History of Senior Housing

The history of senior housing is complex. It is tied to many movements in United States history. For example, early America was largely agricultural. As a result, housing was a family matter. Also, early America was religious. Thus, other housing solutions emerged from Church efforts. For example, strong religious beliefs supported families and families deserving of need. If a family lost their home due to fire or another legitimate reason the community and church helped. Loss due to undeserving reasons was another matter.

Deserving Versus Undeserving Home Owners

This dialectic between deserving and undeserving homeless is complicated. Unlike God’s love, where everyone is welcome, the virtuous, and sinner alike, homeownership, and even housing are more complex. Homes are expensive and resource-intensive. General consensus is getting a home should involve sacrifice and hard work. Being given one is a whole different story. Clearly, this dichotomy exists and creates issues around universal housing.

For this reason, it’s helpful to know a bit about the psychology and sociology of housing and how those roots still guide perceptions, decisions, and options. For example, the psychologist Carl Jung views some history as a kind of collective consciousness. A shared sensibility or history we have buried in our minds. This can surface when we are dealing with the emotional issues of housing.

Village And Christian Virtue

Home comes from the word meaning village. Historically a village is a place associated with family and friends. A place where if you got sick, people were there to care for you. Also, think of the meaning of “Christian Charity.” The old English definition of charity is “Christian love of one’s fellows.” Charity is a core virtue of Christianity. This is one of the seven virtues. The history of housing is closely tied to the notion of tribe or community.

St. Augustine said, “Charity is a virtue which, when our affections are perfectly ordered, unites us to God, for by it we love him.” In other words, you can’t really be a Christian without a deep desire to care for your fellow Christians. Live among your fellow Christians; your obligation to God is intertwined with your fellow Christian’s well-being. Also, this sentiment is shared among all Abrahamic religions.

Historically Americans Cared For Those Without Housing

Americans provided for those in need at its founding. For example, if you were in need, the community considered you “dependent.” Dependency fell into several categories, including illness, disability, orphanhood, derangement, illegitimacy, feeble-mindedness, impoverishment, alcoholism, and advanced age.

However, early Americans drew a firm line between “deserving poor,” and “non-deserving.” Whereas Americans were generous to the deserving poor, they were less likely to support the non-deserving. However, classes of dependency were designed to identify and separate the deserving from the non-deserving. Those within the deserving class, that could work, were often hired out for work or employed within the institution.

Poor Laws And Housing

Americans adopted “Poor Laws” from England. The local government imposes taxes. The taxes are used to care for and manage the poor and unhealthy. Management includes observation, housing, education, and medical treatment.

Poor laws are rooted in three concepts:

Locality In The History Of Senior Housing

The history of senior housing is local. If the people having a housing problem pass through the problem disappears. When they stay, they are an issue for the local community. The “why” people are homeless is what local communities debate. For example, debates are based on the perception that the homeless bring disease, laziness, crime, and debauchery to a community.

Local responsibility means the local citizenry takes care of the problem. There are many reasons for this, some psycho-social and some administrative. Sociologically and psychologically, people usually resist helping people from a different place. Especially when the local community perceives the visitor’s problems as self-induced. Administratively, local parishes and city governments better understood the need. The combination meant the homeless were at the mercy of their neighbors.

The organizations and people making up the community respond. That includes local governments, religious institutions, church groups, fraternal organizations, and guilds. How they respond usually depends on their wealth and goals. When the homeless problem falls within the goals of the organization and the organization has the wealth to address the problem, solutions to homelessness emerge. When they don’t, they’re made unwelcomed or chased out.

The Problem Of Newcomers

Communities accept their local responsibilities for the needy. However, this didn’t cover newcomers. What are the rights of newcomers? Are newcomers entitled to form the community?

The answers to these types of questions were known as settlement and removal: a set of rules concerning who qualifies as a local citizen and how interlopers are removed from the locality. Local governments and organizations created these rules for newcomers. Sometimes communities create actual written laws. Other communities enforce community customs.

If You Had Family, Family Was Primary Caregiver

In the history of senior housing, early American culture involved a strong work ethic and conviction to the family. Early Americans believed strongly in the Protestant work ethic and the primacy of family. This meant that families were the primary provider of help and assistance to their own. Those in need with families should have their families provide support.

These three concepts have been evolving ever since. You’ll find them today in various forms.

History Of Senior Housing, Types Of Funding For The Homeless

There are three basic ways to get funds in the hands of the homeless. One is to pay an institution that houses a homeless person. This is like a for-profit prison model. The prison is paid to manage the inmate. Another example is to pay the homeless person. This is like a voucher model where the needy receive a voucher for housing. Third, are guardianship models. A guardianship is created between the needy and the helping institution or person. This guardian gets the funds to use for housing on behalf of the homeless person.

Historically, these options were defined in two ways. One was indoor relief. The other outdoor relief. Indoor relief is payment to an institution. Usually, a facility housing and managing a resident (often called an inmate). Outdoor relief is payment to the needy person or the person managing their needs (often a religious leader, family member, or county home manager). The vast majority of expenditures were for indoor relief, but many rural areas used forms of outdoor relief to offload the needy to third parties willing to board the needy.

History Of Senior Housing – 19th And 20th Century Housing Providers

In America in the late 19th Century and early 20th Century, seniors that were poor and had no family to care for them were classified as poor and dependent. Poor Laws and social outreach programs provided help for these seniors. Outreach programs took many forms, but the most common were (1) almshouses or poorhouses, and (2) county homes. Funding came from local governments, state governments, and private contributions. Because poverty was part of the catchall, Almshouses housed lots of different demographics. The old, the young, the insane, the feeble, and the orphaned were all housed together. County homes often catered to the subset that was able to work or perform some tasks.

You can find a great article about the modern evolution of senior housing here.

Help From Fraternal Organizations And Benevolent Societies

There were also fraternal organizations and benevolent societies building institutions to house the needy. Government funding supported some of these institutions. Others are privately funded. These organizations are made of groups of like-minded persons representing guilds, crafts, and political ideologies.

These organizations often built and managed institutions to care for the poor and the needy. They also supported their members that fell on hard times. Religious benevolent societies were also active in housing and supporting the sick and the elderly. Religious-based organizations were responsible for funding the first hospitals and nursing homes.

The Country Home Or Work Farm

A county home was usually a room in a home. Sometimes they were larger and provided care for more seniors. County homes were everywhere. They could literally be a house on a farm where the farmer needed to supplement their income or a house in a city where the owners needed help paying their monthly expenses. There were tens of thousands of these homes at the turn of the 20th century; many farm-related. In fact, the farmer would build the housing compound. Then they would take on needy (but capable) to help run the farm or ancillary businesses.

Home Care For Those With Means

If you weren’t poor, almost all care was home care. In other words, medical care is performed at home. This includes nursing care, basic medical care, and surgery. For example, members of the medical profession or trained caregivers (nurses, midwives, etc.) would come to your house and provide services. As a result, if you are old and have a family, the family cares for you. Similarly, if you had a family and money, the family would hire caregivers to help you.

Early Convalescent Homes

There were also other options for those with money. For example, if your family couldn’t care for you, or you didn’t want to live with your family, you could choose a rest or convalescent home. Rest and convalescent homes provided the elderly help with meals, bathing, and dressing. This was classic senior “board and care.” Early in the 20^th Century, there were thousands of private facilities, mostly homes that took in elderly boarders.

The Psychology Of Home

Psychologically, people have a powerful connection to their homes. Carl Jung has said the home is the “universal archetypal symbol of the self.” Additionally, Sigmund Freud, in Interpretation of Dreams, equates the house with the self.

As we age, our home becomes more entangled with our sense of self. It is our number one concern. We fear moving. In other words, being unhealthy represents the possibility of being homeless.

This was a collective concern and one well known among all Americans. Issues of poverty and homelessness and their consequences on individuals and communities would play a transformative role in senior support in the 1930s. Specifically, the 1930s began the movement toward the senior housing solutions we have today.

Homelessness, Disease, And Growing Cities

Historically, senior housing follows the growth of cities, the health profession, and homelessness. To illustrate, lots of homeless people in growing cities led to disease and debauchery. These problems enforced the need to address the homeless problem.

Growing Medical Profession

As the country continued to industrialize and move off the farm in the early 20th Century, change started to accelerate. First, the medical profession was organizing and growing. To illustrate, membership in the American Medical Association grew from 8,400 in 1900 to 70,000 in 1910.

Also, according to the AMA, in 1910, 100,000 physicians were licensed. In addition, 100,000 nurses are practicing, and 4,000 hospitals are operating. As the medical profession grew and became better at diagnosing disease and curing the sick. Finally, they learned the needy were not homogenous and housing everyone together created unnecessary challenges.

Medical Expertise And An Understanding Of Germ Theory Of Illness Grows

World War 1 and the Spanish Influenza of 1918 were also fueling growth and expertise in the medical professions. The concepts of medicine, medical specialties, the germ theory of illness, and isolating contagious patients were all becoming more ubiquitous in the second decade of the 20th century.

Cities Grow

Cities and trained medical professionals grow contemporaneously. For example, by 1920 there were 12 US cities with populations over 500,000. These included New York, Chicago, Philadelphia, Detroit, Cleveland, St. Louis, Boston, Baltimore Pittsburg, Los Angeles, Buffalo, and San Francisco. Also, the medical professionals supported housing initiatives. They knew without managing the homeless they would roam the city. This would include the sick. Accordingly, every large city built and supported hospitals for the sick. Smaller cities also were also building hospitals. 

City governments and communities also built and supported institutions to house the deranged, orphaned, old, and impoverished. Religious societies also built facilities to care for the elderly and orphaned. There were also private hospitals and a growing insurance industry to help pay for medical care.

In short, advancements in medical knowledge, economic growth, and city growth were creating the right environment to house and manage the homeless and sick. The myriad of institutions and organizations supporting and managing these institutions were real-world experiments for future institutional solutions. For example, the New Deal of the 1930s was based on experience gained in the 1920s.

City Growth And The Debate Over Undesirables

At the turn of the 20th century, the perception was that anyone that could work should work. Thus, nonworkers are undesirables. As Americans left their family farms and moved to the cities and immigrants migrated to America, this debate became more complex.

However, World War 1 and the 1918 influenza change the country’s perception of undesirables. Through no fault of their own, millions of people are injured in the War and made sick in the pandemic. They are unable to care for themselves. However, they weren’t lazy or acting sinfully. The general public recognizes how war and illness can devastate individuals and families.

These sentiments didn’t last long. The roaring 1920’s shifted the debate back to the “deserving poor.” Additionally, the roaring ’20s supported the notion everyone could succeed. You simply had to work. Unemployment was low (around 5%), real GNP was growing, and prices were stable. If you weren’t making it, you weren’t trying.

The country’s perception of “deserving” change again during the Great Depression. Millions of people lost their jobs and homes. Millions more went hungry.

The debate over who is deserving of public funds involves ideas about “Christian Charity,” laziness, prejudice, and xenophobia. This debate influenced how this class of needy persons should receive aid. Is aid to be provided in a controlled setting? Do we aid the needy?

The Great Depression Makes Anyone A Potential Undesirable

The Great Depression overwhelmed State, local and private efforts to care for the elderly, poor, sick, and disabled. For example, millions became homeless and jobless. Also, millions were going hungry. The needy were everywhere and everyone.

The Social Security Act of 1935

The Social Security Act of 1935 (Act) addressed the needs made manifest in the Great Depression. For example, the Act established:

The Act provided funds in a new manner. They paid the needy. Although institutions received funds, the vast amount of expenditures were designed to go to the needy themselves. The new idea was that the elderly and needy could choose how best to support and address their own needs.

However, the program excludes self-employed professionals, domestic workers, and field hands. Eligibility required a worker to complete an application at their local post office. The government would then assign a unique, nine-digit identification number and issue a national identity card.

Click here to learn more about today’s government programs.

The Roots of Senior Housing

Surprisingly, there was a quirk in the Acts that precluded federal funds from supporting the elderly in almshouses. This led to an explosion in “county homes,” now more frequently referred to as “rest” or “convalescent” homes. Seniors use OAA payments for these homes. As a result, by the 1940s, there were hundreds of thousands of these homes throughout the United States.

Nursing Homes For Seniors

These early “county homes,” “convalescent homes,” and “nursing homes” were the start of the long-term senior housing industry. As residents in these facilities grew older, they needed more services. For this reason, amendments to the Social Security Act provided funds via state grants for nursing home facilities.

Medicaid becomes law in 1965 This is now the way poor Americans pay for institutionalized, long-term care, when they were broke and couldn’t live on their own.

Other Resources On The History Of Housing

Good article on the history of housing in the US here.

Interesting site on the history of housing here.