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. 2022 Nov 16:10.1111/puar.13572. Online ahead of print. doi: 10.1111/puar.13572

Inequity after death: Exploring the equitable utilization of FEMA's COVID‐19 funeral assistance funds

Rebecca M Entress 1,✉, Jenna Tyler 2, Abdul‐Akeem Sadiq 1
PMCID: PMC9874591  PMID: 36712178

Abstract

As of March 2021, the United States had nearly 1 million COVID‐19 deaths. To aid families, the Federal Emergency Management Agency (FEMA) established the Funeral Assistance Program. Using publicly available data, we examine the equitable utilization of FEMA's COVID‐19 Funeral Assistance Program funding. Results show a significant relationship between FEMA COVID‐19 Funeral Assistance Program funding and some, but not all, social vulnerability components. Specifically, counties with higher percentages of the population with disabilities and higher percentages of minorities receive lower amounts of funding per 100,000 residents. These findings suggest that FEMA's equity efforts are not fully materializing regarding the utilization of the FEMA COVID‐19 Funeral Assistance Program funding among socially vulnerable groups. FEMA should broaden its social equity outreach and priorities for those not traditionally considered in social equity discussions, such as people with disabilities while continuing efforts toward traditional social equity.

Evidence for Practice.

  • In general, counties with a higher number of COVID‐19 deaths received a greater amount of Federal Emergency Management Agency (FEMA) COVID‐19 Funeral Assistance Program funding.

  • Some counties, particularly counties with a high number of deaths in the Southern United States, could benefit from increased utilization of FEMA COVID‐19 Funeral Assistance Program funding.

  • Counties with high percentages of minorities as well as people with disabilities are more likely to receive lower amounts of FEMA COVID‐19 Funeral Assistance Program funding, suggesting that additional efforts are needed by FEMA to enhance social equity.

Globally, more than 5.6 million people have died from COVID‐19 as of January 24, 2022, making this pandemic one of the largest and most widespread mass fatality incidents in history (Farivar, 2020; John Hopkins Centers for Civic Impact, 2021; Security Solutions for Enabling and Assuring Businesses, 2020). A mass fatality incident is a “situation where there are more bodies than can be handled using existing local resources” (McEntire, 2007, p. 159). Evidence from various parts of the world indicates that existing resources are insufficient to meet the enormous number of COVID‐19 bodies that need to be managed (Zavattaro et al., 2021). For example, in the Northern region of Lombardy, Italy, local crematoria were overwhelmed with COVID‐19 deaths (Castelfranco, 2020). In Madrid, Spain, crematoria and funeral homes were overwhelmed, prompting local authorities to use ice rinks as temporary morgues for COVID‐19 deaths (Amaro, 2020). In the United States (U.S.), the number of COVID‐19 deaths overwhelmed morgues and cemeteries, so much so that in many cases, refrigerated trucks were used to store bodies (Davies, 2020; Entress, Tyler, & Sadiq, 2020).

Mass fatality incidents have physical and mental health consequences. In terms of physical health, there is a potential risk of illness when handling dead bodies, especially if the deceased died of an infectious disease, and in terms of mental health delays in identifying the dead and in funeral and burial services can cause psychological and emotional distress for survivors (Kumar & Nayar, 2020; Sadiq & McEntire, 2012; Tun et al., 2005). Moreover, COVID‐19 has caused significant and unexpected financial burdens and stress on COVID‐19 victims' families who are left to defray the cost of funerals (Federal Emergency Management Agency [FEMA], n.d.). These psychological, emotional, and financial challenges posed by COVID‐19 are unlikely to disappear as evidence suggests there will continue to be more COVID‐19 deaths and fewer resources to handle them in the future (Kumar & Nayar, 2020).

The U.S. Department of Health and Human Services serves as the lead federal agency for mass fatality management (MFM), with the Federal Emergency Management Agency (FEMA) acting in a supporting role. Historically, FEMA's role in MFM has been one of resource acquisition, planning and training, and grants management. For instance, at the onset of the COVID‐19 pandemic, FEMA coordinated with the Department of Defense to secure 100,000 body bags to help state and local governments manage the growing number of COVID‐19 fatalities (Cappacio & Natter, 2020). Additionally, FEMA provides planning guides as well as training courses on the foundations of MFM and the roles and responsibilities of public, private, and nonprofit groups. Most recently, FEMA authorized the FEMA COVID‐19 Funeral Assistance Program, which reflects a shift toward humanizing the pandemic and is the focus of this study. Specifically, FEMA provides up to $9000 in funeral assistance funding to families of individuals who died because of COVID‐19 after January 20, 2020 (FEMA, 2021a). Individuals can apply to receive this funding so long as they “are a U.S. citizen, non‐citizen national, or qualified alien who incurred funeral expenses on or after January 20, 2020, and that the funeral expenses were for an individual whose death in the United States, including the U.S. territories or the District of Columbia, may have been caused by, or was likely the result of, COVID‐19” (FEMA, 2021a). FEMA's COVID‐19 Funeral Assistance Program funding is not automatically provided when a funeral occurs (Webster, 2021). Individuals seeking reimbursement must apply to FEMA with documentation of the eligible funeral expenses incurred, documentation that the death was attributed to COVID‐19, and documentation that the death occurred in the U.S. (Webster, 2021).

To apply, applicants must call FEMA and begin the application via phone (FEMA, 2021a). Once the application is submitted, applicants must submit their required documentation via an online portal, fax, or mail (FEMA, 2021a). If approved, FEMA will either reimburse recipients through direct deposit or by mailing a check (FEMA, 2021a). The FEMA COVID‐19 Funeral Assistance Program funding is an important factor in alleviating the financial stress and burden of COVID‐19 on victims' families (FEMA, n.d.). This is especially true for socially vulnerable groups like Black and Hispanic populations as they have been disproportionately impacted by the COVID‐19 pandemic (Wright & Merritt, 2020) and are less likely to have financial reserves to cover emergency expenses like funeral services (Lopez et al., 2020). For example, Menifield and Clark (2021) examined Centers for Disease Control and Prevention (CDC) data and found that compared to White, Hispanic, and Asian residents in the U.S., Black residents experienced twice as many deaths from COVID‐19. Menifield and Clark (2021) note that this could be due to socioeconomic factors, such as lower rates of medical insurance and higher rates of chronic diseases. If the FEMA COVID‐19 Funeral Assistance Program funding is utilized equitably, it can enhance the financial wellbeing of COVID‐19 victims' families, especially families who are unable to pay for the funeral of their loved ones killed by the virus and contribute to the overall community recovery from COVID‐19.

The purpose of this study is to explore whether there is an equitable utilization of FEMA COVID‐19 Funeral Assistance Program funding. When the researchers say equitable utilization, they are referring to two different measures of equity. First, they consider utilization to be equitable when the amount of COVID‐19 Funeral Assistance Program funding received by a county is commensurate with the number of COVID‐19 deaths in that county. Second, they consider utilization to be equitable when the amount of FEMA COVID‐19 Funeral Assistance Program funding received by a county is not negatively impacted by high county populations of socially vulnerable groups, such as minorities, persons with lower incomes, and persons where English is not their primary language. For example, if counties with a higher percent of minorities receive lower amounts of funding, the researchers would consider this an inequitable utilization of FEMA COVID‐19 Funeral Assistance Program funding. The researchers specifically seek to answer the following two research questions: (1) How was the FEMA COVID‐19 Funeral Assistance Program funding utilized throughout U.S. counties? (2) To what extent is FEMA's COVID‐19 Funeral Assistance Program funding utilized equitably? We divide the second research question into two sub‐questions to further examine the relationship between the number of COVID‐19 deaths per 100,000 residents experienced in a county and the amount of FEMA COVID‐19 Funeral Assistance Program funding per 100,000 residents received by a county. Specifically, these sub‐research questions are: (2a) What is the relationship between the number of COVID‐19 deaths in a county and the amount of FEMA COVID‐19 Funeral Assistance Program funding residents received? (2b) What is the relationship between county social vulnerability and the amount of FEMA COVID‐19 Funeral Assistance Program funding residents received? Answering these questions will help FEMA determine if changes and improvements are needed to ensure more equitable utilization of the COVID‐19 Funeral Assistance Program funds.

The next section reviews the literature on mass fatalities engendered by COVID‐19, MFM and associated public health consequences, and FEMA's growing interest in addressing social equity. Following the literature review, the methods section presents information about the data including the sources of the data and the statistical techniques used. The result section is next, followed by a discussion of the results and recommendations. The article concludes by discussing the study's limitations and identifying areas for future research.

LITERATURE REVIEW

Mass fatality management research

Empirical research on mass fatality management is relatively sparse in comparison to other topics in the emergency management space, such as collaborative networks, individual and household preparedness behaviors, and the overall evolution of the field. The limited scholarship on the topic can be partly attributed to the challenges with researching mass fatality management, such as the logistics to quickly arrive at a disaster scene to acquire data as well as the psychological distress imposed on both researchers and research participants.

Existing scholarship on mass fatality management center on a few notable disasters in less developed areas, namely the 2004 Indian Ocean Earthquake and Tsunami and the 2010 Haiti Earthquake. For example, Phillips et al. (2008), conducted interviews with local government officials and individuals that aided in the body recovery process during the 2004 Indian Earthquake and Tsunami, which killed over 300,000 individuals. These interviews revealed that communities experienced unprecedented challenges in properly managing the number of deaths, including removing debris to uncover bodies, identifying bodies, addressing health and sanitation issues, and the necessity of using mass graves. Similarly, Morgan et al. (2006) conducted case studies in Indonesia, Sri Lanka, and Thailand after the 2004 Indian Earthquake and Tsunami to understand how these countries managed fatalities. Through both observational data and interviews with key witnesses, the authors found that there was a lack of refrigeration for preserving human remains, which resulted in the use of dry ice or temporary burials. The lack of preservation made identification of bodies nearly impossible after 48 h. Results also indicated that the lack of local and national mass fatality management plans undermined the quality and timeliness of the response.

Sadiq & McEntire, 2012 and McEntire et al. (2012) found similar results when examining the response to the 2010 Haiti Earthquake. Specifically, these authors traveled to the capital of Haiti, Port‐au‐Prince, 1 month after the earthquake struck, and again nearly 5 months later. During both trips, the authors gathered observational data from mass grave sites and also conducted 28 interviews with key mass fatality management personnel. These interviews revealed a host of challenges related to mass fatality management, such as dealing with aftershocks from the earthquake, removing debris, and addressing the threat of an epidemic, among other things. These findings, like Morgan et al. (2006), further underscored the need for communities and nations to develop comprehensive mass fatality management plans. Although these examples represent natural disasters, they provide important insights and lessons learned for managing other types of disasters, such as the COVID‐19 pandemic.

Mass fatalities during the COVID‐19 pandemic

As of March 29, 2022, the U.S. had more deaths from COVID‐19 than any other country in the world with over 975,000 deaths (New York Times, 2022). The CDC estimates the number of deaths each year and reports that the number of deaths consistently outpaced the number of expected deaths throughout 2020 and 2021, and the excess deaths spiked to nearly 20,000 each week during the three main COVID‐19 peaks during 2020 and 2021 (CDC, 2021a). The number of deaths from COVID‐19 is so high that some scholars estimate that it could fundamentally change society, specifically in terms of changing the population of electorates, thus altering future election outcomes (Johnson et al., 2020). The number of deaths overwhelmed the death care system, creating a worldwide mass fatality incident (Entress, Tyler, & Sadiq, 2020). Such impacts were more concentrated in communities that are socially vulnerable, as deaths during the pandemic were not evenly spread throughout communities.

MFM and public health consequences

Mass fatalities during the COVID‐19 pandemic continue to create multiple public health consequences, impacting both physical and mental health. In terms of physical health, mass fatalities create a risk of spreading the virus to the uninfected individuals who have lost a loved one as well as individuals working in the death care industry providing services, such as funerals, embalming, and storing bodies. Bodies of the deceased potentially can spread COVID‐19 to the living, meaning extra care and caution are needed when handling the deceased (Kumar & Nayar, 2020). Indeed, during COVID‐19, cases were reported of family members opening coffins of COVID‐19 victims, and subsequently, spreading the virus among family members (Adnan et al., 2021). This means that in addition to the mental anguish involved in the mourning process, families must also cope with the stress of their own illness as well as compounded stress resulting from delays in mourning the dead.

While clearly there are risks to physical health during mass fatality incidents, literature and standards on how to handle the dead have been developed to mitigate risks to physical health (Suwalowska et al., 2021). The International Committee of the Red Cross, for example, developed guidance for managing the dead, which includes prioritizing health and safety, and specifically notes that protective equipment is needed for reducing infection (Finegan et al., 2020). This includes gowns, N95 masks, face shields, boots, and gloves (Petrone et al., 2021). Yet, there have been equipment and PPE shortages during the COVID‐19 pandemic, increasing the risk of contracting COVID‐19 during the death care process (Kapucu et al., 2022; Sadiq & Kessa, 2020).

Mental health during COVID‐19

MFM has dire mental health consequences as well, much of which is largely absent from literature and guidance on handling mass fatality events (Suwalowska et al., 2021). Because of the overwhelmed death care management system, during the COVID‐19 pandemic, the dead were often cared for without dignity and without regard to cultural and religious death care practices (Entress, Tyler, & Sadiq, 2020). This has multiple effects, including potential conflict between cultures and members of different religions, erosion of public trust, and exacerbation of mental health issues (Entress, Stacie, et al., 2020). Poor death care practices, including delays in burials or funerals, can cause psychological trauma, anxiety, and depression for those left behind (Entress, Tyler, & Sadiq, 2020). For example, limited resources and the high number of bodies led to some COVID‐19 victims being buried in mass graves, making it difficult for families to find closure and ultimately leading to psychological impacts for survivors (Suwalowska et al., 2021). This, coupled with limited social contact during funerals and/or memorials due to COVID‐19 infection control, can compound the mental health consequences of COVID‐19 victims' families (Entress, Tyler, & Sadiq, 2020).

It is important to note that these consequences are not limited to only those who have experienced a loss. In fact, first responders and those participating in a mass fatality incident response can also experience psychological stress and mental health consequences (Entress, Tyler, & Sadiq, 2020). There are cases of health care workers committing suicide after responding to the COVID‐19 pandemic, showing the emotional toll responding to a mass fatality incident can take (Benham et al., 2020). This is tragic for the health care workers responding to COVID‐19, but it can also diminish the health care workforce, weakening the health care infrastructure needed to respond to the ongoing pandemic (Benham et al., 2020). Such impacts are far‐reaching throughout various aspects of society.

The poor mental health consequences are large because, during the COVID‐19 pandemic, economic productivity was valued over humanistic responses (Zavattaro et al., 2021). In essence, there has been a lack of humanity ingrained in COVID‐19 responses, including that of death care (Entress, Stacie, et al., 2020; Zavattaro et al., 2021). However, as the pandemic progressed, more humanistic approaches have been incorporated which could potentially reduce or limit the mental health consequences that are a result of poor death care management during mass fatality incidents. For example, FEMA began providing funeral reimbursements for victims of COVID‐19 after the Biden administration took office (Zavattaro et al., 2021). The FEMA COVID‐19 Funeral Assistance Program, which is the focus of this article, is a federal program that reimburses individuals who lost a loved one to COVID‐19 on or after January 20, 2020, up to $9000 (Webster, 2021). Funds can be used for eligible expenses, which include costs for funeral services, burial plots or cremation services, caskets, death certificates, and headstones (Webster, 2021). The implementation of this program reflects a shift toward incorporating humanistic responses to COVID‐19, as the program focused on helping with psychological recovery, and largely ignored economic productivity.

The rise of social equity

Public administration has contributed immensely to making America more socially equitable (Frederickson, 2005). Nevertheless, more work remains to address the issue of social inequity from the perspective of public administration. Hence, in 2020, the National Academy of Public Administration (NAPA) announced fostering social equity as one of its 12 grand challenges (NAPA, 2020). Social equity involves acting with fairness, treating the public and those in society equally, and providing and distributing benefits equitably (Meier et al., 2022).

In public administration, much of the social equity discussion centers around the extent to which resources are distributed fairly (Domingue & Emrich, 2019; Lavee, 2022), disparities in social equity, and the necessity to standardize social equity measures (Gooden, 2017), and the need for public sector managers to hold social equity as a core value (Roberts et al., 2021). Although equity and equality are often used interchangeably, there are subtle differences. While equality involves “sameness or identical distribution,” equity involves “fair or just distribution” and allows for greater flexibility based on need (Gooden, 2015, p. 372; Guy & McCandless, 2012). This manuscript focuses on equity. In the emergency management space, scholars tend to use social equity and social vulnerability together in discussions about social equity, especially when socially vulnerable populations do not receive adequate resources (Emrich et al., 2019; Lavee, 2022). Indeed, Tate and Emrich (2021) succinctly note that “social vulnerability research explores the differential susceptibilities and capacities of disaster‐affected populations, whereas social equity analyses tend to focus on population disparities in the allocation of resources for hazard mitigation and disaster recovery. Interventions with an equity focus emphasize full and equal resource access for all people with unmet disaster needs” (p. 1). While social vulnerability is technically a measure of risk (Cutter & Finch, 2008), it also represents a measure of equity, meaning when socially vulnerable communities do not have equal opportunity to utilize resources, the result is a lack of social equity (Domingue & Emrich, 2019; Drakes et al., 2021; Emrich et al., 2019). As Domingue and Emrich (2019) explain, inequity is “a case when highly socially vulnerable counties receive a lesser benefit from federal disaster relief than other counties experiencing similar disaster impacts” (p. 898).

Over the past year, FEMA as well as other federal agencies have made significant strides in supporting efforts related to social equity. These strides stem in part from the White House issuing three executive orders—two on diversity, equity, and inclusion (DEI) and one on advancing racial equity and support for underserved communities. The first executive order underscored the importance of advancing racial equity and support for underserved communities, the second required executive departments and agencies to make DEI a priority component of the agency's management agenda and strategic plan, and the third executive order requires federal agencies to conduct an equity assessment and promote “equitable delivery of government benefits and opportunities” (The White House, 2021).

In line with the executive orders, FEMA's recent Annual Planning Guidance (APG) instructed its program offices to promote DEI in both new and existing projects. Additionally, FEMA recently released its 2022–2026 Strategic Plan, which states three goals FEMA will pursue over the next 4 years; the first of which is to instill equity as a foundation of emergency management. FEMA identified three objectives to achieve this goal: “(1) cultivate a FEMA that prioritizes and harnesses a diverse workforce; (2) remove barriers to FEMA programs through a people first approach; (3) achieve equitable outcomes for those we serve” (FEMA, 2022a, 2022b, p. 8). Achieving these objectives is crucial to ensure FEMA operates in an equitable manner. These objectives also underscore FEMA's recognition that vulnerable populations often experience greater barriers that limit or prevent access to receiving assistance.

Equitable utilization of FEMA funding

The tools the federal government most frequently uses to aid individuals include vouchers, loans, and grants (Salamon, 2002). For example, the U.S. Department of Agriculture provides vouchers to low‐income individuals and families to purchase food through its Supplemental Nutrition Assistance Program (SNAP). The United States Department of Education offers student loans to individuals seeking to pursue higher education. FEMA mainly helps individuals in the form of grants, with the Individuals and Households Program (IHP) being the main source of funding available to those affected by a disaster. Through this program, disaster survivors can apply for IHP funding to meet basic needs like food and housing or to supplement disaster recovery efforts (FEMA, 2022a, 2022b).

Given that individuals must apply for such funding, scholars and practitioners alike have become increasingly interested in determining if individual demographics and community characteristics have any influence on individuals' ability to acquire IHP funding (Rivera, 2016). Kamel and Loukaitou‐Sideris (2004), for example, examined the relationship between sociodemographic characteristics and disaster aid following the 1994 Northridge Earthquake. These authors found that socially vulnerable communities were less likely to receive FEMA aid. A study by Kousky (2013) found similar results. Specifically, the author examines FEMA's IHP program in the context of the 2008 floods and tornadoes in Missouri and found, among other things, that communities with higher percentages of Black residents had higher IHP application approvals, but lower funding amounts. In addition, Rivera's (2016) study on potential racial biases in disaster aid applications found that the only demographic variable significantly related to an individual receiving aid was the individual's employment status.

With the recognition of social equity as a pillar of emergency management coupled with divergent extant findings, additional research is needed to determine the extent to which FEMA is successful in these efforts. Hence, the aim of this article is to investigate whether there has been an equitable utilization of FEMA's COVID‐19 Funeral Assistance Program funds across counties in the U.S. Based on the literature above, the researchers developed three hypotheses for research questions 1, 2a, and 2b, respectively:

Hypothesis 1

FEMA COVID‐19 Funeral Assistance Program funding is utilized more in counties with a high number of COVID‐19 deaths per 100,000 residents than in counties with a low number of COVID‐19 deaths per 100,000 residents.

Hypothesis 2a

There is a positive relationship between FEMA COVID‐19 Funeral Assistance Program funding per 100,000 residents and the number of deaths per 100,000 residents in a county.

Hypothesis 2b

There is a negative relationship between FEMA COVID‐19 Funeral Assistance Program funding per 100,000 residents and the percent of the population that is socially vulnerable in a county.

Hypothesis 1 and 2a were developed based on the FEMA Funeral Assistance Program goals. Specifically, we hypothesize that because individuals can only utilize funds if they have lost a loved one to COVID‐19, the funding would be higher in counties where deaths are higher. Hypothesis 2b was developed based on the results of past literature, which found that socially vulnerable populations had lower utilization of other FEMA benefits (Kamel & Loukaitou‐Sideris, 2004; Kousky, 2013; Rivera, 2016).

METHODS

This study uses secondary, publicly available data from multiple sources to answer the three research questions. Each variable and the source for each variable are presented in Table 1 and explained below. The data were collected at the county level and include data from all U.S. counties and statistically equivalent entities. Two counties were excluded because of missing data: Alfalfa, Oklahoma, and Tillman, Oklahoma.

TABLE 1.

Data sources

Variable Data source
Social vulnerability measures (% below the poverty level, % without a high school diploma, % with a disability, % speaking English less than well, % minority) 2014–2018 American Community Survey from the U.S. Census
FEMA COVID‐19 Funeral Assistance Program funding OpenFEMA Dataset for Registration and Individual Household Programs (1/20/20–10/16/2021)
COVID‐19 deaths USAFACTS (1/20/20–10/16/2021)
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First, the study uses county‐level data for five independent variables as measures of social vulnerability: (1) the percent of people living below the poverty line, (2) the percent of civilian population with a disability, (3) the percent minority, (4) the percent of people without a high school diploma, and (5) the percent of people who speak English less than well. Social vulnerability is used in this article to examine social equity because, consistent with past studies, when areas with high social vulnerability do not equally utilize resources, a social equity issue arises (Cutter & Finch, 2008; Domingue & Emrich, 2019; Drakes et al., 2021). These five variables were included for two primary reasons. First, they are included as part of the CDC/Agency for Toxic Substance and Disease Registry (ATSDR) social vulnerability index. The CDC/ATSDR social vulnerability index is a composite measure of risk based on 15 individual measures from the U.S. Census (CDC, 2021b). These 15 measures include the percent below the poverty level, percent unemployed, per capita income, percent without a high school diploma, percent over the age of 65, percent under the age of 17, percent with a disability, percent of single‐family households, percent minority, percent who speak English less than well, percent of multi‐unit structures, percent of mobile homes, percent of households with more people than rooms, percent of households without a vehicle, and percent living in group quarters (CDC, 2021b).

Second, the five variables are components of the index that are specifically noted as part of FEMA's social equity initiatives or could directly impact the ability of applicants to complete the application process. FEMA's equity initiatives explain that President Biden's executive order focuses on “equity with respect to race, ethnicity, religion, income, geography, gender identity, sexual orientation, and disability” (FEMA, 2022a). Among the 15 social vulnerability components contained in the CDC/ATSDR social vulnerability index, these equity considerations most closely align with (1) the percent of people living below the poverty line, (2) the percent of civilian population with a disability, and (3) the percent minority; thus, these three components are included as independent variables. The researchers also include the percent of people with no high school diploma and the percent of people who speak English less well as independent variables because they are social vulnerability components that could directly impact the ability of applicants to complete the FEMA COVID‐19 Funeral Assistance Program application.

The data for the five variables measuring social vulnerability for each county were gathered from the CDC/ATSDR. The CDC/ATSDR originally gathered this data from the U.S. Census, specifically the 2014–2018 American Community Survey 5‐year estimate.

County‐level data regarding the amount of FEMA COVID‐19 Funeral Assistance Program funding per 100,000 residents were gathered from the OpenFEMA Dataset for Registration and Individual Household Programs (FEMA, 2021b). The dataset contains information on FEMA individual and household programs funding for all declared disasters as of July 2013 (FEMA, 2021b). The researchers confirmed with FEMA program staff that the database contains only Funeral Assistance Program funding for COVID‐19 and excluded all data with disaster numbers unassociated with the COVID‐19 pandemic. The resulting data were used to calculate the amount of COVID‐19 Funeral Assistance Program funding per 100,000 residents for each county. According to the website, the database was last updated on October 16, 2021, meaning the FEMA Funeral Assistance Program funds reflect spending between January 20, 2020, and October 16, 2021 (FEMA, 2021b). 1

Finally, data on the number of deaths per 100,000 residents for each county were gathered from USAFACTS, which aggregates data from the CDC, state health agencies, and local health agencies (USAFACTS, 2022). This study uses the number of deaths between January 20, 2020, and October 16, 2021.

RESULTS

Research question 1: How was the FEMA COVID‐19 Funeral Assistance Program funding utilized throughout U.S. counties?

The first research question is examined with two different methods. First, the researchers create two maps: one map illustrating where FEMA COVID‐19 Funeral Assistance Program funding has been utilized and one map illustrating the distribution of COVID‐19 deaths throughout counties in the United States. Second, the researchers identify the 10 counties in the United States that have received the most funding per 100,000 residents and the 10 counties in the United States with the highest number of COVID‐19 deaths per 100,000 residents. The researchers then compare the distribution of COVID‐19 deaths and FEMA COVID‐19 Funeral Assistance Program funding to describe how funding was utilized.

Figure 1 below shows both the amount of FEMA COVID‐19 Funeral Assistance Program funding per 100,000 residents and the number of COVID‐19 deaths per 100,000 residents for each county as of October 16, 2021. The number of deaths per 100,000 residents ranges from 0 to 906.34. Counties with a lighter shade of green had a lower number of deaths, and counties with a darker shade of green had a higher number of deaths. The amount of funding per county ranges from $0 to $4,121,746.26. Counties with a lighter shade of green received a lower amount of funding, and counties with a darker shade of green received a higher amount of funding.

FIGURE 1.

FIGURE 1

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Maps of FEMA COVID‐19 Funeral Assistance Program funding per 100,000 residents and number of COVID‐19 deaths per 100,000 residents

As shown in Figure 1, funds from FEMA's COVID‐19 Funeral Assistance Program are concentrated in a few small geographical areas around the United States. Most counties received similar amounts of funds, with some exceptions in Montana, North Dakota, South Dakota, Pennsylvania, Texas, and Georgia. However, the number of deaths is more evenly spread throughout the United States, meaning not all counties with a high number of deaths are utilizing the funding.

Table 2 lists the 10 counties which received the highest amount of funeral funding per 100,000 residents, the 10 counties that had the highest number of deaths per 100,000 residents, and the social vulnerability information for each of these 20 counties. Consistent with the maps shown in Figure 1, Table 2 reveals that a small number of counties received a high amount of FEMA COVID‐19 Funeral Assistance Program funding per 100,000 people. Montour County, PA, for example, had significantly more funding than any other county, almost twice the amount of funding received by the county with the second highest amount of funding. Interestingly, there is no overlap between the top 10 counties in these two lists, meaning the counties with the highest number of deaths per 100,000 residents are not receiving the most amount of funeral funding per 100,000 residents. As shown in Table 1, Montour County, PA received the most funding, with over $4 million per 100,000 residents provided by the FEMA COVID‐19 Funeral Assistance Program, but Montour County ranks 476th in terms of their death rate. Similarly, McMullen County, TX had the highest number of deaths per 100,000 residents but received $0 in funeral funding. This suggests that some counties with the greatest need, in terms of the number of deaths per 100,000 residents, did not receive adequate funeral funding, meaning Hypothesis 1 is not supported. In terms of social vulnerability, the top 10 counties in terms of funding, on average have lower percentages for each of the five social vulnerability measures when compared to the top counties in terms of deaths. This means that the counties with the highest number of deaths per 100,000 people are more socially vulnerable than the counties that received the most funds per 100,000.

TABLE 2.

Comparison of funeral assistance and deaths by county as of October 16, 2021

County Funeral funding per 100,000 Funeral funding ranking a Deaths per 100,000 Deaths ranking % people living below the poverty line % people with no high school diploma % civilian population with a disability % minority % people who speak English less than well
Counties with the highest amount of funeral funding per 100,000 people
Montour County, PA $4,121,746.26 1 383 476 11.1% 9.3% 14.2% 8.3% 0.6%
Madison County, TN $2,190,692.74 2 311 917 19.4% 11.7% 14.8% 43.8% 1%
Powder River County, MT $2,063,063.62 3 555 76 10.4% 5.2% 16.6% 6.9% 0%
Lee County, MS $1,925,444.49 4 234 1192 15.9% 16.2% 25.8% 34.1% 0.8%
Florence County, SC $1,863,591.15 5 527 486 19.1% 15.4% 15.8% 47.8% 0.7%
Crisp County, GA $1,845,687.65 6 464 196 30.8% 19.9% 17.9% 49.8% 0.7%
Gregory County, SD $1,842,658.65 7 714 13 13.9% 10.7% 13.1% 12.0% 0
Dickey County, ND $1,726,392.35 8 664 32 5.3% 9.9% 10.5% 6.6% 0.2%
Lafayette County, MS $1,687,521.05 9 258 1362 23.8% 10.5% 11.2% 30.0% 0.6%
Pierce County, ND $1,635,717.34 10 279 1153 17.1% 8.1% 10.3% 6.0% 0.1%
Mean b $2,090,251.53 N/A 439 N/A 16.7% 11.7% 15.0% 25.0% .5%
Counties with the highest number of deaths per 100,000 people
McMullen County, TX $0 2793 1208 1 14.0% 20.0% 15.8% 44.7% 1.5%
Hancock County, GA $198,640.89 1638 937 2 24.1% 28.5% 16% 75.8% 0.2%
Galax City, VA $1,287,576.98 39 919 3 25.5% 28.6% 24.3% 24.7% 4.6%
Gove County, KS $1,355,387.17 34 840 4 11.8% 8.7% 15.6% 7.1% 0.3%
Jerauld County, SD $1,488,229.00 20 837 5 8.3% 11.3% 12.5% 3.8% 0.4%
Candler County, GA $881,591.11 125 785 6 32.8% 23.5% 18.1% 39.3% 1.1%
Emporia City, VA $ 678,957.07 252 780 7 29.0% 22.4% 13.8% 77.5% 0.3%
Motley County, TX $0 2793 779 8 9.6% 13.8% 19.3% 25.5% 0.5%
Robertson County, KY $829,631.36 145 747 9 27.1% 22.0% 14.9% 1.5% 0%
Iron County, WI $634,190.20 306 735 10 14.8% 6.3% 17.6% 4.4% 0.8%
Mean c $735,420.38 N/A 857 N/A 19.7% 18.5% 16.8% 30.4% 1.0%
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a

Rankings are ranked highest to lowest.

b

Mean is calculated based on the top 10 counties in terms of amount of funding per 100,000 people.

c

Mean calculated based on the top 10 counties in terms of number of deaths per 100,000 people.

Research question 2: To what extent is FEMA's COVID‐19 Funeral Assistance Program funding utilized equitably?

The second research question is divided into two sub‐research questions. As a reminder, social equity is operationalized in this study in two different ways. First, the researchers consider utilization to be equitable when the amount of FEMA COVID‐19 Funeral Assistance Program funding received by a county is commensurate with the number of COVID‐19 deaths in that county. Second, they consider utilization to be equitable when the amount of FEMA COVID‐19 Funeral Assistance Program funding received by a county is not negatively impacted by high county populations of socially vulnerable groups such as minorities, persons with lower incomes, and persons where English is not their primary language. Each operationalization of social equity is explored individually below.

Table 3 shows the descriptive statistics for all study variables, as well as the expected association with funeral funding. The average amount of FEMA COVID‐19 Funeral Assistance Program funding per 100,000 residents a county received was $282,135.06, and the average number of COVID‐19 deaths per 100,000 residents was 253.08. In terms of socioeconomic characteristics, the average percent of people living below the poverty line was 15.60 and the average percent of people with no high school diploma is approximately 13.40%. Looking at disability, the average percent of the civilian population with a disability is 15.92. In terms of minority status and language spoken, the average percent of minority population and the average percent of people who speak English less than well are 23.48 and 1.70, respectively.

TABLE 3.

Descriptive statistics

Variable Expected association with funeral funding Obs Mean Standard deviation Min Max
FEMA COVID‐19 Funeral Assistance Program funding per 100,000 residents n/a 3139 282,135.10 286,053.30 0 4,121,746
Deaths as of 10/6/21 per 100,000 residents (+) 3139 253.08 130.50 0 1208.459
% people living below the poverty line (−) 3139 15.60 6.48 2.3 55.1
% people with no high school diploma (−) 3139 13.40 6.40 1.2 66.3
% civilian population with a disability (−) 3139 15.92 4.41 3.8 33.7
% minority (−) 3139 23.48 20.16 0 99.3
% people who speak English less than well (−) 3139 1.70 2.79 0 30.4
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Research question 2a: What is the relationship between the number of COVID‐19 deaths in a county and the amount of FEMA COVID‐19 Funeral Assistance Program funding residents received?

The first sub‐research question is examined with an OLS regression model with the number of deaths per 100,000 residents as the independent variable and the amount of funding per 100,000 residents as the dependent variable. If the regression model shows that the number of deaths is statistically significant, this will indicate that there is a relationship between the number of COVID‐19 deaths experienced in a county and the amount of FEMA COVID‐19 Funeral Assistance Program funding received by a county.

Table 4 shows the results of the OLS regression, demonstrating the predictors of FEMA COVID‐19 Funeral Assistance Program funding per 100,000 residents. It is important to note that the dependent variable was positively skewed because 349 counties received $0 in FEMA COVID‐19 Funeral Assistance Program funding, meaning there were an excess number of zeros in the dataset. To account for the skewed data, the dependent variable was log‐transformed before running the regression model. Log transformations are commonly used in public administration to correct skewed data (see, for example, Alkadry & Tower, 2011; Meier & Wilkins, 2002). With log transformations, cases with a value of zero are excluded in analyses, but these cases can be maintained by adding a “small pre‐fixed constant” to the dependent variable (Lambert et al., 2010, p. 242; Motta, 2019). To maintain the counties with $0 in the database through the log‐transformation process, “1” was added to the amount of county funding before running the log transformation. In addition, post‐hoc tests indicated heteroskedasticity in the dependent variable. Heteroskedasticity involves having error terms that do not follow a normal distribution; in other words, the error variance is not constant (Beck, Bryman, & Liao, 2004). To account for heteroskedasticity, the researchers used robust standard errors, which allow the researchers to obtain more efficient estimates (Yamano, 2009).

TABLE 4.

OLS regression results showing predictors of FEMA COVID‐19 Funeral Assistance Program funding per 100,000

Variable Coef. St. err. t‐value p‐value* 95% confidence interval** Sig
Number of deaths per 100,000 0.01 0.001 11.53 0 0.008 0.011 ***
% civilian population with a disability −0.122 0.027 −4.46 0 −0.176 −0.068 ***
% people living below the poverty line 0.025 0.023 1.11 0.265 −0.019 0.07
% people with no high school diploma 0.015 0.024 0.64 0.524 −0.032 0.062
% minority −0.016 0.006 −2.74 0.006 −0.028 −0.005 ***
% people who speak English less than well −0.066 0.04 −1.63 0.102 −0.145 0.013
Mean dependent var 10.927 SD dependent var 3.965
R 2 0.107 Number of obs 3139
F‐test 26.291 Prob > F 0.000
Akaike crit. (AIC) 17216.746 Bayesian crit. (BIC) 17265.159
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Note: Please note, model includes the 2014–2018 American Community Services county population estimate as a control.

*

p < .1;

**

p < .05;

***

p < .01.

Results indicate that there is a significant positive relationship between the number of deaths per 100,000 residents in a county and the amount of FEMA COVID‐19 Funeral Assistance Program funding. To interpret the logged dependent variable, the coefficient must be multiplied by 100 and interpreted as a percentage (Choi & Choi, 2012; Meier & Wilkins, 2002). With this interpretation, a 1% increase in the number of deaths per 100,000 residents results in a 1% increase in funding in a county, holding all other variables constant. This finding answers research question 2a, and the finding is consistent with our hypothesis.

Research question 2b: What is the relationship between county social vulnerability and the amount of FEMA COVID‐19 Funeral Assistance Program funding residents received?

The second sub‐research question is examined using the same OLS regression model that was used to answer research question 2a, but to answer research question 2b, the regression model also includes the five components of the CDC social vulnerability components explained above. The researchers examine which of the five social vulnerability components are statistically significant in the regression model and conclude that those with significance are related to the amount of funeral funding a county receives.

Results indicate a significant negative relationship between the amount of FEMA COVID‐19 Funeral Assistance Program funding per 100,000 residents and two of the five social vulnerability components (percent with a disability, percent minorities), thus answering research question 2b. As shown in Table 4, there is a significant negative relationship between the amount of FEMA COVID‐19 Funeral Assistance Program funding a county receives per 100,000 residents and the percent of people with a disability (p < .01) and percent of people who are minorities (p < .01). These results mean that while holding all other variables constant, a one percentage point increase in the percent of the civilian population with a disability and the percent of people who are minorities is associated with a 12.2% and 1.6% decrease in FEMA COVID‐19 Funeral Assistance Program funding per 100,000 residents, respectively. This means that in counties with high percentages of these two social vulnerability measures, the amount of funeral funding is lower, suggesting equity issues regarding these two measures. This is partially consistent with Hypothesis 2b, which stated that counties with higher percentages of social vulnerability indicators would have less FEMA COVID‐19 Funeral Assistance Program funding per 100,000 residents. This was confirmed for the percent of population with a disability and the percent of population who is a minority but was not confirmed for the percent of the population below the poverty line, percent of the population without a high school diploma, and percent of the population who speak English less than well.

DISCUSSION

This article explored (1) how the FEMA COVID‐19 Funeral Assistance Program funding was utilized and (2) the extent to which FEMA's COVID‐19 Funeral Assistance Program funding was equitably utilized. The study found that in some geographic areas, counties with more deaths per 100,000 residents received more FEMA COVID‐19 Funeral Assistance Program funding per 100,000 residents based on the analysis of where the funding went, but many counties with a high number of deaths did not receive commensurate funding. While the FEMA COVID‐19 Funeral Assistance Program funding was concentrated in a small number of counties, many of the hardest‐hit U.S. counties in terms of COVID‐19‐related deaths per 100,000 residents received little funding.

This study found a significant relationship between two out of the five social vulnerability components and funeral assistance funding. This suggests that equity issues arise in some areas, as there is a negative and significant relationship between the amount of COVID‐19 FEMA Funeral Assistance Program funding a county receives and the percent of people with a disability and the percent of people who are minorities. In other words, counties with high percentages of people with disabilities and counties with high percentages of people who are minorities are more likely to receive lower amounts of FEMA COVID‐19 Funeral Assistance Program funding. This is consistent with findings by Kousky (2013) which found that following the 2008 floods and tornadoes in Missouri, communities with higher percentages of Black residents had lower IHP funding amounts and the findings suggest that these two socially vulnerable groups are being left behind, ultimately making the utilization of FEMA's COVID‐19 Funeral Assistance Program less equitable. This result is particularly concerning since individuals with disabilities have higher poverty rates (Alexander et al., 2012), and funeral assistance can go a long way in providing some much‐needed financial support. This means that more work remains when thinking about broadening the social equity umbrella to include other vulnerable populations, particularly those with disabilities, as well as continuing efforts toward improving equity among traditionally vulnerable populations such as racial minorities. A possible explanation for these findings is that there is a lack of awareness and/or ability to access the FEMA COVID‐19 Funeral Assistance Program funding. That is, people with disabilities and racial minorities may be unaware of the funding available, may have difficulty filling out the paperwork required for the program, or may not have the means to access the program because they do not have a phone, computer, or email address.

This explanation aligns with media coverage of the issue. Indeed, popular media coverage reports people were either not aware of or did not apply for this funding assistance (Associated Press, 2021). Additionally, the program requires people to call a hotline to file a claim and then fax, email, or mail the required documentation—all steps that could be adding to administrative burdens for grieving families (Moynihan et al., 2015). Recently, FEMA also changed its programmatic guidance to allow people who died during the early stages of the pandemic to apply for assistance if a death certificate showed symptoms related to COVID‐19. Certification of COVID‐19 deaths remains challenging given low testing rates, standardization of diagnosis is still lacking, and some deaths are not properly counted as COVID‐19 related given overburdened physicians and medical examiners/coroners (Kiang et al., 2020). Such challenges reveal the importance of properly classifying deaths related to the virus, as undercounting or overcounting affects public health statistics and tracking (Ioannidis, 2021). Improper classification of COVID‐19 deaths can have a significant impact on the number of FEMA COVID‐19 Funeral Assistance Program applications submitted.

For society's most socially vulnerable populations, not having COVID‐19 listed on a death certificate meant no access to funding. Gaynor and Wilson (2020) note how COVID‐19 exacerbated society's social equity problems, highlighting racialized disparities among Black populations affected by the virus. Some of society's most vulnerable often work frontline jobs that meant lack of social distancing, lack of work‐related support, and inadequate access to medical care (Gaynor & Wilson, 2020). Findings in this article indicate more work remains when thinking about broadening the social equity umbrella to include other vulnerable populations, such as those with disabilities. In short, FEMA should develop new avenues and tools to ensure that there is equitable utilization of the COVID‐19 funeral assistance funds by these two socially vulnerable populations.

CONCLUSION

The ongoing COVID‐19 pandemic has killed millions of people worldwide. In the U.S., as of this writing, the pandemic has killed over 975,000 individuals. This mass fatality incident has caused myriad challenges to communities by imposing financial stress and burden related to the burial cost of COVID‐19 victims, among other challenges. FEMA adopted a humanistic approach to helping COVID‐19 victims' families by providing up to $9000 in funeral assistance to families of individuals who died from COVID‐19. To achieve the goal of easing the financial stress and burden set by FEMA, it is crucial for there to be an equitable utilization of COVID‐19 Funeral Assistance Program funds.

The results indicate that in general, FEMA COVID‐19 Funeral Assistance Program funds have been utilized by counties with a high number of COVID‐19 deaths, but that many counties with a high number of deaths did not utilize a significant amount of funds. In addition, the OLS results show a positive and significant relationship between the number of COVID‐19 deaths experienced in a county and the amount of FEMA COVID‐19 Funeral Assistance Program funding received by a county. Finally, the OLS results indicate that there is a significant relationship between two out of the five social vulnerability components and FEMA COVID‐19 Funeral Assistance Program funding. Specifically, there is a negative and significant relationship between FEMA COVID‐19 Funeral Assistance Program funding and counties with high percentages of minorities and counties with high percentages of individuals with disabilities.

These results suggest that FEMA should consider implementing outreach programs for communities with high percentages of individuals with disability and high percentages of racial minorities, especially in counties hit hard by the COVID‐19 pandemic. While the FEMA COVID‐19 Funeral Assistance Program does not specifically state a goal of equitable implementation within the program, FEMA is dedicated to equity for all programs, which includes this program (FEMA, 2022a, 2022b; The White House, 2021). In fact, FEMA's latest strategic plan outlines FEMA's goal of instilling equity as a pillar of emergency management. However, some may argue that without specific equitable steps in program implementation (such as basing the funding on vulnerabilities, where those with greater vulnerabilities are entitled to greater benefit) that the current program is one that continues generational and historic inequities that are systematically developed in the society. The authors acknowledge the historical inequities but believe that with further efforts in communities with high percentages of individuals with disability and high percentages of racial minorities, that greater equity is possible. In doing so, FEMA will be able to meet its goal of alleviating the financial stress and burden of COVID‐19 on victims' families (FEMA, n.d.) and in the process enhance the financial wellbeing of COVID‐19 victims' families and contribute to the overall community recovery from COVID‐19.

This study is not without limitations. First, the analyses are based on the number of deaths and FEMA COVID‐19 Funeral Assistance Program funding data collected as of October 16, 2021. Hence, it is possible that these findings may change if more recent data are analyzed. As such, the researchers encourage other researchers to examine whether these results hold using the latest available data. Second, as previous research has shown (e.g., Ioannidis, 2021), there is an inaccurate classification of deaths. Such inaccurate classifications of deaths can influence the number of FEMA COVID‐19 Funeral Assistance Program funding applications, and subsequently, alter the findings of this study. The researchers encourage future research to seek out other sources of data that may be more accurate than the data sources used in this study. Despite these limitations, this study provides initial insights into the equitable utilization of FEMA's COVID‐19 Funeral Assistance Program funds by U.S. counties.

Biographies

Rebecca M. Entress is a PhD candidate in the Public Affairs Program at the University of Central Florida. Her research focuses on emergency management, social equity, mass fatality management, and community flood risk management.

Email: rmentress@knights.ucf.edu

Jenna Tyler is a Researcher at Fors Marsh. Her research focuses on evidence‐informed decision making, community flood risk management, and organizational disaster preparedness and recovery.

Email: jtyler@forsmarsh.com

Abdul‐Akeem Sadiq is a Professor in the School of Public Administration at the University of Central Florida. His research focuses on community flood risk management, organizational disaster preparedness, mass fatality management, and collaborative governance.

Email: abdul-akeem.sadiq@ucf.edu

Entress, Rebecca M. , Tyler Jenna, and Sadiq Abdul‐Akeem. 2022. “Inequity after Death: Exploring the Equitable Utilization of FEMA's COVID‐19 Funeral Assistance Funds.” Public Administration Review 1–13. 10.1111/puar.13572

Endnote

1

When contacted, OpenFEMA staff stated that they believe the total amount of funding per county is automatically updated daily and reflects funeral assistance payments through January 2022, but when the researchers calculated this amount, the total amount of funding from all counties combined, the researchers concluded that is it more likely that the data reflect payments through October 16, 2021, as they align more closely with recent FEMA press releases regarding the funeral assistance program payments. The researchers also ran models including the number of deaths as of January 8, 2022, and the results did not vary significantly from those models including the number of deaths as of October 16, 2022.

Contributor Information

Rebecca M. Entress, Email: rmentress@knights.ucf.edu.

Jenna Tyler, Email: jtyler@forsmarsh.com.

Abdul‐Akeem Sadiq, Email: abdul-akeem.sadiq@ucf.edu.

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