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Amy Shea, "Too Poor to Die: The Hidden Realities of Dying in the Margins" (Rutgers UP, 2025)
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- [00:00]
A
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B
Welcome to the New Books Network. I am Stephen Pimpair, host of the Public Policy Channel, and we're joined today by Amy Shea, who is the author of Too Poor to Die, the Hidden Realities of Dying in the Margins from Rutgers University Press. Amy, welcome. Thank you for joining us.
- [01:23]
C
Yeah, thank you so much for having me.
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B
So I wonder if we might kick off by asking you to say a little bit about who you are and what you do and what it is that brought you to this particular project. Sure.
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C
So, yeah, as you mentioned, Amy Shea, I'm the writing program director at Mount Tamil Pius College. There's a free community college for the incarcerated people of San Quentin. So I've been there for a little over four years. Prior to that, I had been working on a doctorate in creative writing, which is where I wrote the first draft of this book and where I did all my research for it. What brought me to the book? It's a slightly complicated question. All the nitty gritty details are in the book. But the short answer is, my father, in his retirement, started doing research down in Fresno County, California, where I grew up, for the Genealogy Society at the library there, and he was mapping all the cemeteries for them. So that if someone came looking for great, great, great Grandpa, for instance, they could say he's in this cemetery, this plot, this row. In doing so, he came in contact with the county coroner. They had a stack of records, just boxes stacked up in a basement somewhere. And these are all the of people who've been buried in the county cemeteries in Fresno, sometimes known as potter's field. And they didn't know what to do with them. And so my dad took them and incorporated this into the work that he was doing and created an online database that still exists today of all 11,000 plus people who are buried in those cemeteries. And while he was doing this, he's telling me about these places. And I had never heard of a potter's field. I didn't at that point, had stopped to think about what happens if you can't afford to, you know, private burial or cremation. And so I would go home. I was living in Boston, and I would go home for visits. And on one of those visits, I said, take me to the cemetery. And he showed me this potter's field. And it just really. I was really struck at the time. We actually couldn't get into it, or we didn't know how to get into it. That's how hidden this space is. In a way. It doesn't look like a cemetery. And from the outside, it didn't seem like there was any real obvious way to get inside. So we stood in the Catholic cemetery adjacent into it and peered through the fence. And there was this real dichotomy, this real difference. And it was incredibly stark of standing in this lush green cemetery in Fresno, which is desert, mind you, and all these headstones and all this kind of opulence. And then on the other side of the fence was what was essentially a dirt field with some weed and scores of cement strips that went through with little numbers on it. And that's how they mark the plots there.
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B
And.
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C
And I just. It stuck with me. And then a series of other things happened, and next thing I knew, I was knee deep and then neck deep in his research. And that was fifth. Oh, maybe almost 15 years ago. And I had written one essay while I was doing my master's on. On those cemeteries on the potter's field. I called it Pushing Up Daisies. It eventually became the first chapter of this book. It's called Remembering the Forgotten, the Space that Still Remains. And yeah, just kind of snowballed from there.
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B
Terrific. So I'm trying to figure out sort of what is the most sensible entry point. And let me throw out the question this way. The book is more or less divided into two big Sections one is, as you put it, what happens to someone when they die homeless, indigent or unclaimed. And then move on to looking at what may be more familiar to folks, which is looking at sort of the systemic causes. How do we understand how it is that people become unhoused or homeless?
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C
So what.
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B
Why don't we start in that first bit and maybe talk to us about what it is to be unclaimed and what does that mean and what does that look like?
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C
Sure. So some of the work that I've actually done since working on this book I founded. We're just a small group called Equitable Disposition Alliance. And our goal has been to create a database of all the county disposition programs around the country, or as many as possible. We're aiming for two per state right now. And so what this is on. On a large, on a kind of high level, as you say, if someone is, quote, unclaimed, and this is unfortunately the best word that that really defines it, and it doesn't do a great job, but it's better than some of the others is essentially, like I said earlier, it's someone who can't afford private disposition, whether that's burial or cremation, et cetera. And when that happens, they're quote, unquote unclaimed. And have they had. The responsibility falls usually to a county within a state. There's kind of three primary ways that people end up or that three categories, so to speak. The first is someone who has no known next of kin and no financial resources. And so if they don't have either of those things, the county, you know, comes, you know, has a body come to them, and they, they can't find any next of kin or any financial resources for this person. The. The next step is that they will likely be handled by the county disposition program, whether that's cremation or burial, depending on what that county does. The other way someone ends up in this situation is they maybe have next of kin and they've been found, but they can't afford that. Next of kin also can't afford to help. And so they have to relinquish responsibility to the county at that point. And then the third option is again, they find next of kin and that next of kin chooses not to take control of that by they don't want to be involved or they can't for whatever reason, and they'll relinquish that responsibility. Once again, as I say this, there's never anything shameful about the county taking over and doing this right it's work that needs to be done ultimately. And I think that it's more of a systemic issue that has led people to. You don't just suddenly pop up and end up in a potter's field, so to speak. But those are kind of the broad categories as to how someone might end up there. And again, unclaimed makes it sound as though, well, one like their property and two, like there's no one there. And that's also a real common misconception. Like I said, there are oftentime friends and family and loved ones. They just also can't bear that financial responsibility.
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B
And you know, folks who have listened, listening, who have, who have been through this with someone in their lives know that the process can be extraordinarily expensive. I wonder if you might just sort of talk a little bit about that for folks who don't understand and are confused as to why this can be such a hurdle for folks.
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C
Yeah. So can I read this first little paragraph out of this chapter called the Department of Transitional Assistance? Just one paragraph. The National Funeral Directors association notes that the median cost for a burial is around $8,000 and a cremation with a service and viewing is more than 6,000. According to their website, the average non declinable basic service fee is $2,100. Then there are optional cost averages, including the removal of the body of the funeral home, $395. Embalming, $845. Other body preparation, $200. Use of facilities staff for a viewing, $425. Use of facilities staff for a funeral cemetery, $500 hearse, $350 service van or car, $150. Basic printed memorial package, $180. Metal casket, $2,400, $295 and cremation casket, $1,300. So I ask in the next paragraph, what happens to someone who can't afford $6,000 to be dead. And on the flip side of that, the counts are, for instance, in Fresno county, in most counties will contract with either cemetery or crematoriums. Crematorium. And in Fresno, I think it's about 250, $300 for them to do so to have a person cremated. Now, that being said, so what happens is the county will pay that. If you want those cremated remains back from them, you also have to cough up that $300. You won't get it for free. And as I think we all understand, $300 can be a lot for some people, and especially if we're Talking last minute without. If this happens suddenly or without any kind of notice or advance warning of this coming. So, yeah, it's very expensive, and especially if you want any kind of memorial service along with that or anything beyond just, you know, kind of super bare bones.
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B
So one of the essays in the book is an extended discussion of a documentary film called A Certain Kind of Death. So I wonder if you might use that and talk to us a little bit about the film and your perception of it and tell us a little bit about who it is who dies alone.
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C
Yeah, that film really, like, again, it was just one of those things that really grabbed me. And as I talk about in that chapter, I watched it at least 20 times, if not more. I just kept coming back to. It's very haunting. And if it highlights. It takes place in Los Angeles county, and it highlights three different people who have died, quote, unclaimed.
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B
And.
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C
And it's an interesting thing because also it's very graphic. It is very. In your face, you there, you see actual decomposition. You see, you know, these bodies are shown on the screen. And I think that brings up a really interesting conundrum of, you know, just this. This ethical and moral question of who do these people belong to and who's giving permission to do this? Because. And again, this, I think, falls within that. This whole idea of they're unclaimed and there's no one there, and there's no one necessarily there to advocate for them either. But I also think it's an incredibly important film to show and to show that stuff up close to see what can happen. And the three people they highlight, in fact, one of them technically wasn't unclaimed. Right. He died alone. I think it's Ronald Eugene Tanner, and he's the one they focus on the most. And I sort of wonder again if they focus on the most because they could. They could gather so much more of his narrative or create more of a narrative, because they had. He had a home. He had, you know, photo albums and all kinds of other things like they could go through. He knew it was very clear, based on the film that he knew he was dying. He had put all of his paperwork out on a table to be found. And I think he also knew he was, you know, he was going to die alone. I think he'd made that choice. And they ended up finding enough money. And this is something that does happen. Someone like that might die alone. And there's. He had no next of kin left. And that's sort of where I guess you would Say he's unclaimed, but they did find that he had paid in advance for a burial. And so they were able to bury him in a family plot and not in the county disposition. And so in that sense, he was handled by the county, but ultimately was buried outside of their jurisdiction. And I think it's an inch. And then the other two. One was definitely. They determined it was an unhoused person who had stayed, decided to stay in a motel for the night, and he died while he was in that motel that night. And then the other man, again, wasn't unhoused. I think he lived in sort of like a single room occupancy type of situation, but was found. And all three of these people, none of them had any next of kin that could be found. And the two. The two other men also did not have any financial resources. I think they were able to recoup a little bit of money from each of them to go toward what the county would pay, but not enough to have any kind of private disposition. And so I think it's interesting to show these different instances I was talking about on a high level, what could happen if someone dies unclaimed. But then what they're also really highlighting is this idea of dying alone. And the filmmaker has a very, I think, strong point of view and that this is not. It's not good death in their. In their perspective, at least from their perspective, at least the way I read the film. And I think this is a common thing you see in a lot of media news articles. There's a article called the Lonely Death of George Bell, which a lot of people have heard of. I think it was in the New Yorker, New York Times, years ago. And again, sort of a similar situation. A man had died alone with no next of Ken. And I'm just fascinated by the narratives in the story. And personally for me, I don't want to die alone. But I think what has happened, watching that film so many times, reading around all of this, I started to kind of come to that understanding that some people maybe don't mind or want to die alone. And I think Ronald Eugene Tanner in that film is a really good example of that. I think he chose ultimately knowing that he was to be found and not knowing how long it was going to be take, you know, it was going to take them to find him. But choosing that as a path versus, you know, maybe going into a nursing home or a hospital facility or something like that. And I think I've really come to respect that. That is a decision that some people make. And, you know, I think it complicates that narrative a little bit because that, I think, like I said, in a lot of these sort of mainstream media outlets, we want the drive is to show that lonely death as a bad one. But I think in some ways, you know, what I'm ultimately advocating for this whole book is agency and autonomy around how you die. And for some people, dying alone is actually what they want. And so I think that. But it's on YouTube, it's free. I did eventually go and find a DVD copy and it cost me a significant amount of money to buy it, but I wanted it so badly because. And then there was like a little director's cut of Q and A at the end. But yeah, I recommend watching it and drawing your own conclusions as well as far as what, what the film is showing us. 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B
Learn more@WhatsApp.com so that feels like a good segue to ask you to talk a little bit about what some folks refer to as the death positivity movement. And how should we. How do you think about that? And how do others?
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C
Yeah, so the death positivity movement. And it's funny, I've had these conversations. I had these conversations with my doctor, one of my doctoral supervisors, who's an anthropologist, about whether or not it really constitutes a quote, unquote movement. Because it's so disparate. Right. It's not like there's this like group organization around it, but it's a disparate group of people and organizations and folks who really are advocating for people to become more familiar and talk more about death, think more about what they want for their own end of life care, et cetera. And I'd say the main ethos or the main drive behind this is that the death positivity movement says that Western countries, particularly the U.S. canada, UK, et cetera, are death shy, that they are afraid that a lot of people are afraid of talking about death or that they just. They don't. And my feelings on all of this, well, one, I got into this death positivity movement. This was part of what led me into writing about all of this. And as I was, you know, going to death cafes, which are places where people go and they're very open. They have tea, coffee and some cake or something. And groups of people come. They're usually very loose and there's not necessarily an agenda, but people come to talk about death. They're not grieving groups, they're not groups for grief. They're just people that talk genuinely about whatever aspects of death and dying they might be interested in. I was going to those and I was reading lots of books. Caitlin Doughty, who is, quote unquote, the queen of the death positive movement, who wrote smoke gets in your eyes and is the founder of the order of the good death. So I was reading and doing all of these things and. But I came across an article or two that really suddenly like held up the mirror, which was making a point that the death positive movement was primarily white, middle class women. And I went, oh. Because at the time I was like, this is great. You know, we're talking about what kind of burial do you want, an environmentally friendly burial. Do you want a definite meth doula? You prefer hospice? Do you want to die alone or not? Etc, And I think all of those conversations are incredibly important. But what it suddenly kind of was like that mirror being held up. I was like, oh, wait, we're having all these conversations because we're very privileged to be able to do so. And there's nothing wrong with having those conversations, of course, but I think that was I. I started connecting that back to the county cemeteries and the work that my dad had been doing. And then my work, volunteer work in homeless shelters. I sort of think, well, what happens to all the people who can't. Not only just can't afford like a death doula or to, you know, access hospice, et cetera, but who can't afford the time to think about these things as deeply as one might be able to, is part of this death positive movement. And that was one of the big things again, that really spurred me and focused on my riding in that direction versus looking at death and dying from a larger perspective, is really starting to think about who's at the table and who's involved in those conversations.
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B
So you mentioned the work that you've done in homeless shelters. And I've spent some time in those spaces myself in the past. And one of the things that continues to strike me and I don't know about puzzles me, but something that I think about that you talk about is why it is that for many people, their initial reaction to people who are unhoused is fear. So I wonder if you might just talk a little bit about how you think the way in which we think about this particular category of precarious people.
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C
Yeah, I mean, we fear what we don't know. Right. And I think we also fear, I think some of these unhoused people do two things. Well, I think they will highlight what's wrong with capitalism and probably make us all feel some shame and some guilt and other things. But they also highlight just how precarious your spot on the rung within capitalism could be. You hear a lot of people say things like you're one or one paycheck away or, etc, and I don't know that that's necessarily true for everybody, but you know, I met a woman in a book reading not too long ago who came up and spoke with me after like, you know, I'm one of those people that's like one accident away from being homeless. Like, I have a master's degree but got in a severe car accident, you know, haven't been able to work, etc. Etc. So I think there's fear for all those reasons. You know, we don't understand it fully. We see that that could potentially be us or, and, and, or, you know, we, we see kind of what's wrong with our current systems.
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B
So in, in one of the later chapters, you argue, and I think perfectly credibly that that housing is healthcare. I wonder if you might talk about sort of the intersection of those kinds of areas.
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C
Yeah, and it's not just any housing, as I point out. This is in the deaths of disparity chapter. And as, as I point out, there, of course we have shelters and we have the shelter system. Those places can be very dangerous to, to be in. And they could be dangerous for a number of reasons. Violence, but also communicable diseases. It's also not necessarily a safe, comfortable place to sleep or be if you're ill or, you know, unwell in some way. And so yes, housing is absolutely healthcare because you can't, you can't get ahead and get out from under things if you're constantly battling to survive on the streets. But that housing has to come along with other things. And you know that we really, this needs to be housing with supportive services and what, whatever that might be, whether it's mental health, job assistance, drug, you know, drug and alcohol assistance. But you can't just stick someone in an apartment and say, okay, go ahead now, live your life and don't be homeless again, you know, it's not necessarily that simple.
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B
You.
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C
You can do that if you catch someone early enough. Right. If someone falls into homelessness because, you know they've lost their job or they've had some kind of loss. If you can catch that early enough and they don't spend too long being unhoused, you might be able to get them right back to where they were. But primarily, I think what we're really talking about are people who are chronically unhoused as well as people who become unhoused in a later stage in life.
- [23:38]
B
And I think what sometimes folks don't fully appreciate is how many people wind up being unhoused because of disability of one kind or another. And the ways in which, as you suggest, once you are unhoused, whether that's in a shelter or if you're sleeping on the street, that exacerbates all of those conditions. So if it was physical disability, well, you are unlikely to get better. If those are the conditions under which you are experiencing your life or it was a mental health crisis that wound up disrupting that very precarious state, you are unlikely to get better.
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C
Absolutely. Or, you know, someone, you know, you. That you relied on dies or you get divorced. And I think underlying all of this is a lack of affordable housing. Yeah.
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B
So as we work our way toward concluding, I wonder if. If we might finish on what in a peculiar way feels like a positive chapter, and that is your discussion about how hospice for unhoused people.
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C
You know, it's so funny. I've had people, I, when I was shopping this book around, I had an agent say, oh, homelessness and death, those are both real bummers. And I was like, okay.
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B
And, you know, not wrong, necessarily.
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C
Not wrong. But as I tell people working on this project, and I think part of the reason I say I went down a rabbit hole 15 years ago and I have not come out of it yet because there has been so much joy and so much hope as well. And I am so happy to have been able to end on that chapter talking about the in between, which is the largest medical respite and hospice in the US they have 30, 40 beds for hospice or something like that. It's pretty. And going there. When I went there, I went for a day, and I spent the whole day there, and I got to interview and talk with people. I actually got to. To cram into a van with a bunch of folks who are on medical respite and go to the state health for a tour and had this whole day there. And I really got to know also, Gillian Olmstead, who's the executive director, and some of the other staff. And there's just. It is such a place of warmth and vibrancy and happiness. And all I could think is I've told them I was actually just there for their gala a couple of weeks ago. And I said to them, I was like, the first thought I had after being there was like, can I come here tonight, die? Because it was just that kind of place. There was that kind of care and love and compassion. And I think that that is why I'm so happy I was able to end on that chapter, as you say, with some hope and some positivity that, look at, it doesn't all have to be bad. And there are these amazing people who are working as hard as possible to fill whatever gaps they can within the healthcare system. Because a lot of this also comes down to not having access to proper health care and especially end of life care. And, you know, if you, if you're chronically in house, you're. You're likely to die 20 years earlier on average than someone who's housed. So in your 50s or 60s of things you would be dying of in your 70s and your 80s. And so when you're, when that's happening, you're not eligible for Medicare. And so how do you afford hospice care? And this is why the work they do is so important. And there are other places around the country doing this, you know, on a smaller scale. There's some that only have three or four beds, some that can house up to 15. But they are, the sad thing is they are few and far between. But what is really positive about it is that everyone there is dedicated to making sure that no matter what you've experienced in your life, that these folks are able to have a dignified end of life and have something they want. One of the things I really love that they have is something called the no One Dies Alone program. And they train volunteers to be able to sit with patients who, and this is the key, choose to have someone there when they're dying. And they, and I tell this story in the book, and this has been highlighted in other articles, but they had a man that they talked about specifically who wanted to actually have his hand held. He didn't want. He wanted to, you know, have that human touch as he was dying. And so volunteers would take turns holding his hand. And when one had to get up to take a break, they would transfer his hand to the next volunteer's hand so that that person could leave. And he was never left not having his handheld. And that's in other instances, they've played music for people. If people have requested to find family, they've done what they can to connect them. And the in between isn't the only place doing this, you know, circle the city. I interviewed a man who also, they got him a sewing machine while he was on hospice because that was a hobby that he loved. And just to be able to see that kind of compassion is really hopeful. And that was the kind of thing I wanted to. Yeah, I wanted to send people away on a hopeful note and hopefully give them something to think about that's positive and think about ways that we can give back or do something to help folks have a dignified end of life.
- [28:52]
B
You're listening to the Public Policy Channel of the New Books Network, and we've been speaking with Amy Shea about her new book, Too Poor to Die, the Hidden Realities of Dying in the Margins, from Rutgers University Press. Amy, thank you very much. Much appreciated.
- [29:07]
C
Thank you so much.