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
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