A Short History Of Nursing Homes in the United States
While you are considering the options of long term care and nursing
homes for yourself, you may be interested in learning about the
history of nursing home care in the United States. The history
of nursing homes in the United States is newer than you might think
and we have come a long way in the last one hundred years.
During the early twentieth century,
there was no federal assistance available to help offset the
cost for the elderly or disabled. Most impoverished people were
sent off to state "almshouses," which
were known for poor care conditions. There was great social stigma
on being relegated to one and the states tended to use this as
an incentive to keep people out of them. At this point, a lot of
the care available for those in need was private. Those who could
afford it would hire live-in care, and those who could not were
left to shift for themselves. At this point, many immigrant communities
set up organizations that helped both new immigrants and the elders
of the community rather than relying on the public services.
In the 1930s, after the Great Depression, the New Deal promoted
the idea that the elderly qualified for federal benefits on the
basis of need. Social Security was now made universal, rather than
needs based. The Social Security Act was signed into existence
by President Franklin Delano Roosevelt, and matched grants to each
state for Old Age Assistance. At this point, there was still a
great deal of stigma attached to the almshouses, so those in public
housing did not receive payments. This lead to the creation of
more private old-age homes. This was changed in the 1950's, when
the Social Security act stipulated that states needed to establish
some form of licensing for nursing homes.
In the late 1960s, after an overly enthusiastic response to Medicare,
the then-Department of Health was forced to discontinue much o
the coverage for nursing homes that the programs had initially
allowed, leaving thousands of people with bills that would prove
impossible to pay off.
1972 saw the advent of Public Law 92-603, which contained a number
of nursing home-reform laws, stating that Medicaid would reimburse
nursing homes for reason cost care. Previously, with many states
using arbitrary fee schedules, there was a massive disparity on
levels of care available, and some nursing homes were quite shocking
in terms of neglect and underfunding. In 1985, a report on nursing
home regulation sparked off legislation that further overhauled
the federal regulations for American nursing homes, standardizing
care and funding.
Nursing homes in America have come a long way, and with the over-80
age bracket the fastest growing age group in America, we can expect
to see a lot more changes in the future!