As hospitals sprang up, they became a comparatively
moreattractiveplacetoputtheinfirm.Thatwasfinally
whatbroughtthepoorhousestoemptyout.Onebyone
throughthe1950s,thepoorhousesclosed,responsibility
forthosewho’dbeenclassifiedaselderly“paupers”was
transferredto departmentsofwelfare,andthesick and
disabled were put in hospitals. But hospitals couldn’t
solvethedebilitiesofchronicillnessandadvancingage,
andtheybegantofillupwithpeoplewhohadnowhereto
go.Thehospitalslobbiedthegovernmentforhelp,andin
1954 lawmakersprovidedfundingtoenablethemtobuild
separatecustodialunitsforpatientsneedinganextended
period of “recovery.” That was the beginning of the
modernnursinghome.Theywerenevercreatedtohelp
peoplefacingdependencyinoldage.Theywerecreated
toclearouthospitalbeds—whichiswhytheywerecalled
“nursing” homes.
This has been the persistent pattern of how modern
society has dealt with old age. The systems we’ve
devisedwerealmostalwaysdesignedtosolvesomeother
problem.Asonescholarputit,describingthehistoryof
nursinghomesfromtheperspectiveoftheelderly“islike
describingtheopeningoftheAmericanWestfromthe
perspectiveofthemules;theywerecertainlythere,and
theepochal eventswere certainlycritical to themules,
but hardly anyone waspaying very much attention to
them at the time.”
ThenextmajorspurtoAmericannursinghomegrowth
wassimilarlyunintentional.WhenMedicare,America’s
healthinsurancesystemfortheagedanddisabled,passed
in1965,thelawspecifiedthatitwouldpayonlyforcare