When the English settled Massachusetts, they brought with them the laws of their native country, where each town was responsible for taking care of its poor. Families were expected, and in some cases legally required, to care for their dependent members. If an individual had no family who could provide support, he/she was turned to the town's Overseers of the Poor (usually the selectmen).

Then, as now, an overriding concern was to provide adequate assistance at the lowest possible cost. The common practice was to place the indigent in private homes through a "vendue" system (from the French word "vendre," meaning "to sell"). Records meticulously reflect the town's payment for each week of subsistence, for every pair of shoes and hose, every apron, pair of britches, and shirts provided to those who had become town charges.

The majority of the poor were widows and orphaned children; a smaller number were disabled men. They were placed for a period of months or a year at a time. Single women, whether widowed or abandoned, saw their families split up, as minor children were bound out as apprentices.

Some adults managed to retain a degree of independence. Rather than pay another household to provide them with subsistence, the town dispensed money directly to them. For example, in Concord, the town used a private fund set aside for the poor to pay the rent for the widowed Ruth Pike and her daughter. At various times, widow Pike also received molasses, milk, butter, pork, beef, bushels of rye, Indian meal, and firewood. If she was ill, the town paid a doctor to visit her. When she died in 1745, along with two other women supported by the town, the taxpayers took care of all burial expenses.

A community was responsible for the care of poor people who were legal residents. To prevent vagrants or the indigent from other places from becoming town charges, Massachusetts, like all the colonies, had "warning out" laws.

The legislature established a period of time within which a town could warn out a newcomer. In one ten-month period in 1753, for example, ten people were warned out of Concord. These individuals were not compelled to leave the town, but Concord had made it clear it would not support them should they fall onto hard times.

In the first quarter of the nineteenth century, the growth and increased mobility of the state's population made it much harder to control who settled where. In addition, reformers began to look for the causes of poverty and for ways to prevent it. Citizens recognized the humiliation of the auctions and the potential for abuse by those who took in the poor for the lowest payment. In 1821 the General Court established a committee, headed by Josiah Quincy, to investigate the condition of the poor in Massachusetts.

Where colonial New Englanders had tended to view poverty as an inevitable part of the human condition, in the early 1800s, growing numbers of people came to view poverty as a social ill, a result of immorality and laziness. Increasingly, people began to view the poor as responsible for their plight, if only by not having planned for the unexpected. The Quincy Report differentiated between the "deserving poor," who were incapable of work, such as orphaned children, the disabled, and elderly, and "paupers" — able-bodied but lazy and unworthy individuals, many of whom had only intemperance to blame for their problems. While the report distinguished between the two groups, it recommended building publicly-funded almshouses to separate all the poor from society and provide them with incentives for self-improvement. 

A few reformers remained sympathetic to the poor, but there were few who doubted that almshouses would prove beneficial as well as economical, since able-bodied residents would contribute to their upkeep. Places of "order, regularity, industry and temperance," they would afford residents the opportunity to learn "constancy and diligence [and] to obey and respect."

Boston was unusual; it had opened the first almshouse in the colonies in 1664 (although it continued to place 80 percent of the town's poor through vendue) and built a larger replacement in the eighteenth century. Before the 1800s, only a few other larger towns in Massachusetts had almshouses. By 1840, however, there were 180, even though several years earlier a legislative committee had toured the state without finding one almshouse that they felt could serve as a model for others.

The men charged with managing the almshouses had no training and often mixed motives. Towns were generally preoccupied with making sure that the new approach to poverty was cheaper than the old. Salem, for example, put up a five-story, two-wing building, and then failed to staff it properly. Individuals sent to an almshouse were not classified in any way except by gender. An orphan, an unwed mother, an elderly widow, a blind person, and someone suffering from mental illness might all be housed in the same room.

In 1852, in part as a result of the influx of immigrants, the state of Massachusetts authorized construction of almshouses in Bridgewater, Monson, and Tewksbury for paupers who were not legal residents. The almshouses provided only a temporary solution; over the course of the next century, a variety of state agencies were created and recreated to serve the poor, the mentally ill, and others in need of assistance as separate populations. was established; by the mid-1900s, scarcely an almshouse remained open The Department of Transitional Services, under the Executive Office of Health and Human Services, established in 1995, is the descendant of these earlier social service agencies.