“From colonial almshouses to privatization and regulation – Once people have a sense that there is money to be made, they look to get involved.”

Almshouse in London Town, Anne Arundel County, Md. in the 1930s, history of nursing homes  |  Credit: Historic American Buildings Survey (Library of Congress)

by Grace Birnstengel

“We are currently at a pivotal point in the nation’s history of caring for the most frail and vulnerable. The way leaders respond to the horrific toll the pandemic has taken on nursing home residents will determine the future of nursing home care for years, possibly decades, to come.

“This is not the first — or second — time where massive outrage has led to calls for significant change and reform in nursing homes. The problems that plague today’s nursing homes are, in many ways, reminiscent and tied to their history in the United States.

“As our 85-and-over population continues to grow, nursing home care is an increasing reality for many of our oldest old who require medical and personal care that can’t be met in home or through community services.

“Today’s nursing homes — also called skilled nursing facilities — include medical care and meals and sometimes offer activities and programming to keep residents engaged. They’re also used as rehabilitation centers for older people recovering from illness or injury between hospitalization and going home. Many have memory care units separated from other residents to assist those with dementia or Alzheimer’s.

“To understand how and why nursing homes evolved into their current iteration requires going back hundreds of years — all the way back to the 17th century.”

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