A look into where senior living started, and how it has evolved in the last two centuries.
“The wise mind mourns less for what age takes away than what it leaves behind.” ~Williams Wordsworth (1770 – 1850).
Evolution of Senior Living
Until the 1800s, there was no regulated form of care for the elderly. Much of the elderly population lived and were taken care of by their families, though life expectancies were much lower than they are now. At the time, it was more common for older women than older men to be unmarried, whether they were never married, divorced, or widowed. As a result, elderly unmarried women were heavily dependent on their children for care without having the financial and physical assistance from a husband. According to a study by Costa of 1997, 10 percent of married women and close to 60 percent of unmarried women above 65 were the dependents of children or other family members in 1890.
Poorhouses were created for older individuals who had no one else to care for them. Populations in poorhouses exploded in the early 1800s. The term reflects exactly how it was. Conditions in these facilities ranged from poor to horrific. The operators of poorhouses most often than not got by doing as little as they could for a paycheck. They had no understanding nor ability to care for residents who were mentally ill. A report by Dorothea Dix revealed elderly women being chained and kept in pens in poorhouses. As time passed, poorhouses became incredibly expensive. Nine states took action against the abuse and neglect caused by these facilities and formed “Boards of Charities” in the mid-1800s which oversaw and reported on poorhouse operations. By the mid to late 1800s elderly care was institutionalized, elderly began to move into mental families, and nonprofit old-aged homes were established. These old-aged homes had much better living conditions than poorhouses, though the residents continued to be treated as inmates, having to ask permission to leave, complete chores, and being overstepped by the operator (“Senior Living History: 1800 - 1899.” 2018.).
The earliest retirement community, the William Enston Home in Charleston, SC, was established in 1889. It consisted of “24 residential cottages; Memorial Hall, a community building; an infirmary; an engine house; a water tower and an entrance gate” (National Park Service).
With the emergence of nursing as a profession in the late 19th century, home health care professionals were often hired by wealthy families as live-in care providers. Poor families could not afford these care providers, though home care services for the poor became popular by women like Lillian Wald of New York City, a nurse who volunteered to care for pregnant women, the disabled, and the elderly. As she saw a need for elderly care, she created the Henry Street Settlement in 1893, also called the Visiting Nurse Society (VNS) in New York. These organizations were often supported by wealthy women interested in philanthropic deeds. (“Senior Living History: 1900 - 1929.” 2018).
The Social Security Act was passed in 1935 that in turn led to the formation of the Old Age Assistance (OAA) program after the Great Depression had left many elderly individuals back in tragic living conditions. This created funds that workers would pay into as they worked which they could later use to support themselves in retirement. Initially, the Social Security law was limited to workers in commerce and industry besides railroads to keep the cost down. New amendments to the law have continuously added more groups and is now available to nearly everyone. The OAA provided the poor elderly with cash payments and led to the formation of the Medicaid Program, the main source of funding for long term care in modern day (“Senior Living History: 1930 – 1939.” 2018).
In the 1950s the Public Health Service created new government regulations. By 1954, there were around 9,000 skilled nursing or personal care homes in the United States. By 1965, Medicare and Medicaid were the primary source of help of financial support to the elderly population. This in turn led to the formation of Extended Care Facilities (ECF) for post-hospital people. In 1967, the Medicaid program was amended to include state standards. This created intermediate care facilities (ICF).
By 1970, there was a great pressure to improve the standards for assisted living and nursing homes. This led to goals to redefine elderly care to focus on choice, dignity, and independence, led by an Assisted Living community in Oregon. (“Senior Living History: 1960 – 1969.” 2018). As a result, “aging in place” communities were formed which give elderly individuals freedom to choose where to live for as long as they can, while getting the changing levels of care as they age. A Continuing Care Retirement Community (CCRC) gives these people the ability to live within the same community through their elderly life. CCRC consists of several forms of senior living communities such as Independent Living, Assisted Living, and Memory Care. (“Continuing Care Retirement Communities.” 2018).
In 1992, the AARP set the definition of assisted living and pushed the terms community and residents over facility and patients, making assisted living less institutional. Today, there are many different types of senior living care, including In Home Senior Care for active seniors, Adult Day Care where older people can go during the day while their caretakers are at work, Active Adult communities which are senior living complexes, Independent Living which requires little care, Assisted Living requiring more care medically and with daily tasks, Memory Care for elderly individuals with mental disabilities, Skilled Nursing Facilities similar to a hospital environment, and finally Hospice facilities for end of life care (K. Rutledge, personal communication, January 21, 2019).
With the growing population of the elderly because of the Baby Boomers aging, there is an incredible need for senior living care and communities. The conditions and treatment in these communities have improved immensely, changing the perception of senior living and the experience.
Sources:
Continuing Care Retirement Communities | What is a CCRC? (2018, August 16). Retrieved January 29, 2019, from https://www.seniorliving.org/lifestyles/ccrc/
Senior Living History: 1800 - 1899. (2018, April 19). Retrieved January 29, 2019, from https://www.seniorliving.org/history/1800-1899/
Senior Living History: 1900 - 1929. (2018, April 19). Retrieved January 29, 2019, from https://www.seniorliving.org/history/1900-1929/
Senior Living History: 1930 - 1939. (2018, April 19). Retrieved January 29, 2019, from https://www.seniorliving.org/history/1930-1939/
Senior Living History: 1960 - 1969. (2018, April 19). Retrieved January 29, 2019, from https://www.seniorliving.org/history/1960-1969/
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