicians and use the facilities of the Municipal Clinic. Under the Law of course, they like O. A. A. clients, have the right to select their own physicians. Of the $77,381.88 expended for medical and nursing home care, some $24,651.11 or about 32 per cent was for nursing home care.
GENERAL RELIEF
The remarks made above in the introduction to this Report should suffice to describe the miscellaneous nature of the cases referred to this most ancient classification of Public as- sistance. Unlike the three categorical types of relief, the burden of financing "Temporary Aid" devolves almost exclu- sively on the local taxpayer, with the exception only of the
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costs for cases having no legal settlement, and cases settled in other Cities and Towns. "Settlement" is a technical statutory device designed to fix financial responsibility on municipalities for public assistance supplied to those in need. It obtains now only in Old Age Assistance and General Relief, having been eliminated by the Legislature from the Aid to Dependent Chil- dren and Disability Assistance programs.
The relatively high costs of medical care for the General Relief clientele is a factor which frequently escapes advertence. During 1953 for example, of the $119,000 provided in cash assistance, $42,334.06 or 35.5 per cent was attributable to medical care including hospitalization. Nursing Home costs were not significant, amounting only to $526.01.
The G. R. caseload dropped from a high of 151 in March to 100 in July, whence it spiralled again somewhat spasmodically to 147 in December, averaging out to 129 cases monthly over the year. The medical caseload averaged 72 per month. Only two persons received Nursing Home care and these only for the two last months.
MEDICAL COSTS
To our comments in the running narrative on the signifi- cance of medical costs we would like to append a few addi- tional points. It is eminently clear that medical costs comprise the largest single identifiable segment of public relief costs. Thus in the year reported, of the total $2,551,087.11 in cash assistance disbursements in the four Divisions of relief, $571,773.69 or 22.4 per cent went for medical and nursing home care. Of the latter aggregate, $317,779.34 or 55.5 per cent was for medical costs and $253,994.35 or 44.5 per cent for nursing home cases. Hence nursing home care cost over a quarter of a million dollars. Neither figure used includes the cost of medical care at the City Home which equalled another $1,659.49 or the cost of maintaining the Municipal Clinic which amounted to $20,860.01. If we add the total cost of conducting the City Home, that is $43,303.16 to the nursing home costs, the total expended for domicilary care amounted to close to $300,000 or to be exact, $297,297.51, thus bringing the grand total for medical and sheltered care to $615,077.25, exclusive of the costs of the Municipal Clinic, which if added, would push up the ultimate figure to $635,937.26.
Detailed breakdowns of medical costs may be seen in the Tables adjoining.
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WELFARE DEPARTMENT
PERSONNEL
There was considerable personnel activity during 1953 .. Several major promotions took place, fresh recruits were em- ployed, some reinstatements were effected, and depletions were caused by death and resignation.
Four Social Workers received promotional appointments to Social Work Supervisors on June 3, 1953. They were: Edward . J. Ash, Joseph W. Bradley, Lawrence J. Crowley and Joseph A. MacDonald. Mr. Ash was immediately assigned to assist Mr. Griffin in the Old Age Assistance Bureau. Mr. Crowley was , named Supervisor of Domestic Relations, Mr. MacDonald was placed in charge of General Relief and Mr. Bradley after being deputed to serve as a substitute for vacationing Division Super- visors was eventually placed tentatively in the Old Age Assist- ance Bureau as a second assistant to Mr. Griffin.
Margaret J. Driscoll was promoted from Senior Clerk to Principal Clerk on May 20, 1953.
Katherine Arvanitis and Kathryn C. MacCarthy were pro- moted from Senior Clerk status to positions as Social Workers on January 7, 1953. The former was assigned to the Old Age Assistance Bureau, the latter to the Disability Assistance Division.
New staff members employed during the year are: Sal- vatore A. Biondo appointed as Junior Accountant in the Old Age Assistance Division on February 8, 1953, and, Mary L. Cacicio hired as a Junior Clerk in the A. D. C. Division on De- cember 6, 1953. Mr. Biondo replaced Joseph C. Cain whose temporary appointment expired on February 7, 1953, and Miss Cacicio replaced Mrs. Doris Voner whose resignation became effective on November 30, 1953.
Marilyn P. Curry was reinstated after a leave of absence, as a Junior Clerk in the A. D. C. Office on February 1, 1953.
Frank L. Fitzgerald reinstated after six months leave of absence because of illness, as a Social Worker in the Disability Assistance Division, passed away on September 2, 1953.
Mr. Edward Colbert and his wife Leona were appointed Superintendent and Matron respectively of the City Home as of July 1, 1953 following the Board's acceptance of the resig- nation of Mrs. Elizabeth Goodrich and her daughter Virginia who had held these positions.
Dr. Joseph Baldassarre returned from Military service to active duty with the Staff of City Physicians on March 1, 1953 ..
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FINAL REMARKS
During the course of the important year just concluded, a host of crucial and complicated problems confronted the De- partment, but due to the persevering efforts and conscientious devotion to duty manifested by the members of the Board of Public Welfare as well as to the constant cooperation of Mayor Lynch, and the helpful attitude of the personnel of the Depart- ment generally, most of the difficulties presented were suc- cessfully solved or are on the way to solution.
One of the most urgent long-standing needs of the Depart- ment was well advanced towards fulfillment as the year drew towards its close. With the prospective removal of several City Departments to the newly constructed Public Works Building, Mayor Lynch formally approved the use of the entire basement floor for the Welfare Department. Appreciable headway was also made in the acquisition of needed equipment by virtue of the purchase of some new typewriters, steel desks, and posture chairs.
Since the advent of the new management at the City Home, notable gains have been made there and this progress is attributable very directly to the unceasing vigilance and solicitude of the members of the Board of Public Welfare who have repeatedly visited the institution, inspected menus, evalu- ated developments and suggesting various improvements in administration. A policy-setting new code of regulations formulated after diligent study by the Board has served to en- hance the standards of performance and living there. A new Intake Register was developed by the undersigned for system- atic and adequate recording purposes.
At the instance of His Honor Mayor Lynch, Mr. Griffin conducted a survey of procedures at the Municipal Clinic and filed a report of his findings and recommendations with the Chairman of the Board. After carrying out a resultant study, the Board instituted a new inventory procedure which was set up by Mr. Biondo, the Junior Accountant.
During his tenure as Acting General Agent, the under- signed with the approval of the Board, introduced a system of uniform statistical reporting, thus extending to all the Divisions of the Department a procedure long operative in the Old Age Assistance Bureau. The new system was set in motion with the enthusiastic sanction of the General Agent.
As for the three preceding years, the Board of Public Wel- fare effectively carried out its responsibilities under the com-
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petent Chairmanship of John J. Conway. Mr. Conway's cease- less interest, unbounded energy and well recognized talent for positive planning and dynamic leadership have proven invalu- able assets in the forward march of the Department. Zealously cooperating in every move of the Chairman towards betterment of conditions and more excellent norms of administration, the two associate members of the Board, Mr. J. Clement McCann (whose term expired on December 31, 1953) and Mr. Charles J. Sullivan equally contributed to the very substantial progress made under the genuinely congenial spirit and well-coordi- nated initiative of the Board.
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