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How will you celebrate your 122nd birthday? That prospect sounds futuristic, perhaps even fantastical, but it’s not impossible. Advances in medicine have made it possible for people to live much longer than before, which means there are older seniors and more seniors to take care of than in the past. That’s great news for anyone reaching seniorhood in this century, but the elderly population in the 1700s didn’t have it nearly as good.  

There have been many attempts at creating a place where seniors can be taken care of, with different types of setups tested to find the right sort of living arrangement. Some of these arrangements prioritized senior care, but others didn’t. Over time, though, an improved model was reached.


The original nursing homes were the poorhouses, dating back to the 17th century. The name of these “homes” was telling: They housed what was referred to as the “undeserving poor,” meaning those who the community believed were unworthy of financial help. Residents weren’t limited to the “undeserving” elderly, but also to children who were orphaned and people who had mental disabilities or illnesses.


While the conditions in some of the poorhouses were horrific, it seems that seniors did receive a higher level of care in others. The Friends’ Almshouse of Philadelphia was founded in 1713, making it one of the very first organizations created to care for seniors and people in need. The Almshouse catered to Quakers and was soon followed by the opening of a public almshouse in 1732.


The poorhouses became more crowded following the Civil War, when many families, even those that had been wealthy at one point, found themselves out of money. The families could no longer care for their elderly members, deciding to send them to poorhouses when they had no other options. Shortly after the Civil War, the 14th amendment was passed, which made poorhouses voluntary instead of involuntary.

The Progression of Senior Care

Senior care continued to evolve, with many changes being in response to less-than-desirable conditions and treatments:


●        1817: The Indigent Widows and Single Women’s Society was established, providing care for poor, elderly widows.

●        The mid-1800s: Religious groups opened nonprofit homes for seniors. This was to offer an alternative to the terrible conditions in many poorhouses.

●        1935: The Social Security Act was passed, providing federal support for the elderly.

●        1950: Private nursing homes started popping up. By 1965, there were more than 500,000.

●        1960-1976: The availability of beds in nursing homes increased by more than 300 percent.

●        1965: Medicaid and Medicare programs became law.

●        1968: The Moss amendments established a standard of care in nursing homes and regulated the industry.

●        1974: The first hospice was founded in Connecticut. Hospice provides end-of-life care for people.

●        1987: The Nursing Home Reform Act clarified the services seniors would receive.


Today and in the near future, some seniors may not even need care until they’re well past 65 years of age. The new entrepreneurs are in their mid-60s, sometimes leaving established, high-paying jobs to create a business of their own. There seems to be a shift in how to achieve a high quality of life — income doesn’t create the same type of happiness that you get from working at a job you love.

Social Security and the Rise of Board-and-Care Homes

When the Social Security Act was passed, many seniors opted to live in a board-and-care home instead of a poorhouse. Seniors who continued to live in a poorhouse were not able to receive Social Security payments. In response, many seniors decided to move. These homes allowed seniors to rent a room and provided two meals a day. The seniors also received a basic amount of care while there.

The Need for Nursing Homes

Before there were nursing homes, seniors who needed an advanced level of care, such as those with Alzheimer’s disease, would go to the hospital and stay for an extended period of time. The hospitals weren’t necessarily equipped for these long stays, but the seniors didn’t have many options. The government created grants so that nursing homes could be built, the idea being that the nursing homes would offer the same type of care as hospitals but for a longer time period.


While the first nursing homes solved many of the problems they were created to solve, there were still several pressing issues that residents had to deal with. Seniors could be mistreated or could lack the type of care they required. Without formal regulations, conditions could still be poor. Through the 20th century, more and more regulations and guidelines emerged, many of them becoming law, that improved residents’ quality of life and healthcare in nursing homes.

The Moss Amendments and the Resident’s Bill of Rights

The Moss amendments in the late 1960s were among the first attempts to regulate nursing homes for the sake of the residents. They established safety codes that nursing homes had to follow. They ensured that there were registered nurses on staff who knew how to provide quality care. Abuse and fraud also became easier to recognize and stop.


Part of nursing home reform in the late 1980s was The Resident’s Bill of Rights, which outlines the rights that all residents of a nursing home are entitled to. These rights address issues of mistreatment, privacy, and type of care. They also cover social interactions between residents and family members, personalized care plans and discrimination.


The Bill of Rights reiterates the importance of certain human rights, such as “the right to be treated with dignity.” This continues to be a major concern for social workers today. As noted by Regis College:


As the social work industry is built around the idea that individuals have an inherent right to respect and dignity, the National Association of Social Workers prioritizes promoting client self-determination, within the bounds of social responsibility, as a key ethical issue. This point incorporates being mindful of cultural and ethnic diversity and providing treatment that resolves any conflicts between client interests and those of society. Ultimately, the goal should be to empower clients to change and meet their own needs.

By empowering senior citizens in this way, society can give the elderly more agency in choosing how they live out their years.

Preventing Harm in Nursing Homes

Despite the many advances the nursing home industry has made since the 18th century, seniors are still at risk. Abuse and mistreatment have much more severe consequences than in the past, yet some nursing home residents are still treated poorly by those who care for them. It’s necessary to know the common signs of nursing home abuse in order to recognize it and put a stop to it:


●        Injuries, old or new

●        Rapid and noticeable weight gain or loss

●        Family members who are prevented from visiting the senior

●        Unexpected and fast deterioration of mental capacities

●        New fear of human contact


By 2030, it’s possible that 20 percent of the United States population will be made up of seniors. Seniors have numerous living options, whether they choose a supported lifestyle at home or more attentive care in a nursing home. While the number of options makes it hard to choose, it’s also an indication of how far the industry has come.

About the Author:

Frankie Wallace contributes to a wide variety of blogs and writes about many different topics, including politics and the environment. Wallace currently resides in Boise, Idaho and is a recent graduate of the University of Montana.