The History of Assisted Living

It’s in our nature to want to care for those who cared for us. We are creatures of compassion and love after all. In the past, this often meant families all lived together under one roof, even after marriage for a while. Or elderly parents moved in with their married children. Many cultures still practice this kind of care for each other. However, as countries became more stabilized, and in the case of the United States, larger, families started to separate more. People started to leave the family home in order to find their own way instead of staying in the family business. This meant that as parents aged they were sometimes very far from family members who could take care of them. This created the need for a home where the elderly could go that would take care of them when family members couldn’t.

In the United States, before Assisted Living Facilities existed before Medicare and Medicaid were enacted in 1965, there were charity organizations that funded what was then called homes for the elderly. After the enactment of Medicare and Medicaid, many of these facilities received funding to become nursing homes. Those that could not meet the standards for nursing homes became retirement homes, also known as rest homes, adult care homes, boarding homes, or other names. These homes targeted different demographics with the care ranging from poor to extravagant, all depending on what you could pay. There was not yet a care standard for these facilities.

The first time the term “assisted living” was used was in 1985. It started to be used more widely after that, and by 1991 many residential care facilities were referring to themselves as “assisted living facilities.” Many facilities had to get housing licensing in order to create their assisted living facilities, but that ended up creating a conflict as licensing agencies realized that the needs these facilities were meeting were also met by nursing homes. Eventually, the State of Oregon created a “living center with assistance” that more closely resembles what we have today. They were able to provide privacy, medication help, dementia care, and more.

The last part of the history of assisted living facilities to discuss today is the evolution of 4 different models of assisted living. The first is the hybrid model. This model focused on building a community. It created apartment-style housing and often had separate spaces for public features like libraries or salons. These facilities wanted to completely separate from nursing homes and often even changed the terminology used for care. The second model is the hospitality model. Think of this model as more of a retirement home. Often these were purchased by hotel chains as a type of investment. They focused heavily on service and ensuring that the consumers were satisfied. The third model is the housing model. This model developed more in the eastern states. The idea was that the government funding to housing also is used to house those who needed subsidized housing but with a bit more care. However, this model struggled due to its lack of 24-hour care and inability to take care of heavier care needs. The housing model did however lead to the development of the standard of care in assisted living facilities, most importantly allowing for private living space. The fourth and final model is the health care model. This model was developed mainly from assisted living facilities. Most of these facilities were part of existing nursing homes. Some were even extra wings in the homes. The idea with these facilities was that they were more like stops along the way to a nursing home, mainly used by those who didn’t need a very high level of care yet. A great benefit this model brought was the concern for helping to reduce mishaps, such as falls, medication mismanagement, and involuntary transfers.

Of course, the models evolved further as more regulations were put in place. When many assisted living facilities and other care facilities went public in the United States, this also created a need for developing higher standards of care. Assisted living facilities went through more growing pains to become what we have today. This is just a short history of assisted living facilities. We are so grateful for all who worked to make this field reputable as it allows our elderly to age with dignity.

References:

https://academic.oup.com/gerontologist/article/47/suppl_1/8/614189

https://pubmed.ncbi.nlm.nih.gov/18162565/