Salem, Massachusetts' Overseers of the Poor was established in 1692, when the Commonwealth of Massachusetts passed Acts and Resolves which ordered that "freeholders and other inhabitants of each town…choose three, five, seven or nine persona, able and discreet…to be selectmen or townsmen and overseers of the poor." At its creation, the Overseers were to place poor children as apprentices until they were old enough to take care of themselves, replicating the English tradition in which poor children were "bound out." By the turn of the eighteenth century, the Overseers usually provided "outdoor relief" in the form of food, housing, and sometimes, money. However, with the increase in poverty levels and the expense of providing outdoor relief, towns began to look at "indoor relief," or institutionalized housing as a cheaper alternative. Salem created an alms house in 1719, and ordered that all indigent citizens be moved in, in place of providing outdoor relief by 1749. At the same time, Massachusetts ordered all towns to build poor houses in 1744, and outdoor relief was used less often (Chandler). Outdoor relief was still granted to some people; however it was increasingly seen as expensive, inefficient, and encouraging laziness. Instead, towns such as Salem placed their poor into a town-owned and-operated alms house, poor farm, or work house, arguing that this way the poor could contribute to their own care (Old Sturbridge Village).

In August 1815, the town of Salem agreed to build a new poor house. This one was designed by architect Charles Bulfinch, and was five stories, with two wings. However, it was not staffed properly, and individuals who entered the house were not classified in any way except by their gender. This meant that an orphan, a young mother, an elderly widow, and someone suffering from mental illness might find themselves in the same room. By 1902, the State Board of Charities assumed full responsibility for the costs of the alms houses, and by the mid-1900s very few alms houses remained open ("Town Meeting Auctions…"). Residents of these houses were often referred to as "inmates."