Skilled nursing facilities evolved out of almshouses which historically housed the community’s most incapacitated individuals. In the eighteenth century, the elderly who were poor, disabled or isolated from their families were placed in the almshouse along with the mentally ill, alcoholics, homeless individuals and orphans. In the nineteenth century, women and church groups established alternative housing options for the elderly, but they only accepted individuals who they considered worthy and of the same ethnic and religious background as they were. As alternative options opened up for the younger residents of the almshouses, the older adult population began to dominate this setting.

 

By 1880, 33% of the national almshouse population was made up of older adults. Despite the change of residency, the institution remained as a symbol of failure and despair through the twentieth century. During this time, the government viewed the “Poorhouses” as a drain of financial resources and they cut funding to eliminate the facilities. Residents of the almshouses were forced to find private care or live on their own. 

 

In 1954, the Medical Facilities Survey and Construction Act was passed and the development of the first public institutions for older adults were built. In 1965, Medicare and Medicaid began and aided the growth of the nursing-home industry. The number of residents in these facilities grew dramatically and many institutions provided substandard care. The 1970s brought upon many active push-backs against the culture of the nursing homes and many policies were passed including the Office of Nursing Home Affairs Act, reforms of Social Security and the Older American Acts. Unfortunately, the new policies did not reform the standards of care in many nursing homes and the development of the modern-day industry reflects its historical roots. (The History of Nursing Homes, n.d).