Before the middle of the 20th century, "the poorhouse" wasn’t an abstract concept.
Through the World War II era, mostly county governments in the U. S. provided much of the care for the indigent and elderly folks who could not afford medical care or couldn’t take care of themselves.
The facilities—“poorhouses” or, in some areas, “poor farms”—were often marginal or wretched.
They were systematically closed by mid-century, in tandem with a massive, federally-sponsored buildout of hospitals after WWII. In 1954 the federal government started providing funds so hospitals could build separate custodial units for patients who needed an extended period of “recovery,” and people who couldn’t take care of themselves increasingly ended up in extended stays in the expanded hospital facilities. That was the beginning of modern nursing homes.(1)
In the present time, economic constraints in the hospital health care system are reducing a patient’s time in hospital, and steadily pushing the indigent, elderly, helpless and terminal people toward retirement homes, nursing homes, hospice care, private care or no care.
(1) Atul Gawande, Being Mortal: Medicine and What Matters in the End (New York: Metropolitan Books, Henry Holt and Company, 2014), 68-71.
Copyright © Richard Carl Subber 2015