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Care of the Aged Poor (1926)

Proposed Measures For Improving The Care Of The Aged In Massachusetts

A Presentation by Richard K. Conant, Massachusetts Commissioner of Public Welfare, Boston

At The National Conference Of Social Work’s Fifty-Third Annual Session Held In Cleveland, Ohio May 26-June 2, 1926

A Commission on Old Age Pensions has for two years been studying our system of caring for the aged in Massachusetts. Its report is a most valuable statistical study and shows a widespread lack of means in old age, emphasizing the sinister dread of poverty which is experienced by many good people. The commission disagreed as to the remedy and reported a majority bill and a minority bill, neither of which, in my opinion, would accomplish much toward preventing poverty or toward removing the dread of poverty in old age. The pension bill proposed by the majority, giving a dollar a day to those who have incomes less than that amount and who have not children able to support them, is really not a pension. It is relief for the poor. Poverty must be shown in order to secure it. It is hedged around with an investigation of need, and it is reduced by the ability of children to support. It is really poor relief under another name. In Massachusetts a real pension for all citizens over sixty-five, even if it were only a dollar a day, would amount to $60,000,0ooo a year. No state could afford a real old age pension under our present scheme of government.

Nor does the bill proposed by the minority of the commission, modeled on our mothers’ aid law, do much to prevent poverty or to relieve the dread of poverty. The minority bill attempts to increase the amount of aid which is being given to those who already have become dependent. The inadequacy of poor relief in Massachusetts in I913 was sufficient justification for the state setting up a system of mothers’ aid with state supervision of the local city or town overseers and a state subsidy. The report gives no evidence of any such inadequacy at the present time in the care of the aged. The effect of the mothers’ aid law has been to increase the standards of adequacy in all poor relief, so that now the care which is given to aged persons in Massachusetts is reasonably adequate and is constantly being made more and more adequate. The commission’s report discloses no great evil in this respect. People are not going to dread poverty in old age any less if the overseers of the poor give more aid to the people who have become dependent. The bill might add a thousand to the 3,791 persons who are at present in receipt of public relief. To add a thousand people to the overseers’ lists will not improve the condition nor the state of mind of the I8,ooo people whom the report shows to have yearly incomes of less than $300 and who cannot adequately be supported by their children. The minority bill attempts to do away with the pauperizing, as it says, of persons over seventy years of age. How about those between sixty and seventy, and those between fifty and sixty? Is there any use in beginning to do away with pauperization at the age of seventy? Will you pauperize a man up to the age of seventy and then expect to depauperize him? The minority bill says that persons over seventy shall not be sent to almshouses. Will you send them to almshouses up to the time they are seventy and then take them out at the age of seventy? The minority bill attempts to give suitable and dignified care to a person when he gets to be seventy. Why wait until a person is seventy before giving him suitable and dignified care?

The remedy for the real evil which the commission’s report shows (such extreme dread of poverty as still remains) is, I believe, to be found in a continuance of our progress in making relief both sufficient and humane. We must entirely abolish the old idea, already largely abolished, of treating a dependent person as a pauper. The old practice, the old words, the old attitude, all constitute the evil which modern measures try to abolish. For the last six years I have stricken the word “pauper” from every one of our hundreds of departmental forms which has come up for reprinting. We need an amendment to our statutes which will entirely eliminate the word “pauper.” It is an obsolete word except in the law.

The majority bill would set up a new system of district boards in place of local overseers of the poor. I do not believe that we need such a system in Massachusetts. Two years ago several boards of overseers desired to change their names and I suggested that a permissive law be enacted allowing any city or town to change the name to “board of public welfare.” Nineteen cities and eleven towns have now changed the name. Each one which has tried the new name likes it better than the old one. With the reforms of the last fifteen years a new attitude has almost entirely replaced the old attitude, and the change of name expresses and registers the change in attitude. We need an amendment to our law requiring all cities and towns to change to the new name.

We need also to change the word “almshouse” to “hospital.” Our almshouses today are used almost wholly for sick persons. We do, in most cases, just what the minority bill, in section 2, would have us do: “Give aid in the home or at some other suitable place, and not in an almshouse unless the person is ill.” The institutions have ceased to be houses for almsgiving. They have become hospitals for persons too sick to take care of themselves outside an institution. Several of these institutions are already called hospitals. For instance, in Lowell the almshouse is called the Chelmsford Street Hospital; in Boston, the Long Island Hospital; and in Lawrence, the Lawrence General Hospital. In the almshouses today there are 188 nurses and approximately 866 beds, which are known as hospital beds. Today nearly all the patients in the almshouses are within the category of hospital patients. The change in name would not immediately demand any change in the institution equipment or structure, but it would help in the constant progress which we are making toward getting better hospital care in the almshouses. This year, for example, Mr. Francis Bardwell, our expert on the care of the aged, has induced four cities to make considerable changes in their almshouses to make them hospitals for chronic care. These changes would be more than verbal changes in effect. They would, I believe, greatly influence the attitude of all who deal with poor persons and the attitude of the whole community, so that substantial progress would be made in wiping out the dread of poverty.

I have one more change to recommend: a substantive change to prevent poverty, to help those who are on the way down to poverty. I would add to our present law, which provides that towns shall relieve persons in distress, a new provision that they may in their discretion aid a needy person even when he owns property. That is our policy under our mothers’ aid law. The fact that the person aided owns the equity in her small home or has a small amount of cash (up to $200 under our rule) does not bar the aid. It is not necessary to wait until the wolf crosses the threshold. It is better to meet him outside the door. The minority bill of the old age pension commission would, I suppose, allow this in the case of persons over seventy years of age. The proper time to give aid in the prevention of destitution is not at the age of seventy, but long before the age of seventy.

If we could make these four changes in the statutes: strike out the word “pauper,” change the name “overseers of the poor” to “board of public welfare,” change the word “almshouse” to “hospital,” and give aid to needy persons even though they have some property, I believe that we would have done something toward preventing poverty, and that we would be doing a great deal toward eliminating the unnecessary dread of poverty.

Source: Proceedings Of The National Conference Of Social Work Formerly National Conference of Charities and Correction At The Fifty-Third Annual Session Held In Cleveland, Ohio May 26-June 2, 1926 (p.562)