USA > Massachusetts > Middlesex County > Somerville > Report of the city of Somerville 1956 > Part 7
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The administration of "Settlement" is disproportionately costly beyond all reason, and its implementation constitutes an
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unjustifiable burden on the tax-payers of our modern, mobile, urban, industrial civilization. The retention of this antiquated anomaly, moreover, additionally confuses the generally bizarre pattern of State-local fiscal relationships which are so urgently in need of complete reform.
DOMESTIC RELATIONS
This Division was especially busy, during the year, as the report appended below suffices to demonstrate. Before ad- verting to the report, itself, we would like to point out that, while this Division remains under the direct supervision of Mr. Lawrence J. Crowley, his title was changed, effective as of July 1, 1956, from that of "Supervisor of Domestic Relations" to that of "Supervisor of Social Work". Moreover, we incorpo- rated the Domestic Relations phase of the work with the serv- ices to be provided by our new Division of integrated "Intake And Settlement". Preliminary preparations, for the operation of this latter Division, have already been undertaken and actual functioning will begin as soon as necessary changes in our staff structure can be effected.
Mr. Crowley carries on his domestic relations work in col- laboration with Police Inspector Jeremiah F. Donovan. His Divisional report follows:
"The following report covers the activities of the Domestic Relations Division for the past year, 1956.
"Our records show that we were present on 154 occasions, in our District and Superior Courts, on cases concerning the Welfare Department and involving complaints concerning non- support, illegitimacy, violation of terms of probation, etc. In 14 of these cases, jail terms of from one month to a year (the maximum) were imposed. An additional 17 cases were given suspended sentences of from 3 months to a year.
"It is gratifying to report that, in a high percentage of these latter cases, a fair measure of success was obtained, and the men met the imposed obligations to support.
"Our policy of accepting payments directly from husbands legally separated or divorced, who are under Court orders from Probate Courts, has, for the most part, been satisfactory.
"Through the facilities of the Social Security Administra- tion, we were successful in locating two of our "missing
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fathers" - one, in the state of Maine, and the other, in New Hampshire. In both instances, these men agreed to return to Massachusetts without involving the expenses that would fall on the City for "rendition" proceedings. Upon their appear- ance, the Court accepted our recommendations for suspended sentences, and imposed court orders of $25.00, weekly, in. each case.
"Information, obtained from Social Security on another case (A.D.C.), concerning a parent who had failed to provide any support to his family since 1946, resulted in his arrest and subsequent sentence to one year in the House of Correction.
"We also succeeded in processing two cases, (one in Texas, the other in Illinois), under Chapter 273A, commonly referred to as "The Uniform Reciprocal Enforcement of Support Act". In one of these cases, (Texas), an order of $10.00, weekly, was imposed. In the other, a Chicago case, a $25.00 weekly order was put into effect, resulting in the assistance case being closed (A.D.C.), as the recipient decided to go to work.
"Another case, involving an A.D.C. recipient, was closed following investigation which revealed that the adjudicated father of her illegitimate child had returned to her home fol- lowing a jail commitment.
"A similar case, concerning a legally separated couple, was also closed when it was discovered that the husband was again living with his family.
"Another case on A.D.C. was closed following refusal of the recipient to testify before the Grand Jury for the purpose: of obtaining an indictment, as the result of information we had obtained from Social Security on man's whereabouts.
"I might also mention a case involving a former husband of another of our A.D.C. cases. This man was apprehended following receipt of information from the Social Security Of- fice. Upon his appearance at our Court, he was given a six months' sentence. This sentence was suspended, upon his promise to pay $200.00, immediately, and $35.00, weekly, toward the support of his children. This money later was. "turned over" to our department.
"We also succeeded in closing another A.D.C. case, follow- ing the arrest of a husband in Maine. Upon his appearance in
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Superior Court, it developed that the recipient had knowledge of her husband's whereabouts and had accepted money from him without reporting same.
"Our continued policy of requesting notices of discharge of prisoners from State and County Penal Institutions, has also been of value to the Department, in evaluating the need for continuance of assistance where husbands are released prior to the completion of their sentences.
"Some 500 written reports were submitted to the A.D.C. Division, governing action taken by this Division with respect to cases in that category, in addition to some 150, in cases on General Relief.
"I would again like to express my appreciation for the co- operation extended at our local Court and Probation Depart- ยท ment, as also for that received at Middlesex Superior Court."
MEDICAL CARE COSTS
Although there was a fractional diminution of medical care costs in 1956, nevertheless, the aggregate expenditures were well over three quarters of a million dollars, for the second consecutive year. In 1955, we spent $776,442.50 for this ne- cessity and in 1956, we paid out $763,297.20, or $13,145.30 less.
While there were some decreases in several quarters, there were increases in others.
A review indicates that the savings were principally ef- fected in fees for physicians, which fell after the promulgation of new regulations by the State Welfare Department. Effective as of March 1, 1956, locally, calls on chronic cases were re- duced from four, to one, monthly. This fact, plus our address to and subsequent conferences with the Somerville Medical Society, undoubtedly had a salutary effect. The main purpose of our talk to the Society was to explain the new ruling, and to insist on its observance.
The cost of physicians' services tobogganed from $64,301.37, in 1955, to $42,271.41, in 1956, or $22,029.96 less. Home and office calls swirled downward from an altitude of 20,926 to a comparative plateau of 13,795.
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The preposterous and exorbitant character of the previous program is self-evident, since it is perfectly plain that no re- cipient is presently suffering neglect, insofar as needed serv- ices are concerned.
We have, on several occasions, publicly protested against the extravagant provisions of the State's Medical Care Plan. Such criticism is generally regarded as impolitic because it is subject to misunderstanding on several counts. Recipients are prone to misconstrue it as unreasonable opposition to what they regard as "adequate" medical care. Some welfare officials interpret it as an index of an illiberal attitude. The truth is usually suppressed or overlooked that such extravagance does not benefit the recipients, but simply the vendors. Reflecting quite objectively, now, on the abandoned original provision of four Physician's calls a month for chronic cases, we can scarcely repress the question: "How much needless and un- justifiable expenditure of tax-derived public money did this one provision entail during the more than one year and a half that it was in effect?" In Somerville, alone, during the course of ten months, its modification resulted in savings of over one third. If this percentage holds for the entire State, the lesson is certainly significant and strikingly reveals the practical im- plications of official policies, which extend statutory require- ments.
The unpleasant fact is that, in public welfare, as in virtually all other governmental agencies, today, the onrush of events, the unceasing succession of legislative enactments, and the constant pressure of interested groups, conspire to preclude sufficient opportunity to amass enough informational back- ground, against which policies can be properly and wisely projected. Moreover, in our field of endeavor, as in others, there continues to prevail a crisis psychology which supposedly warrants what amounts to legislation by administration. One of the primary reasons for this baneful condition is the break- down of the lesser autonomies. Financial dependence has diminished the identity of cities which are beholden to the State, and of our "sovereign" States which beg alms from the Federal exchequer.
There was a slight decline in the costs for drugs and medi- cation. The disparity downward amounted to $1,785.29. In 1955, the relevant expenses equalled $99,352.52, while in 1956, they totalled $97,567.23. Our clerical staff, assigned to checking drug bills, exercised ceaseless vigilance in the tedious sifting of the bills and deserves credit for the work done in this very difficult area.
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During the last months of the year, we personally were working on a new Code of Regulations for Drug Purchasing. We hope to have this new plan ready early in 1957.
Our experience, in respect to hospital costs, varied in 1956. The State Division of Hospital Costs, which promulgates man- datory rates to be paid by public welfare agencies, did not alter the rates at our two local institutions although the "per diem" in many Metropolitan Boston hospitals did rise. Rates of course, are only one important factor. The incidence of disease and accidents is variable.
While our expenditures for general hospitals fell appre- ciably, those for chronic cases mounted significantly. In 1955, we subsidized 10,634 days of care in general hospitals and, in 1956, only 8,970 or 1,664 less. The corresponding costs were $164,000.53, and $137,340.17, or $26,660.36 lower in 1956. In the chronic disease hospitals, the days of care rose from 7,425 to 10,367 - up 2,942. The comparable expenses were $50,264.38, and $62,096.16. Thus, the 1956 figure was $11,831.78 higher.
Our hospital experience appears to be consonant with the known state of medical science. Antibiotics, or the so-called "miracle" drugs curtail the need for lengthy hospitalization in acute illness, while extended life expectancy has increased the number of people, especially the aged, who are suffering from chronic degenerative ailments.
Pertinently, out-patient care in hospitals declined, both in calls and costs. The number of visits dropped from 3,023 to 2,770 or 253 less, and costs, from $6,198.00 to $5,650.70, or $547.30 less.
On the other hand, Visiting Nursing services and costs went up a little. Visits were plus 338, rising from 4,098 to 4,436. Relative payments went from $7,778.08 to $8,553.97, which was $775.89 greater than the year previous. In addition to the increased number of calls, a higher rate prevailed for the year.
As we have learned to expect, the costs of Nursing Home care spiraled further upwards, once again. This time, to the tune of $25,191.61, ascending from $330,057.51 to $355,853.12. As we have pointed out before, when we add the costs of chronic hospital care to the cutlay for nursing
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home care, it becomes obvious that the costs of chronic illness consume more than half of all expenses for medical care.
Moreover, the cost per patient per month for medication in nursing homes is alarmingly high. Welfare administrators, throughout the Commonwealth, are deeply disturbed by this phenomenon. It is realized, of course, that somewhat higher medical costs might be reasonably expected, in many instances. But the discrepancies are rather frightening.
Recently, we scrutinized our local records for a month, and arrived at the following results: In the month selected, a total of 587 Old Age Assistance recipients received medication cost- ing $5,355.64, an average of $9.12, per individual, for the month. Of the 587, some 131 were Nursing Home cases. These 131 received medicines costing $1,615.94 which is an average of $12.33 per person. The 456 clients, outside of Nursing Homes, had medication costing $3,739.70, or an average of $8.20 per patient. The Nursing Home cases, therefore, aver- aged $4.13 higher, or more than 50% higher than medicine- purchasing clients in their own homes.
In respect to Disability Assistance recipients, the facts were even more appalling. Some 93 persons received medicines costing altogether $1,488.58, or an average of $16.00. Of the 93, some 13 were in Nursing Homes and the costs for them were $384.36, or an average of $29.56. The 80 persons, in their own domiciles, incurred medicinal expenses totalling $1,104.22, or an average per case of $13.80, which is well under half of the former figure. From the data at hand, there- fore, only one conclusion appears logical, that is, that the costs of medication in Nursing Homes are exorbitantly high. The Massachusetts Public Welfare Administrators Association is assuredly well justified, therefore, in calling this situation to the attention of the State Legislature.
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 nurses and the dental assistant.
The expenditures of our municipal medical services ad- vanced somewhat in 1956. Total costs equalled $17,912.53,
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of which $15,151.12 went for salaries. The corresponding figure for 1955 was but $16,404.76, or $1,507.77 less.
During the year we discovered that medicine, administered to tubercular patients discharged from sanatoriums, could be purchased less expensively from wholesale drug firms by the Clinic, with consequent savings to the Department if such a procedure were to be followed instead of permitting the indi- vidual client to procure the medication at a local retail phar- macy and, thereafter, return to have it injected at the Clinic. Accordingly, the more economical and expeditious plan was introduced.
The maintenance and operation of this particular project remain a source of continuing anxiety to us. We are definitely not satisfied with the situation which prevails. The physical environment is assuredly not conducive to high hygienic stand- ards, and the locale is not congruous with modern public health norms. In our opinion, it is impossible for the Clinic to func- tion competently in its present quarters, which are substandard and inadequate from every sound viewpoint.
PERSONNEL
The Department experienced considerable mobility of Staff during the year, 1956.
During the General Agent's hospitalization and subsequent convalescence, which extended from April 30th to June 25th, Mr. William T. Casey served as Acting Agent.
Two members of the Staff, with lengthy records of service, were retired. Helen E. Haselton, Medical Social-Worker, re- tired on February 1, 1956, and Stephen A. Colahan, Social- Worker in the Bureau of Old Age Assistance, retired on December 28, 1956. Mrs. Haselton was a City employee for almost forty years and was with the Department since 1921. Mr. Colahan had completed eighteen years of employment on December 1, 1956.
Three members of the regular personnel resigned from their positions. Marilyn Curry, Social-Worker in the Aid to Dependent Children Division, resigned, after three months' leave of absence, as of October 8, 1956. Barbara (O'Keefe) Poplawski resigned as a Junior Clerk-Typist as of March 17, 1956. She had served in the General Agent's Office. Gloria
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Mell, a Junior Clerk-Typist, resigned as of July 19, 1956. Winifred Winn resigned as Secretary to the Board on Septem- ber 12, 1956.
The following persons were appointed, on a permanent basis, to fill existing vacancies :- Marie Reardon, as a Junior Clerk-Stenographer, on January 8, 1956; as Junior Clerk- Typists, Lucy Sliney, on July 8th; Margaret Murray, on August 1st; Barbara Loomer, on August 26th; Ruth Rothery, No- vember 7th; Mary Corcoran, November 9th; and Gertrude Parker, December 28th.
Temporary personnel, employed during the year, include Mildred Murphy, as Junior Clerk-Typist, from February 26th to August 24th, and Patricia Hynes, Junior Clerk-Typist, from June 4th to August 31st, 1956.
Three members of the clerical staff were appointed Social- Workers on November 1st. They were Rose A. Amlaw, Lillian M. Birmingham, and Mary Alice Dolan.
Inter-Divisional shifts included, as of March 7th, Elmer E. Haselton, from Aid to Dependent Children Division to the Bu- reau of Old Age Assistance; Katherine Arvanitis, from Old Age Assistance Bureau to Disability Assistance Division; and Nureen McCarthy from Disability Assistance Division to Aid to Dependent Children Division.
A long-standing dispute with the State Department of Pub- lic Welfare, regarding the title of Supervisor of Domestic Relations, was terminated after successful negotiations, which culminated in revision of title for Lawrence J. Crowley, from "Supervisor of Domestic Relations" to "Supervisor of Social Work." For the sake of convenience in claiming, Mr. Crowley was transferred from the Aid to Dependent Children payroll to the General Relief payroll, on July 22, 1956. He was assigned to the task of organizing the new "Intake and Settlement" Division.
Dr. Joseph A. Baldassarre resigned as a temporary assistant Physician, effective as of December 31, 1956.
In addition to the General Agent, two other Staff members were absent from duty because of illness for extended periods of time. They were Margaret A. Conley, Social-Worker in the Old Age Assistance Bureau, from March 16th to September
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4th, 1956; Lawrence J. Crowley, from November 1st through the end of the year.
PERSONNEL ROSTER
Miscellaneous Welfare Payroll
Name
Rating
John J. Griffin
General Agent
Lawrence J. Crowley Social Work Supervisor
Joseph MacDonald Social Work Supervisor
Maurice F. Breen
Social Worker
William Mahoney Social Worker
John H. Singleton
Social Worker
Anna Burns
Jr. Clerk Typist
Disability Assistance Payroll
William T. Casey
Social Work Supervisor
Katherine Arvanitis
Social Worker
Kathryn MacCarthy
Social Worker
Joseph Navoy
Social Worker
John F. Roche
Social Worker
Margaret Murray
Jr. Clerk Typist
Jessie Taylor
Jr. Clerk Typist
Aid to Dependent Children Division
Ecio L. Luciano
Social Work Supervisor
Kathleen Ash
Social Worker
Dorothy Connors
Social Worker
Nureen MacCarthy
Social Worker
Anna Reale
Social Worker
Margaret Riley
Social Worker
Frances Lewis
Head Clerk
Mary L. Cacicio
Jr. Clerk Typist
Mary Collazzo
Jr. Clerk Typist
Margaret Corcoran Jr. Clerk Typist
Helen G. Leahy
Jr. Clerk Typist
Old Age Assistance Payroll
Edward J. Ash Social Work Supervisor
Social Work Supervisor
Rose Amlaw Social Worker
Lillian M. Birmingham
Social Worker
Margaret Conley Social Worker
Albert Davis Social Worker
M. Alice Dolan
Social Worker
Francis Fitzpatrick
Social Worker
Mary Fogarty
Social Worker
Elmer Haselton
Social Worker
William Keeley
Social Worker
Albert McAuliffe
Social Worker
Nicholas Seonis
Social Worker
Thomas Tarpey
Social Worker
Salvatore Biondo
Jr. Accountant
Margaret Driscoll Principal Clerk
Elva Robinson
Sr. Clerk Typist
Joseph W. Bradley
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ANNUAL REPORTS
Mary Comfort
Jr. Clerk Typist
Mary Corcoran Jr. Clerk Typist
Barbara Loomer Jr. Clerk Typist
Anne Meaney
Jr. Clerk Typist
Gertrude Parker Jr. Clerk Typist
Marie Reardon Jr. Clerk Stenographer
Ruth Rothery Jr. Clerk Typist
Lucy Sliney Jr. Clerk Typist
Mary Willwerth Jr. Clerk Typist
Winifred Winn
Jr. Clerk Typist
Board and Clinic
J. Helen Clough
Board Chairman
John J. Conway
Board Member
John P. Henry
Board Member
John M. Tavares, M.D.
City Physican
Benjamin Blesoff, M.D.
Asst. City Physician
Marie Hanrahan, R.N.
Nurse
Mary C. Welsh
Med. & Dent. Asst.
Joseph Baldassarre, M.D.
Physician
PUBLIC RELATIONS AND EDUCATIONAL PROGRAM
During 1956, we continued our efforts to prosper a sus- tained program of community relations, an important facet of which, is that of educating the public, generally, and especially, its influential leaders, in respect to the precise functions, scope, problems and performance of our agency. Our experi- ence repeatedly and abundantly attests that our purpose, plans and preoccupations hold great interest for diverse groups of people. Professional societies are interested in the legal, medi- cal and social case work aspects of our program, business men, real estate brokers and taxpayers' associations are concerned about our exact statutory responsibility, investigative proce- dures and financing, while the common citizenry indicates a deep regard for our humanitarian objectives and the relative place and significance of our public assistance programs in the Nation's broad social welfare system.
The cooperation of the local and metropolitan Press, with us, has been nothing short of superb. Never before, in the history of the Department, have our projects received such prominent publicity. We owe a genuine debt of gratitude to the SOMERVILLE JOURNAL, the BOSTON AMERICAN, the BOSTON GLOBE, the BOSTON HERALD, and the CHRISTIAN SCIENCE MONITOR, as well as to the recently terminated BOSTON POST.
An important and entirely unprecedented development was the fact that the General Agent was interviewed on a variety of
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subjects by four major newspapers, published in Boston, and the results were published as feature articles. The BOSTON SUNDAY POST of April 22, 1956, carried, as one of its chief featured articles beginning on page one, an interview on the subject of old age, written by Paul R. Stevens. The BOSTON SUNDAY HERALD of September 30, headlined an interview by Fred Brine on the Effect of Family Disintegration on Taxa- tion. The BOSTON SUNDAY GLOBE, of November 11, placed as the first article in its News Feature Section, an interview by Herbert A. Kenny, in which we treated certain aspects of aging. The CHRISTIAN SCIENCE MONITOR of Tuesday, November 27, on page two, featured a lengthy column interview by Emilie Tavel, on the National Desertion Law proposed to Congress by the Massachusetts Public Welfare Administrators Association. The General Agent is Chairman of the Association's Legislative Committee.
But these were only a few of the many articles published. Considerable discussion, and a veritable furore in professional circles ensued, as consequences of a statement, the General Agent made as to his views on the role being played by private social agencies, which was published in the BOSTON SUNDAY HERALD of March 4, and referred to again in a page one fea- ture article by Wayne Hanley in the BOSTON SUNDAY HERALD of April 1, 1956. The same medium also published releases of ours on "Medical Care Costs", in the issue of Sun- day, February 12, and on our improved investigative proce- dures, in the edition of Sunday, April 8, 1956.
The BOSTON AMERICAN, in its SOMERVILLE EDITION, was also quite generous, both in its news columns and its "Stroller" section. Major news stories included those of :- March 23, "Vanishing Husbands"; February 4, on "New Regu- lations for Physicians' Calls"; August 24, on "Medical Costs"; August 18, on "Lien Payments"; and August 16, on "Family Breakdowns". Other news articles were published on August 18, concerning "Nursing Home Licensing"; October 20, on "Promotion of Three Clerks to Social Workers"; and, on Octo- ber 26, "Promotional Examination". The "Stroller" penned numerous references and occasionally used our releases in his column. Notable items included :- June 20, "New Law on Obsolete Records"; July 2, "Increased Assistance Allowances"; August 10, "Social Security Amendments"; August 13, "An- nual Report", and October 11, "Call for Wheel Chairs".
The February 1st edition of the BOSTON AMERICAN con- tained a picture of John J. Conway, just confirmed for his third
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successive three year term as a member of the Board of Public Welfare, with General Agent John J. Griffin, confirmed for an eighth successive three year term as a member of the Board of Public Library Trustees.
The BOSTON GLOBE (Somerville column), for September 14, recorded a resolve passed by the Somerville Newsmen's Association commending, among others, the General Agent and his staff, for effective help in aiding the victims of the Elm Street fire.
The BOSTON POST, of January 1, 1956, published a Book Review, which the General Agent was invited to write. The title of the book, reviewed, is "Towards Evening", by Mary Hope, which deals with reflections on aging.
The SOMERVILLE JOURNAL has been traditionally most liberal in according us space, and, during 1956, published several major articles of ours and numerous minor notices, designed to keep the public abreast of our activities. Multi- columned essays included those of February 9, "Physicians' Calls on Chronic Cases"; February 23, "Fiscal Facts of Welfare Budget"; March 1, "Differences Among Forms of Public As- sistance"; March 8, "Prosecution of Fraud"; March 22, "Wel- fare Department, Police and Courts Combine to Battle Adult Delinquency"; August 16, "Family Disintegration"; Septem- ber 6, "Expanded Social Security Benefits"; October 25, "Contractual Rights for Contributory Retirement System"; December 6, "National Desertion Law Proposed".
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