Assisted Evolution

In Senior Living

By Joel Nelson on Apr 9, 2021 in News, Senior Living

Assisted living facilities, which fill a need for seniors who don’t need nursing homes but can’t live independently, are a mainstay of senior care. The American Health Care Assn./National Center for Assisted Living counts nearly 1 million licensed beds in about 28,900 communities in the U.S. But even as assisted living holds stature as the fastest growing residential housing for older Americans, it may surprise some to learn that this model didn’t assume its present-day form until the 1980s.

The roots of assisted living in America can be traced at least as far back as 1713 with the founding of an organization designed to care for seniors in Philadelphia. Foster homes and group homes became the norm later in the century when family members couldn’t care for a senior loved one. By the mid-1800s, religious and fraternal groups opened nonprofit homes for seniors, the genesis of the modern care system.

Hundreds of nonprofit old-age homes were built in the late 1800s and early 1900s, with many adding hospitals, staff homes and other structures as their populations grew. Urbanization and tuberculosis epidemics helped spur state and local governments to develop institutions that provided chronic care. Nursing care in homes also became popular, with the number of visiting nurse agencies more than doubling from 1909 to 1924.

By the middle of the 20^th century, advances in medicines such as penicillin, the expansion of various assistance payments, and the exodus of men and women from the home during World War II were among the factors that prompted the further development of care facilities, including boarding homes for seniors. The private nursing home industry debuted in 1950, serving 270,000 people by 1954. That year, Congress provided funds to nonprofit organizations for the construction of skilled nursing facilities that met certain hospital-like building standards.

The inception of Medicare and Medicaid in 1965 inspired the conversion of boarding homes for the aged into nursing homes that would qualify for federal payments. The private nursing home industry served 500,000 by 1965. In 1966 there were only a few publicly traded nursing home chains; they numbered 58 by 1968 and 90 in 1970.

In 1972, new laws required nursing homes to meet specific care requirements to qualify for funding. This prompted the creation of assisted living and intermediate care options. In 1981, the first recognized U.S. assisted living facility opened in Portland, Ore., offering residents private rooms with doors that locked, 24-hour staffing for medical emergencies and community areas for social interaction.

Since then, says Brad Breeding, president and co-founder of continuing care retirement community information resource site myLifeSite, assisted living has gone “full circle … on how senior living accommodations are designed, getting away from the sterile, hospital feel and readopting the home-like setting of the boarding house.” That includes providing as much autonomy and independence as possible with personalized dining schedules, furnishings and sleeping schedules, complemented by an array of supportive care services.

Senior living commentator Carol Marak, writing in SeniorCare.com, notes, “Assisted living offers a desirable way of life for older adults; better physical environments, improved care and service capacity.” Depending on their needs and preferences, seniors can “select from high-rise buildings to one-story Victorian mansions to large multi-acre campuses. There are some assisted living communities today that offer all the amenities found in an entire town.”

Several sources provide narratives on the evolution of senior communities, including SeniorLiving.org,  myLifeSite, the Gerontological Society of America and SeniorLivingLink.

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