Left Behind in Death

The Need for Reform to Address Massachusetts’ Indigent Burial Crisis

The late Peter Stefan enlisting the help of Worcester cemetery workers to bury an abandoned decedent, 2018, MassLive Article

In Massachusetts, morgues, funeral homes, and hospitals are overwhelmed. This crisis mirrors the broader neglect of the Commonwealth’s most vulnerable citizens. Every year, residents die without family or financial resources, and no one is left to oversee their final arrangements. The burden often falls on hospitals and police departments, or on funeral homes and municipalities, many of which lack the resources to address it. 

The Black Tie Coalition (BTC), founded by Massachusetts funeral director and decedent affairs coordinator Matt Mazzuchelli, works tirelessly to address this gap. 

“My team and I have worked tirelessly to spread awareness of our mission - there’s just so much wrong with how our state handles this issue,” Mazzuchelli said. 

Through advocacy and financial assistance, the nonprofit works to make certain that everyone receives humane disposition after death. The BTC is doing the work the Department of Transitional Assistance (DTA) is failing to do alone, which makes legislative support all the more critical. 

“The main issue is it [the DTA’s program] isn’t enough, and I don’t think money and bureaucratic hurdles should stand in the way of dignified burials, ” Mazzuchelli said when asked about the DTA’s currently implemented program. 

Matt Mazzuchelli, BTC founder, gives a presentation on the Black Tie Coalition, October 2024

The Scope of the Crisis 

The issue of unclaimed and abandoned bodies is prevalent. The Office of the Chief Medical Examiner (OCME) has over 686 unclaimed individuals listed in the National Missing and Unidentified Persons System (NamUs) as of February 2025, yet this figure excludes thousands of unrecorded cases in hospitals, nursing homes, and police departments. For the majority of individuals that die without OCME intervention, the burden is placed on the unassuming public. 

The most affordable burial solutions in Massachusetts start at approximately $3,000; cemetery fees alone often fall in the $1,500 to $4,000 range. With only $1,100 per case available from the state’s burial assistance program, funeral homes must cover the remaining expenses or refuse cases entirely. To further complicate this, total funeral expenses must not exceed $3,500 in order to be eligible for the $1,100. 

The Burden on Hospitals and Funeral Homes 

MGH is one of many hospitals in the Commonwealth facing this issue

Hospitals Strained by Overcrowded Morgues 

Many hospitals now find their morgue facilities pushed to capacity due to delayed burials of unclaimed decedents. In some cases, the deceased remain in morgues for extended periods of time. This practice far exceeds the space and resources available for standard operations. 

Current options are limited. When a hospital identifies an unclaimed body, staff must go through a process of locating family members and securing financial assistance. Subsequently, when it comes time to coordinate with funeral homes, many facilities are unwilling or unable to take the case. For funeral 

homes, working without a next of kin is both a liability and costly. In some cases, funeral directors pay out of pocket just to get the individual laid to rest. This creates an inefficient, costly cycle that diverts hospital resources away from patient care. 

Funeral Homes Caught in a Financial Dilemma 

For funeral directors, handling indigent cases has become nearly impossible under Massachusetts’ current funding model. The $1,100 reimbursement falls short of covering actual costs and may be reduced based on any assets the deceased might have had, no matter how small. 

As a consequence, fewer than four funeral homes in Massachusetts still accept indigent burials. Funeral directors like the late Peter Stefan of Worcester’s Graham Putnam & Mahoney Funeral Home have voiced concerns about the issue; many are forced to store unclaimed bodies for extended periods of time and, when necessary, pay burial costs out of their own pockets. 

The Role of The Black Tie Coalition 

The BTC has stepped in where the Massachusetts DTA has fallen short. The nonprofit organization works to: 

● Fund unclaimed burials by providing financial assistance to funeral homes willing to take on these cases. 

● Support families and non-familial guardians who cannot afford funeral costs but want to provide their loved ones with a dignified burial. 

● Advocate for systemic change, by increasing state burial assistance and promoting alternative solutions like publicly funded cremation options. 

Since its inception in 2024, the BTC has raised over $17,000 yet spent $16,400 covering burial expenses for those most in need. Without legislative reform, the current crisis will increase substantially. 

“It’s been a tough journey so far, but even the moderate amount of money we’ve raised has made an incredible impact. Sometimes it feels like a slow process, but I’m determined to help however I can, no matter how long that takes,” said Mazzuchelli, when asked about the organization’s one year anniversary. 

The Black Tie Coalition’s services are typically engaged via contact from social workers, religious organizations, hospitals, and sometimes even funeral home’s caught in difficult situations. From there, the organization provides financial assistance, offers guidance, and sees that the individual in need is laid to rest. 

When asked what the future goals of the organization are, Mazzuchelli responded, 

“My plan right now is to just keep plowing ahead - spread awareness, fundraise as much as possible, and maybe eventually raise enough money for a public, no-cost cemetery. For now, we will just keep doing whatever it takes to give people dignified burials” 

Legislative and Policy Solutions 

To address the problem, stakeholders must implement both legislative and community-driven solutions. The BTC and other advocates propose the following reforms: 

● Increase state burial assistance 

The $1,100 burial stipend is grossly inadequate. Adjusting this amount to reflect current burial costs (at least $3,000 to $5,000) would allow funeral homes to take indigent cases without financial hardship. 

● Allow for publicly funded cremation 

State law currently prohibits cremation without next-of-kin authorization, even for unclaimed decedents. By revising Chapter 114, Section 43M, Massachusetts could allow local Boards of Health to authorize cremation after a reasonable waiting period. 

● Create an emergency burial fund for hospitals 

A dedicated fund for hospitals handling unclaimed decedents would ease financial strain and make burials more efficient. These changes could significantly ease the overcrowding problem in local morgues. 

● Improve funeral home incentives 

Tax incentives or subsidies for funeral homes that manage indigent cases could alleviate the bottleneck of unclaimed burials. 

● Expand public-private partnerships 

Partnerships among the Commonwealth, funeral homes, hospitals, and nonprofit organizations like the BTC could prevent the deceased from being abandoned. 

Massachusetts Lives Impacted by the Crisis 

While statistics may highlight the scale of Massachusetts’ unclaimed burial crisis, the scope of the issue comes through in the real, human stories of those affected. These case studies, sourced from press materials and a letter to former Governor Charlie Baker, demonstrate where the current system falls short. 

A Hospital Morgue Overcrowded with Unclaimed Bodies 

Between April 1, 2023, and January 1, 2024, one Massachusetts community hospital documented 909 decedents moving through its morgue, with some bodies staying over 90 days because no funeral home would accept them. The longest stay recorded was 108 days. On two occasions, the emergency morgue was activated due to lack of space. 

Due to the Commonwealth’s strict cremation laws under (see Section 13 of Chapter 38), bodies accumulated far past the morgue’s capacity, which forced the hospital to rely on facilities usually reserved for emergency surges. Hospital staff found themselves diverted from patient care to managing an overflow of decedents. 

The Man No One Would Claim 

In Brockton, a 53-year-old unhoused man named Stephen Ledoux died at a friend’s apartment. His history of opioid addiction and COPD made his death, while tragic, not unexpected. 

It also drew attention to serious gaps in the system. When police tried to arrange transport for Ledoux’s body, the Office of the Chief Medical Examiner refused, citing the policy of only investigating violent deaths. Meanwhile, funeral homes turned them away because of inadequate reimbursement rates. As a result, police officers waited more than nine hours with Ledoux’s body before they found someone willing to take him. 

The Veteran Whose Family Refused Him 

James, an unhoused veteran living near Boston’s infamous “Mass and Cass”, wanted to be cremated — to have his ashes scattered on Cape Cod. His friends Jane and Bill hoped to honor his request, but because James had living relatives who refused to claim him, his friends could not legally authorize his cremation. 

In the end, James was buried in a low-cost grave paid for by the hospital. Jane and Bill watched helplessly as bureaucracy overrode this veteran’s final wishes. 

The Nursing Home Director’s Plea for Help 

At Heritage Hall Nursing Home in Agawam, a resident named Thomas Colligan died. Without family or money, there was no one to claim his body. Nursing home staff made call after call to local funeral homes, but one after another turned them down. 

After days of calls, the late Peter Stefan agreed to take Colligan. Stefan, who had gained a reputation as the “funeral director of last resort,” accepted cases that no one else would until his own death in 2022. Even so, he spoke out about how the system places an unfair burden on funeral homes. 

A Multigenerational Perspective 

In March 2021, William F. Spencer wrote directly to then Governor Charlie Baker about the indigent burial crisis. Spencer’s family has run their funeral home since 1896, starting “in a store front with a horse and hearse.” 

“I have been in the funeral business for over forty years and am struggling to understand the Commonwealth's response to those of low socioeconomic class, or lack thereof,” Spencer wrote in the unpublished letter, which the BTC has permission to share. “DTA continuously denies cases, cases that should never be denied, the 50-year-old homeless, struggling addict, and mom of three who overdoses in a Stop and Shop bathroom; the 35-year-old returning citizen who overdoses a month out of prison; the veteran who dies alone in their 1-bedroom apartment.” 

Throughout the pandemic, Spencer visited “houses, nursing homes, tent cities, hospital morgues and everywhere in between,” and saw firsthand how under-resourced families struggled with burial costs. 

Each of these stories represents a larger crisis. These cases are not isolated incidents. They are happening in rising numbers throughout the Commonwealth, from Boston to Worcester to Brockton. 

Spencer Funeral Home in South Boston, one of the few funeral homes willing to take on the task of burying the Commonwealths indigent population. Mr. Spencer has been a pioneer on advocating for change on this issue,

A Call for Urgent Action 

The BTC provides direct financial assistance to those left behind in Massachusetts. However, it can only do so much without legislative intervention and support from the DTA. Without immediate policy change, hospitals, funeral homes, and law enforcement will continue to struggle. 

Ultimately, the crisis of unclaimed and indigent burials in Massachusetts is a moral failing on the part of the DTA. The current system leaves the most vulnerable without dignity in death; it forces hospitals and funeral homes into impossible financial decisions. Meanwhile, grieving families are left to grapple with unnecessary burdens as they process their losses. 

The Massachusetts House of Representatives must take action. Legislative action is necessary to: 

● Increase state burial assistance so funeral homes can take on indigent cases. 

● Allow for publicly funded cremation to prevent unnecessary delays. 

● Provide financial relief for hospitals overwhelmed by unclaimed bodies. 

Until these changes occur, the BTC will continue to fight for those who have no one else to fight for them. For more information, visit www.BlackTieMA.org. 

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Unclaimed: Why Is This an Issue?

Unclaimed: Why Is This an Issue?

A seemingly small yet growing issue is unfolding within Massachusetts—one that affects a marginalized group of residents who often go unnoticed by the general population. If left unchecked, this "invisible" hardship may begin to seep into broader society, creating unforeseen consequences.

The Unanswered Question: What Happens When Someone Dies Alone?

Most people understand that when someone dies in a hospital, their body is moved to the hospital morgue. But what happens next? That’s where the process becomes complicated.

Over the past decade, societal and economic shifts have reshaped the post-mortem process. The traditional expectation is that a deceased person’s body is picked up by a funeral home, prepared for burial or cremation, and laid to rest in a timely manner. However, this is not always the case.

What happens when someone has no surviving relatives to make funeral arrangements? Or when estranged family members refuse to claim the body? What if there are relatives, but they lack the financial means to cover funeral expenses? Under current Massachusetts laws, the options in such situations are limited, often leading to prolonged delays and bureaucratic challenges.

The Harsh Reality of Unclaimed Bodies

Consider these real-world scenarios that illustrate the issue:

• A man dies in a hospital. The only contact listed in his records is a friend, who struggles with addiction and refuses to take responsibility. As a result, the deceased remains in the morgue for months, sometimes even years, awaiting action.

• A sister is notified of her brother’s passing. Instead of making arrangements, she angrily tells the hospital never to contact her again. The cost of a funeral is too high, and bitterness outweighs any sense of obligation.

In both cases, the deceased remain unclaimed for an indefinite period. Hospitals, which have limited morgue space, eventually must intervene. However, their options are restricted due to state laws.

The Legal and Financial Barriers to Resolving the Issue

Massachusetts law requires that all human remains be handled by a licensed funeral home. This means hospitals must find a willing funeral home to take custody of an unclaimed body. The preferred method of disposition is burial rather than cremation due to concerns about legal liability—if a family member were to surface years later and object, a burial allows for exhumation, whereas cremation is irreversible.

In 2017, the state updated its statutes after funeral directors raised concerns about unclaimed bodies. According to Massachusetts General Law (ALM GL ch. 114, § 43M), cremation is allowed only if:

"...the board of health has received notice from a licensed funeral director that either no person has come forward to claim the remains or that no person may legally claim the remains; provided, however, that the board of health shall wait 30 days after such notification under this clause prior to signing the cremation form."

However, many local boards of health hesitate to approve cremation due to liability concerns. Even if the statute is followed, it still requires a funeral home to take custody of the body—a step that presents its own challenges.

Why Funeral Homes Are Reluctant to Accept Unclaimed Bodies

Funeral homes are often unwilling to take responsibility for unclaimed bodies due to several factors:

1. Financial Burdens – Funeral expenses, including burial, typically range from $3,000 to $17,000. Many funeral homes face significant financial risks in handling unclaimed bodies, as government reimbursement programs, such as the Department of Transitional Assistance, often fail to cover the full cost.

2. Legal and Logistical Uncertainty – There is no standardized procedure for handling unclaimed bodies across different cities and towns, leading to inconsistent practices among hospitals, medical examiners, and funeral homes. This lack of clarity makes funeral homes wary of potential legal complications.

3. Limited Storage Space – Many funeral homes lack the capacity to store unclaimed bodies for extended periods, especially if there is an increase in cases.

4. Cremation Restrictions – Although cremation is more affordable than burial, Massachusetts law requires consent from all next of kin, which can be impossible to obtain in unclaimed cases. Without universal consent, funeral homes risk legal repercussions.

   
   

These obstacles leave hospitals in a difficult position, as they must bear the financial and logistical burden of finding a funeral home willing to accept an unclaimed body.

The Financial Strain on Hospitals and Funeral Homes

When a hospital must arrange a burial, the cost is typically divided into two parts:

1. Funeral home charges – Covering body preparation and basic services.

2. Third-party charges – Mainly cemetery fees, which can be exorbitant.

If a funeral director agrees to take on such a case, they must cover these expenses upfront, hoping to be reimbursed later. However, Massachusetts offers minimal financial support.

Under MGL 117A, §9, the state provides reimbursement to funeral homes under strict conditions:

“...the commonwealth shall pay an amount not exceeding $1,100 to the funeral establishment if the total expense of the funeral and final disposition does not exceed $3,500.”

This cap on total funeral expenses is extremely limiting. Cemetery costs alone can exceed $3,500, leaving funeral homes with little financial incentive to accept unclaimed cases.

The Need for Legislative Change

As societal norms evolve, state policies must adapt to reflect modern realities. Current laws fail to address the increasing number of unclaimed bodies, leaving hospitals and funeral homes overwhelmed by a problem with no clear solution.

Possible policy changes that could alleviate this issue include:

• Increased State Funding – Raising the reimbursement limit would encourage more funeral homes to accept unclaimed bodies.

• Streamlined Legal Processes – Establishing a uniform system for handling unclaimed remains would reduce confusion and delays.

• Liability Protections – Clarifying legal protections for funeral homes handling unclaimed remains would help mitigate concerns about future lawsuits.

• Cremation Policy Revisions – Allowing cremation without universal next-of-kin consent in cases where no claimants are expected could significantly reduce costs and logistical challenges.

  
  

Closing Remarks

The issue of unclaimed bodies is not just about logistics and finances—it is a matter of dignity. When a person dies, they deserve a proper and timely disposition, regardless of their financial status or family situation. The current system is failing both the deceased and the professionals responsible for handling their remains.

Without policy reforms, this problem will only worsen, placing greater strain on hospitals, funeral homes, and state resources. Addressing this growing crisis requires legislative action, financial support, and a more compassionate approach to end-of-life care.

Unclaimed, Abandoned, & Indigent Decedent's - Hospital Deaths

Research study by The Black Tie Coalition

Disclaimer: The following report does not represent the involved hospital's position towards the following issue. This was an outside research study conducted by the Black Tie Coalition, with proper authorization and notification made to the involved hospital, and was found to be just 1 of 12 hospitals in the greater Boston area to be facing this issue.

Abstract

The neglect of indigent and unclaimed individuals in death mirrors societal inequalities, urging systemic reforms to ensure dignity in death for all. The inadequacies in current policies have significant implications on healthcare systems, which face operational challenges. This issue highlights deep-seated societal disparities, as individuals without financial resources or familial support often do not receive dignified and timely end-of-life care, impacting hospital efficiency and resource allocation. There is an urgent need for policy reform, societal engagement, and improved community attitudes toward death and dignity.

Urgency of the Matter

Ongoing public health crises, such as the opioid epidemic and COVID-19, have amplified the challenges faced by the homeless and indigent populations. As urban populations grow and socioeconomic disparities widen, the number of indigent individuals facing death alone and unclaimed is projected to rise. This escalation not only exacerbates the logistical and financial burdens on public services, but also deepens the ethical crisis at the heart of this issue. Without immediate and decisive action, we risk normalizing a culture of indifference that undermines our societal progress and cohesion.

The Strain on Hospital Facilities and Resources

The prevalence of unclaimed bodies in hospital morgues has become a pressing concern, with many hospitals experiencing significant strain on their facilities and resources. This issue is not isolated but widespread, affecting various healthcare institutions, leading to overcrowded morgues and, consequently, the need for emergency measures such as the activation of alternate morgue facilities. The extended occupancy of morgue space by unclaimed bodies, some lingering for months, highlights not only the systemic issues within death care management but also the social and economic factors contributing to this situation. The result is a logistical and ethical dilemma, impacting hospital operations and diverting essential resources from patient care and other critical services.

The issue is aggravated by limited morgue capacity, leading to situations where long-term decedents necessitate the activation of alternative morgue facilities in times of high surge—situations that the hospital would normally be able to handle but for the volume of long-term decedents occupying morgue space. This stopgap solution, while alleviating immediate space constraints, underscores the pressing need for systemic improvements. It reflects the broader implications of failing to ensure proper and timely burial for a marginalized population, straining hospital resources and highlighting inefficiencies within the death care management system.

Data: Context, Interpretations, and Implications

Appendix A represents 909 decedent’s entry and exit from a community hospital morgue from April 1, 2023 to Jan 1, 2024. Any decedent staying over 20 days has a numeric value of days displayed. Appendix B reflects the same information, but the vertical dashed magenta line indicates when capacity reaches crisis. It’s important to note the correlation between the emergency level threshold and number of long-term decedents occupying morgue space.

The data indicates periods of markedly high occupancy within the morgue, with days where the number of concurrent decedents significantly exceeded the facility's standard operational capacity. Several cases were documented where individuals remained within the morgue for periods exceeding 90 days, with the longest stay reaching up to 108 days. These extended stays underscore the challenges in the timely processing and disposition of bodies, particularly for those without claimants.

Lastly, the data reflects minimal to no assistance from state authorities in addressing the challenges posed by unclaimed, abandoned, or indigent decedents. The prolonged stays and overcapacity issues, compounded by the absence of clear guidelines or support mechanisms, point to a significant gap in the regulatory and support framework.

Inherent Challenges Faced by Hospitals

Hospitals encounter significant challenges in the management of unclaimed, indigent, or abandoned decedents, due to a combination of legal requirements and logistical hurdles. Under Section 13 of Chapter 38 of the Massachusetts General Laws, the release of a body must adhere to a prioritized list of individuals with legal authority, starting with the surviving spouse, next of kin, or any friend of the deceased. This requirement complicates the process when family dynamics are strained or when no next of kin is available, as the hospital must navigate these relational complexities before proceeding with processing the body.

Additionally, Chapter 114, Section 43M of the Massachusetts General Laws allows local Boards of Health to authorize cremation for unclaimed remains; however, this provision is not universally recognized. As a result, hospitals find themselves constrained by a lack of clear, actionable options, wedged between stringent legal requirements and the practical realities of uncooperative or absent family members and wary funeral homes.

In addition to the challenges imposed by legal and familial complexities, hospitals also face significant hurdles in collaborating with funeral homes due to financial constraints. Funeral homes are often hesitant to take on cases involving unclaimed or indigent decedents due to the limited financial assistance available from the Department of Transitional Assistance (DTA). Currently, the DTA provides only a modest subsidy of $1,100, but only if the total funeral costs do not exceed $3,500. In today's market, organizing a funeral within this stringent budget is nearly impossible, given the rising costs associated with funeral services, burial, or cremation.

The gap between the DTA's provided subsidy and the real-world costs of funeral services highlights a critical area of need within the system. Addressing this gap requires a collaborative effort among state authorities, hospitals, and funeral service providers to ensure that all individuals, regardless of their financial or familial status at the time of death, are afforded the dignity of a proper farewell.

Proposed Solutions

A critical step in addressing the significant challenges presented by Section 43M and the financial constraints of the DTA is the revision of Section 43M. The law should be updated to provide clear, streamlined procedures that enable local Boards of Health to more efficiently authorize the cremation or burial of unclaimed remains and minimize bureaucratic delays and adapt to the varying circumstances surrounding unclaimed bodies, ensuring a faster transition that respects the dignity of the deceased while alleviating morgue overcrowding.

In conjunction with legal reforms, there is a pressing need to reevaluate the financial assistance provided by the DTA. The current allowance is starkly inadequate in today's economic climate, where funeral expenses far exceed the provided subsidy. Advocating for an increase in this allowance is essential. By aligning the subsidy with actual market rates, the state can alleviate the financial burden on funeral homes and families, encouraging more establishments to participate in the burial or cremation of indigent individuals.

Furthermore, fostering public-private partnerships can significantly contribute to resolving this issue. By collaborating with state agencies, local communities, funeral homes, and charitable organizations, Massachusetts can establish a more robust support system. This network could facilitate funding pools or subsidies, ensuring that all decedents receive respectful and timely burials or cremations regardless of their financial status.

Moreover, community involvement plays a pivotal role in addressing this dilemma. Raising awareness and rallying community support can lead to more volunteer-driven initiatives and contributions, aiding in the dignified treatment of unclaimed and indigent decedents. Engaging religious groups, local businesses, and civic organizations in these efforts can foster a community-oriented approach to end-of-life care, bridging the gap between legal mandates and compassionate action.

Implementing these solutions requires a concerted effort from all sectors of society, including legal, financial, community, and legislative domains. By addressing these challenges holistically, Massachusetts can set a precedent for dignified, compassionate, and practical care for all individuals at the end of life, ensuring that no one is left behind due to financial or familial circumstances.

Conclusion

Ultimately, the neglect of unclaimed individuals in death illuminates undeniable societal inequities, necessitating systemic changes. Addressing these challenges demands a comprehensive approach, including garnering financial support, engaging communities, and advocating for legislative reform. In developing a comprehensive approach to this multifaceted issue, we ensure that all individuals, regardless of their financial or familial circumstances at the end of life, receive the dignified final resting place that they deserve.

As an organization, The Black Tie Coalition is working to purchase common grave space throughout Massachusetts for the sole purpose of indigent, abandoned, and unclaimed burials. To do so properly, The Coalition needs at least $50,000 for the purchase of 50 to 60 plots. Any contribution will greatly benefit the cause, as well as the Commonwealth of Massachusetts and the invisible issue occurring in our state daily.