USA > Massachusetts > Middlesex County > Somerville > Report of the city of Somerville 1955 > Part 10
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A study by the State Welfare Department Field Repre- sentative of a five percent sampling of A.D.C. cases in refer- ence to conformity with State Letter No. 69, proved of value in highlighting certain factors, and a consequent Staff Con- ference with the State Official in the Office of the General Agent resulted it is confidently hoped, in a generally deeper appreciation of the import and methods of intensive case work.
More searching investigative procedures particularly in reference to bank accounts, proved fruitful in a few specific
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instances and a series of notices sent to clients regarding pos- sible income, resources or employment brought about the dis- continuance of aid in several cases.
A speed up in the monthly reporting of payments received from husbands under Court orders, by the Probation Depart- ment of the District Court has facilitated the filing of requisite reports with the State Welfare Department, and is attributable to the effective mediation of Supervisor Crowley.
DOMESTIC RELATIONS DIVISION
The year 1955 was probably the busiest of all in the history of this Division.
The Staff of the Division experienced a change with the retirement in August of Inspector John Courtney and his re- placement by Inspector Jeremiah F. Donovan. Inspector Courtney served the Department with genuine skill and in a spirit of unfailing cooperation for many years. The Board of Public Welfare formally paid tribute to his efficiency in a communication sent to him upon the occasion of his leaving, and our Staff presented him with a wrist watch at the Christmas party.
The volume of work handled by the Division may be ap- preciated from a series of statistics accumulated by Supervisor Lawrence Crowley who was present on one hundred and twenty-five occasions at the District, Superior or Probate Courts on cases involving non-support, failure to pay as ordered, illegitimacy and violation of probation. The success of these appearances in terms of financial savings to the De- partment has been well documented in a series of four detailed quarterly reports submitted during the year to the General Agent for presentation to the Board. Furthermore, a total of 553 written reports were relayed to the A. D. C. Bureau and an additional 162 to the General Relief Division. These re- ports dealt with legal action taken in reference to cases on relief, the findings and disposition made by the Courts, col- lateral contacts made with employers, relatives, parents, and agreements concluded obviating judicial decisions. Some twenty-five jail sentences were handed out by the Courts to men who refused to provide support for their families in ac- cordance with their legal liability as determined.
The national business Office of the Social Security Ad- ministration in Baltimore has proven a rich source of informa-
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tion in the search for missing husbands whose employment records can thus be traced. Approximately 60 requests were made to the Federal Agency at different times and in several instances clinching data was obtained about deserting spouses who in years past would simply be lost under the generic title of "whereabouts unknown".
Further insight into the activities of this Division may be gathered from the following excerpt culled from a summary recently filed with the General Agent by Supervisor Crowley:
"As the result of information received from this Agency, (Social Security Board) we processed five cases in our District Court under Chapter 273A, commonly referred to as the Uni- form Enforcement of Support Act. It is gratifying to report that, as of this writing, the Department is in receipt of pay- ments, ranging from $28.00 to $80.00 monthly on four of these cases which are located in Kentucky, Louisiana, and Texas. We have also relayed information on about ten of these above-mentioned cases, on which data was obtained, to the Office of the District Attorney for his consideration, as Indict- ments on these individuals have already been obtained.
"One case dealing with Neglect of Minor Child, was processed in our Court under a comparatively new Chapter (646). Judge Brine, in this case, found the mother of a child (A. D. C. Case) guilty of Neglect and she received a jail sen- tence of thirty days. The child was adjudicated as being neg- lected and committed to the Division of Child Guardianship.
"We have also, in certain instances, made arrangements to accept payments here at the Office when it was felt that it would be to our benefit to follow this policy rather than to re- new action in our Court. This procedure was followed in cases wherein previous Court action terminated unsatisfactorily.
"We also closed two cases off our A. D. C. rolls on grounds of unfitness, and another also A. D. C. - for failure to co- operate.
"A policy of contacting various Probation Offices request- ing their cooperation in notifying this Department in the event of a favorable consideration being given to petitions for the release of a Prisoner, prior to the completion of a jail sentence, has also been of considerable value, as under certain conditions an A. D. C. recipient would not qualify for continuance of benefits when her husband would be no longer incarcerated.
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"Similar agreements have also been effectuated with our State Parole Divisions as well as with the State Penal Institu- tions."
Clerical assistance on a regular basis was made available to the Supervisor of Domestic Relations during the latter months of the year and this advantage greatly expedited his work.
A major improvement redounding to the benefit of this program was the establishment of the Supervisor in an Office of his own where he can interview clients in an atmosphere of privacy (especially important to this delicate work) and where he has independent telephone facilities. The new arrangement is a real advance over the previously existing situation wherein the Supervisor of Domestic Relations shared the Office, furni- ture and telephone equipment of the A. D. C. Division.
SETTLEMENT DIVISION
This Division was partially reorganized and was amalgam- ated with the General Relief Division during the latter part of the year. A clerk was assigned exclusively to this phase of the agency's work and another Social Worker was transferred to duty with the Division. A certain measure of progress has been effected as a result of these changes and some inroads made on an enormous backlog of bills, notices and claims. A con- siderable amount of tedious work remains to be done and we are not wholly satisfied with the present arrangements in re- spect to personnel and procedures. The situation is under constant review and further changes will be accomplished as. circumstances permit.
From the financial viewpoint no aspect of the Agency's® activity is more significant than "Settlement" which deter- mines the ultimate fiscal responsibility for assistance granted under the General Relief and Old Age Assistance programs. It is an unfortunate fact that proper emphasis and concentration on the work deteriorated over the years for reasons too numer- ous to detail, but with results most detrimental to our interests.
Early in the year we were notified that the City of Boston had filed suits against Somerville totalling on their face some $60,000. While it may be some years before the actual litiga- tion is heard in Court, we immediately assigned a Special Social Worker, Katherine Arvanitis from the Old Age Assistance Staff to an analysis and processing of the allegations in question.
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With commendable alacrity Mrs. Arvanitis reviewed all the cases at bar, and as a result, it now appears that the valid claims probably do not exceed $25,000 since evidence has been amassed that numerous bills presented for care of pa- tients in the Boston City Hospital were already paid by insur- ance companies, Blue Cross or other interests. Promiscuous billing by the Boston City Hospital (as well as by other hos- pitals) has long been a cause of concern and unnecessary inconvenience to neighboring welfare departments, and we have addressed a protest to the Board of Trustees of that in- stitution, the claims of which are presented by the Welfare Department of the City of Boston.
During the year the Division processed claims and prepared a series of bill rolls to effectuate the payment of some $83,605.54 to other municipalities. The sum was compounded of $32,205.50 for Old Age Assistance and $51,400.04 for General Relief. As a result of bills sent to other communities, we collected $66,607.40, comprised of $45,141.85 for Old Age Assistance, $18,917.33 for General Relief and $2,548.22 for City Home cases.
It has somehow or other become circulated abroad as a popular misapprehension that other communities must owe Somerville as much as Somerville owes them, as if the mobility and migration of human beings was regulated by some mech- anistic norm. The fact is of course, that indebtedness one way or the other varies unpredictably from year to year and from community to community. Since Somerville remains one of the most congested residential areas in the nation with some 100,000 persons tucked into 4.2 square miles of territory, it is not surprising to find that more Somerville settled individuals find their way to Boston hospitals for example, than persons from the metropolitan center resort to our local facilities.
Illustrative for the time being of the unbalance existing in this respect, is an analysis of Old Age Assistance cases under- taken in December by Mrs. Mary B. Fogarty, Social Worker in charge of O. A. A. Settlement. This examination shows that of the approximately 2032 O. A. A. cases active, some 294 were without local settlement (and therefore chargeable to the State), and 301 recipients have acknowledged settlements in other Cities and Towns. On the other hand, some 444 persons with acknowledged Somerville settlements are now being aided by other communities under the provisions of Chapter 118A of the General Laws (OAA). In addition there are always a few dozen cases awaiting determination of legal settlement.
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Comparable figures for the mercurial General Relief pro- gram are not available but the volume of cases under all head- ings is many times greater.
One of the multiplicity of tasks clamoring for attention in reference both to O.A.A. and G.R. is the review of claims and bills carried over from year to year on the Estimated Receipts Schedule which should be abated because they have become defunct by virtue of the statute of limitations, by loss of settlement or by default. The practice of carrying forward these cases annually is not peculiar to Somerville and it should be universally abandoned as providing a false impression of debts due. Locally it is a portion of the combrous legacy of "unfinished business" which we have inherited without gra- titude.
MEDICAL CARE COSTS
Medical Care cost the Department well over three quarters of a million dollars in 1955. In fact, the aggregrate direct ex- penditures for this item totalled $776,442.50.
An analysis of medical costs from various angles provides helpful insight.
First of all, the medical care costs represented some 24 percent of our entire expenditures for assistance which amounted to $2,791,328.23. This latter figure of course, ex- cludes administrative costs.
Examining the categories we find that of the $1,831,285.42 spent for assistance by the Old Age Assistance Bureau, ap- proximately 30 percent or $548,573.32 went for medical care. Of the A.D.C. assistance expenditures of $477,725.99 on the other hand, but $40,111.25 or almost exactly 8 percent was consumed for medical care. The contrast is due not only to the age and condition of the clientele but also to the fact that A.D.C. recipients are not allowed physicians of preference, and the salaries of the City Physicians are absorbed in admin- istrative costs. The same principle applies in General Relief (Miscellaneous Welfare) as it is styled, where the $41,401.67 expended for medical care was equivalent to 20.8 percent of the entire assistance budget of $199,312.45. In Disability Assistance however, the essential nature of the program is re- flected in the fact that $146,356.26 equalling over 51.1 per- cent of the assistance outlay of $283,004.37 was used for med- ical care.
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Looked at from another aspect, the statistics demonstrate that Old Age Assistance which costs 64 percent of all the $3,010,429.67 expended by the Department in 1955, also used 70 percent of the $776,442.50 spent for medical care. A.D.C. on the contrary, while using but 5.2 percent of the medical outlay, cost 17.5 percent of the total monies spent. This fact of course, simply documents from the statistical and fiscal viewpoints, the realization that ill health is a compara- tively incidental cause of dependency in the A.D.C. program while it is a major precipitating cause of dependency in Old Age. Disability Assistance costs 10.2 per cent of the Depart- ment's total budget, but consumed 19 percent of the med- ical care expenses as might be anticipated. Finally, General Relief costing 8.3 percent of aggregate disbursements utilized 5.8 precent of the total medical expendiutres.
Scrutiny of the constituent components of the Medical Care program reveals that 42 percent or $330,657.51 of the total $776,442.50 was siphoned off by Nursing Homes, and another 27.6 percent or $214,264.91 was channelled to hos- pitals. These two items therefore, Nursing Home care and hospitalization, account for virtually 70 percent of all medical costs.
Drugs or medicines cost the Somerville Welfare Depart- ment almost $100,000 during 1955. The exact sum was $99- 352.52 representing over one-eighth or precisely 12.8 percent of all medical expenditures. Prescriptions accordingly, cost about a third more than the services of physicians who were paid an impressive total of $64,301.37 which represented ap- proximately 8 percent of aggregate medical costs. The re- maining details may be seen in the attached Table.
The costs for medicines show a rise of 15.5 percent over those of the previous year when the figure was $86,016.09. The disbursement for the services of the Doctors of Medicine however, was considerably higher. In 1954 the costs of such services amounted to $46,080.50 in contrast to the $64,301.37 of 1955. Thus, the 1955 expense was 40 percent greater.
In passing, it is worth observing that if to the Nursing Home allocation of $330,657.51 we add the sum spent for chronic hospital care, we find that $380,921.89 or approx- imately 50 percent of the entire cost of medical care, was ex- pended for the institutional care of the chronically ill. While A.D.C. does not subsidize directly the care of the chronically ill, and it is a relatively minor cost in General Relief, it is
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noteworthy that the institutionalization of the long-term sick consumed 59 percent of all the medical costs in Disability As- sistance and 52.8 percent in Old Age Assistance.
The far-reaching significance of chronic illness to the en- tire field of public assistance can scarcely be overestimated. The import of the figures showing the cost of prolonged in- stitutionalization is enhanced and supplemented by the fact that a high proportion of the costs for physicians' services, medicines, prosthetic devices and other items are likewise at- tributable to the chronically ill. Morever, an analysis of the A.D.C. caseload (which shows no charges to us directly for chronic illness) reveals that 14 percent of all cases are ascrib- able to the incapacitation of the father. Furthermore, it is apparent that the entire Disability Assistance expenditure is actually for the chronically ill since eligibility is based on "permanent and total disability." Morever, General Relief bears witness to the effects of chronic illness in the charges incurred for patients at Tewksbury as well as in the costs which result from unemployment traceable to chronic illness.
Since the gross expenditures of the Department in 1955 increased but $74,001.52 (or 2.5 percent) and the medical care costs mounted $86,288.08 (or 12.5 percent), it is sound to conclude that assistance expenses would have actually de- clined somewhat were it it not for the winged Caduceus.
THE WELFARE CLINIC
The costs of the Welfare Clinic (located in the Old Police Station at 50 Bow Street) are recapitulated under General Re- lief and include the salaries of the Staff of City Physicians (3) and the stipends paid the City Dentist as well as the salaries of the nurse and the dental assistant.
A change in the character of the Clinic's traditional func- tion as a dispensary, and confinement of its role to that of a centre for diagnosis and emergency treatment, were reflected in the operating costs for the year. The maintenance expenses declined $3,828.60 from the $20,233.36 total of 1954 to $16,404.76. Of the aggregate expenditures, salaries alone represent 91.1 percent or $14,949.77.
The principal development during the year was the hold- ing of a Staff Conference of all the Clinic personnel in the General Agent's Office on September 22, 1955. Hours of
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duty, official policies, the scope of the program, eligibility requirements for services and a score of related subjects were thoroughly discussed and definitive conclusions reached. All present were later provided with mimeographed copies of the proceedings so that they might have a permanent record for reference.
Among the facts disclosed at the Staff Conference was the need for new equipment and consequently, we purchased and had installed a new sterilizer for the physicians and a dental sterilizer for Dr. Blumsack's use. At our request, the Public Works Department supplied a new three burner elec- tric stove and a dozen chairs for waiting patients.
At the beginning of the year formal instructions were is- sued to the nurse in charge requiring prior authorization of purchases, by the General Agent, and the policy was inau- gurated of procuring necessary supplies in quantity from wholesale drug firms instead of buying minute quantities of needed goods frequently from retail pharmacists
The future of the Clinic and its part in the Department's general medical care program, remains contingent upon a variety of factors and possibilities. A reappraisal of its long- range value and utility may be ncessitated in the near future if municipal authorities carry out projected plans to demolish the old building where it is presently quartered.
EQUIPMENT ACQUISITIONS AND PHYSICAL IMPROVEMENTS
During the year 1955 the Department acquired some very valuable pieces of equipment including two complete Audo- graph sets (each consisting of a transcriber and a recorder), an electric typewriter, and two five drawer steel filing cabinets. Limitation of usable floor space has suggested to us the ad- visability of purchasing five drawer instead of the traditional four drawer filing cabinets.
The Public Works Department supplied the filing cases and also a large electric floor fan for the clerical office and an electric desk fan and an electric wall clock for the Old Age Assistance office.
Physical improvements included the installation of stor- age shelves in the vault of the Social Workers' room and the erection of a partition in the re-located General Relief and
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Settlement Office which was formerly the quarters of the Old Age Assistance Division.
But the most significant advancement of all in this area of instrumental aids, was the installation of a new and efficient telephone communications and inter-communications system. The completion of this long overdue requisite for efficient service to the public together with official instructions to the personnel in respect to proper handling of phone calls, have resulted in a notable enhancement of general efficiency and in economy of motion. The expansion of the main switch- board in the central telephone office upstairs has likewise con- tributed towards the more expeditious handling of calls.
NEEDS
Despite the appreciable progress made during the past two years in respect to expanded quarters and additional equip- ment, this Department designed to alleviate need, finds itself in need of many things.
The basement in which we are quartered is by no stretch of the imagination, anything approaching as ideal or even good location for the efficient operation of a social service agency. Much of our floor is below ground level and the damp mus- tiness of the air is almost tangible in the morning when the rooms are first opened. There is obvious need for improved ventilation throughout. There is similarly a real need for scientifically determined lighting fixtures of enhanced calibre and of better type. Hence, we renew here a relevant recom- mendation contained in our 1954 Annual Report. While it may seem the height of naivete, we think that modern light- ing and ventilation would be reflected in a lessening to a de- gree, of absences due to illnesses or to indisposition.
As we promptly notified the Department of Public Works, the waters of the August 19th flood which inundated the De- partment because of a defective water spout on the side of the building, caused swelling and sagging of the floor cover- ing on several sites. The main offices need new covering.
The dirt from the ground sifts in through the window cracks as does cold air in the winter, and weather stripping of nearly all the windows is needed.
As we also indicated last year, a storm door or weather stripping of the present door at the rear of the main office is
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imperatively needed since the wintry blasts sweeping over the hill assail this portal fiercely during the winter months.
A number of new desks and posture chairs are an unfilled demand which we recorded previously.
From the viewpoint of rational business management we may briefly comment that modern mechanical office equip- ment could undoubtedly expedite functioning of the Depart- ment. An objective analysis is desirable and the availability of adequate funds would be a prerequisite to complete modern- ization.
PERSONNEL
Except for the promotion of the Supervisor of Old Age As- sistance, John J. Griffin, to the post of General Agent on February 15, as aforementioned, there was no alteration in the structure of the Department's permanent Staff, and but com- partively few changes in its composition.
Miss Carolyn F. May resigned as permanent Jr. Clerk Typist effective as of March 14 following the expiration of a six months leave of absence granted her in September 1954. The ensuing vacancy was filled by the appointment of Gloria Mell effective as of May 22, 1955.
Temporary appointments included that of Marie Reardon as Jr. Clerk-Stenographer effective as of March and re: ap- pointed at the termination of her six months employment pending establishment of a Civil Service List for a permanent position; Margaret T. Murray appointed Jr. Clerk Typist for a period extending from March 1 to May 21, 1955.
During the summer vacation season the Department em- ployed two temporary Jr. Clerk Typists: Elizabeth A. Riley from June 19 to August 23, and Patricia A. Hynes from July 3 to Sept. 10.
Mary T. Maguire's temporary appointment as Jr. Clerk- Stenographer expired February 5, 1955.
One of our most esteemed Staff Members, Frances Lewis, celebrated the Silver Jubilee of her entry into the service of the Department in August, and both the Board and the Mayor took cognizance of her excellent record of twenty-five years of conscientious service to the City, in formal letters of testi- monial sent to her.
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PUBLIC RELATIONS
Public relations is much more than simply publicity. It is rather the effects which flow from the sum-total of an agency's communications. The effort to build good public relations must not be merely episodic but on the contrary, constant and inherent in the very administration of an agency's program. We have endeavored to make these principles operative in our never-ceasing relationship with the community and its repre- sentatives on every level.
Moreover, we have endeavored to enlighten the general public and social groups in the Community about the precise functions, policies and laws which govern our activities. We regard public information and education as official responsi- bilities. In this respect the use of available media of mass- communication has particular advantages.
During the year we have been especially fortunate in the generous degree of cooperation accorded us by both the Metro- politan and the local press. We owe a special debt of gratitude to the SOMERVILLE JOURNAL, the BOSTON AMERICAN (Somerville Edition) and the BOSTON HERALD.
On three separate occasions, the Boston Sunday Herald published feature articles detailing our views on various aspects of public welfare administration and professional social work. On Sunday August 14, it presented a feature story expressing our observations on the Medical Care Plan and its cost to Somerville. The article quoted extensively from our 1954 An- nual Report published shortly before in printed form. On September 11, the Herald featured an interview wherein the General Agent discussed the perpetuation on our statute books of costly obsolete Welfare laws. On December 4, a similar article offering our comments on overlapping agencies and functions was featured.
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