The History of Long-Term Care

The History of Long-Term Care

Introduction

One of the most difficult aspects of creating a history of long-term care is simply defining the term: long-term care. The term's definition has varied through time depending upon the social structures and payment policies of the day as well as the type of clientele for whom care is provided. Public social policy that establishes the availability of funding for payment of long-term care residents has determined the types of long-term care as much as has the need or the commercial demand.

To further confuse the issue, there is no one standard, universal and accepted manner to simply spell the term. Various peer-reviewed publications spell it either as "longterm," or "long term," or "long-term." This paper has adopted the later spelling convention for use. Most people would probably associate long-term care with a nursing home, but that is not the only association such care is connected too. For various psychological, social, political, and economic reasons, other care modalities such as home care can also be so classified. This paper will address the history of these issues.

The Historical Roots of Long-Term Care

In the traditions of western civilization, the Patriarch Abraham has been given the credit for creating the institutions of hotels and hospitals by legends that describe his hospitality to travelers. It is said that he pitched his tent in the Moreh plain near the junction of two major trade routes. There he gave succor to all who passed, both the hale and hearty as well as the ill (Shore, 1993). This tradition of helping others was reinforced by the Deuteronomy verse that stated that God "loveth the stranger, in giving him food and raiment" (Bible Gateway Website, 2005).

These biblical roots lead to social support for the care of others from the three western religions that grew from it. The very idea of giving all types of aid to those in need, and especially those who were widows, orphans, ill or aged, was expressly stated in the Talmud and extended to all people alike by the 12th century Jewish philosopher Maimonides. These same biblical roots also speak to the infirmities that afflict those of old age and the need for the aged to be assisted by those younger as seen in verse Ruth 4:5 and supported by the Fifth Commandment (Bible Gateway Website, Exodus 20:12, and Shore, 1993).

Most authorities place the actual creation of care systems to the treatment of the ill following the conversion of Constantine to Christianity in the 4th century. During this time the philosophy of Christianity lead to the development of hospitals of the aged, for the care of the sick only, for foundlings and orphans, and for the helpless poor as well as ill pilgrims. Most, if not all of these institutions for care were staffed by various Roman Catholic orders, some of whom where founded to deal with these types of care and succor. This tradition of religious organizations providing care to the ill and/or aged and those otherwise infirm continues to this day (Shore).

From that early start, through the Medieval and Renaissance Ages, and up to the present time, the further development of long-term care mirrored the public's social conscience and the degree to which the society was willing to provide care for the aged and infirm. These Ð''hospitals' or Ð''almshouses,' as they were known, did not necessarily provide organized oversight by physicians for the residents' disease treatments. As the monastic charities began to deteriorate and break down by the time of the Renaissance, caring for the elderly and ill became translated into a job for various municipal authorities. This shift from being exclusively a religious endeavor to a being a governmental one was finally crystallized in the 1500's with the passage of the Poor Laws in England. The thinking at that time was the destitute required government aid as that would prevent rebellion and stop the spread of "infection and moral contamination" (Shore). Over the next several centuries, the development of medicine, the study of disease and the aging process and the treatment of the ill and aged grew in fits and starts together. The creation of medical schools in Germany and France lead to the study of the ill and aged in the relatively state supported hostels of the day.

When colonists left the Old World and immigrated to the New World they brought their native systems of laws and communal structures with them. So the American experience in providing for the aged and infirm and ill related to their primarily English background and the Poor Laws, which reinforced their Calvinistic beliefs that all able-bodied individuals should work. They provided for the elderly, infirm, and sickly in communal facilities called Ð''almshouses.' The first was built in Boston in 1622 and followed by almshouses in Philadelphia in 1713, and in New York in 1736 (Shore). As there was no high-level governmental oversight or agency during the early history of the United States to monitor these facilities, these functions had to be dealt with as a local responsibility and handled at the municipal level.

Through time, local aid societies sprang up. These initially provided aid to immigrants and then later to the elderly and infirm. These were known as "Ladies Aid Societies" and were formed either around religious affiliations or nationality of origin (AGSNE Website, 2005). Often private homes were purchased by these societies and converted into "homes." The residents were referred to as Ð''inmates' and the homes were operated after the asylum or poor farm models (Shore, 1993). A few of these homes were located within the cities, but most of them were located rurally, outside the city. This created the link in the public's mind that old age, long-term care, and "country home" went together. The thinking became that when a person became "old," that person went to the "country home" and died there (Hirshbein, 2001).

Other models of the country home arose in the period from the 1800's to the late 1920's. Some of the country homes were opened for commercial profit and this modality became more prevalent as time went on. In addition to the Ð''mom and pop' country home (or Ð''retirement' home as they were called) some recent immigrants brought their nationality's own model of care for their declining years with them. Those from Scandinavia and Germany brought the model of "Altenheim." This was a club-residence which long-term