History of Nursing Homes

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A Brief History of the Nursing Home
Today, there are approximately 16,100 nursing homes in the U.S. with approximately 1.5 million residents (www.cdc.gov). However historically, the sick, disabled, and aged were cared for at home by family members. Changes in technology and social changes have created a shift in how we care for our elderly and disabled, and there is evolution in geriatric care that continues today (Morris, 1995). Nurses have had a huge role in revolutionizing the care for our elderly and for creating what is the modern nursing home.

Caring for the old age, or geriatric nursing, is often not viewed as being as prestigious as other specialties in nursing. Despite the growing elderly population and the fact that 46% of all Registered Nurses will be providing direct care to the elderly, the majority of nursing students still do not receive any specialized content in geriatric nursing (Ebersole & Touhy, 2006). Later on, we will discuss the development of geriatric nursing as a specialty and as it relates to the history of long-term care.

In the sixteenth century, we began to see institutions developed to care for a variety of people in need. This did not just include the elderly or disabled, but any dependent poor, sick, orphaned children, widows, insane, and even minor criminals. These institutions could be considered a predecessor to the nursing homes that eventually followed (Morris, 1995). Poor laws in Europe gave rise to these institutions referred to as workhouses, almshouses, or poorhouses. They provided very minimal nursing care, and the care was often provided by “pauper nurses” who were not trained and usually inmates themselves, often alcoholics. Agnes Jones, a Nightingale trained nurse visited a Liverpool Infirmary in 1864 and reported “deplorable” conditions. She was forced to dismiss 35 pauper nurses for drunkenness and stated that bed clothes had not been washed for months (Ebersole & Touhy, 2006).

These poorhouses were common in the United States as well and often had the same deplorable conditions. Carolyn Bartlett Crane, the Chairman of Charity Organization Department of Women’s Civic Improvement League of Kalamazoo, MI attempted to address these problems first with the Michigan State Nurses’ Association in 1906 and again with the Nurses’ Associated Alumni of the United States in 1907 with pleas for nursing care in these almshouses. In her 1907 paper, “Almshouse Nursing: the Human Need; the Professional Opportunity”, she described the county almshouse as a “hospital with the hospital part left out.” She went on to talk about how the specialization of institutions for certain groups, such as asylums and orphanages, left the elderly and infirm to be the majority of those left with no other options besides the poorhouses (as cited in Ebersole & Touhy, 2006 p.8). Little progress was made. In 1912, the American Nurses’ Association Board of Directors appointed an Almshouse Committee to oversee housing in these institutions. Progress continued to be slow. From 1910 to 1920 focus was taken away from elder care due to the war (Ebersole& Touhy, 2006).

An article published in the American Journal of Nursing in 1930 by Munson, R.N. discussed the conditions in the almshouses and lack of quality nursing care. She states, “Modern nursing in England and in this country was started with the purpose of ‘cleaning up’ just such conditions in hospitals as are still found in almshouses.” She proposed that these small almshouses be consolidated into larger facilities that are better managed (1930).

Morris describes the factors that have led to the need for the care that nursing homes provide today. They describe an area of healthcare when a person is not acutely ill and in need of hospital care, but is perhaps chronically ill and cannot return independently to live in his or her home. This “middle” is ever changing and is affected by two factors: technology and...
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