Where Nursing Homes Started

If you look at the history of the asylums blog I posted before this, you see that this type of home replaced the asylums when it came to the elderly. How did this start? Let's take a closer look. 

Photo by Flashbak - a 1970s nursing home (if you didn't guess by the colors in the room)

The nursing home may have had some similarities to asylums. I'd say it isn't the same, mostly because the focus is different. The focus isn't to cure, but instead to keep the elders of the community comfortable and somewhat happy. This is where you send grandma and grandpa when you can no longer take care of their needs by yourself. The asylums in comparison were similar, yet the goal of the asylum was recovery. 

You think of medical care when you think of nursing homes. Older asylums look like nursing homes in some cases. I know that nowadays nursing homes are not all homey. It didn't start that way. The homes were literally homes set up for those who needed support in their older age. Hospitals also took on some of the chronic, age-related care. The social security act of 1935 resulted in institutionalized rest homes because it provided funding from the government. Almshouses closed their doors around this time. Government funding was followed by government regulations, which were created to combat any abuses within the system. 1965 revealed medical facility-like nursing homes. 

The Beginning

We still haven't addressed where it all started. Early on the elders of the family were cared for by the family. Urban environments and work schedules, as well as lack of living space, created a demand for sending the older family members elsewhere. One of these places could be an almshouse (poor house or workhouse). The almshouse was one of three places you could send your relatives. Frankly, I find that appalling. Do you know who else ended up in almshouses? The insane, orphans, the poor, prisoners, and the displaced in society. Those with chronic and long-term illnesses could sometimes not be admitted into hospitals, and therefore, ended up here. Conditions were awful in these poor houses. 

Blackwell Island Almshouse -
 photo by Dailymail

Where else can you send your elders? Let's see, how about the board and care homes. This is nothing more than a rented room with basic care and meals. This is closer to the system we have today. Churches could be running these places. Sometimes you required a bit of money and proof of good character to get in, leaving the people of the streets out of the boarding houses. The earliest homes were not licensed, unlike later ones. They began providing more care as residents needed more help. The board and care homes transitioned into skilled nursing homes.

Assisted living was created as people disliked and complained about the medical atmosphere that overtook nursing homes. I can tell you that assisted living is not the same as a nursing home, mostly because the people are far more independent and might just need rehabilitation Even the rooms are fancier. At times, people are transferred to the nursing home section after they have declined. By now people were getting the picture when it came to making money; this is evidenced by the prices of assisted facilities today. There were so many places built and much like asylums this meant a lack of quality and ability to control quality. Some days I wonder if the nursing homes will end up in a similar situation to asylums (though I greatly hope that won't be the case). Lack of staffing is a warning sign that is hard to ignore and it worries me. 

Currently, Covid 19 and nursing homes have been having a hard time. We are more regulated there than in any other public place. While most businesses have said "don't worry about the mask if you're vaccinated", nursing homes and care facilities (heck, anything medical) have not. I do agree with the protection of our older humans. I also understand that abuses can easily happen and the regulations put in place are for the safety of the residents. The system is changing in odd ways due to the pandemic and I can't predict what it will look like two years from now. All I know is that the system itself is shifting.

Conclusions

After researching this and asylums in the same week, I can understand why they would keep an eye on the nursing and rest homes that are here. If unregulated, abuses can easily go unchecked and the whole system could crash into the same obstacles that asylums have. If over-regulated, we all go insane trying to meet impossible standards. It is a tight rope in the truest sense. We've come a long way from almshouses, thankfully, but the system is forever changing. May it change for the better as life evolves and we assess how we treat our elders. 

What truly makes me sad is that rest homes run by churches didn't reach out to the poor as much as they should have. They were too busy asking about character to help, which makes me sad inside. If you have read the previous blog on asylums, you will note that some unfortunate elders were sent to asylums to cut state costs. That is one place you could end up, which was just as bad as the almshouse if you were committed to an over-populated one. Food for thought. Take care of your family elders and make sure they are loved and provided for, especially when they are in a care facility of any kind. Give them the love you'd want in your old age. Check on them to make sure the home is treating them well. Hold the system accountable. That could make all the difference in the world to your family member and future residents.

Sources:

 https://www.nextavenue.org/history-of-nursing-homes/

https://www.americannursinghistory.org/history-nursing-homes-in-america

https://www.americanscientist.org/article/the-evolution-of-the-nursing-home