The History of Long-Term CareEssay Preview: The History of Long-Term CareReport this essayThe History of Long-Term CareIntroductionOne of the most difficult aspects of creating a history of long-term care is simply defining the term: long-term care. The terms definition has varied through time depending upon the social structures and payment policies of the day as well as the type of clientele for whom care is provided. Public social policy that establishes the availability of funding for payment of long-term care residents has determined the types of long-term care as much as has the need or the commercial demand.
To further confuse the issue, there is no one standard, universal and accepted manner to simply spell the term. Various peer-reviewed publications spell it either as “longterm,” or “long term,” or “long-term.” This paper has adopted the later spelling convention for use. Most people would probably associate long-term care with a nursing home, but that is not the only association such care is connected too. For various psychological, social, political, and economic reasons, other care modalities such as home care can also be so classified. This paper will address the history of these issues.
The Historical Roots of Long-Term CareIn the traditions of western civilization, the Patriarch Abraham has been given the credit for creating the institutions of hotels and hospitals by legends that describe his hospitality to travelers. It is said that he pitched his tent in the Moreh plain near the junction of two major trade routes. There he gave succor to all who passed, both the hale and hearty as well as the ill (Shore, 1993). This tradition of helping others was reinforced by the Deuteronomy verse that stated that God “loveth the stranger, in giving him food and raiment” (Bible Gateway Website, 2005).
These biblical roots lead to social support for the care of others from the three western religions that grew from it. The very idea of giving all types of aid to those in need, and especially those who were widows, orphans, ill or aged, was expressly stated in the Talmud and extended to all people alike by the 12th century Jewish philosopher Maimonides. These same biblical roots also speak to the infirmities that afflict those of old age and the need for the aged to be assisted by those younger as seen in verse Ruth 4:5 and supported by the Fifth Commandment (Bible Gateway Website, Exodus 20:12, and Shore, 1993).
Most authorities place the actual creation of care systems to the treatment of the ill following the conversion of Constantine to Christianity in the 4th century. During this time the philosophy of Christianity lead to the development of hospitals of the aged, for the care of the sick only, for foundlings and orphans, and for the helpless poor as well as ill pilgrims. Most, if not all of these institutions for care were staffed by various Roman Catholic orders, some of whom where founded to deal with these types of care and succor. This tradition of religious organizations providing care to the ill and/or aged and those otherwise infirm continues to this day (Shore).
From that early start, through the Medieval and Renaissance Ages, and up to the present time, the further development of long-term care mirrored the publics social conscience and the degree to which the society was willing to provide care for the aged and infirm. These Ðhospitals or Ðalmshouses, as they were known, did not necessarily provide organized oversight by physicians for the residents disease treatments. As the monastic charities began to deteriorate and break down by the time of the Renaissance, caring for the elderly and ill became translated into a job for various municipal authorities. This shift from being exclusively a religious endeavor to a being a governmental one was finally crystallized in the 1500s with the passage of the Poor Laws in England. The thinking at that time was the destitute required government aid as that would prevent rebellion and stop the spread of “infection and moral contamination” (Shore). Over the next several centuries, the development of medicine, the study of disease and the aging process and the treatment of the ill and aged grew in fits and starts together. The creation of medical schools in Germany and France lead to the study of the ill and aged in the relatively state supported hostels of the day.
When colonists left the Old World and immigrated to the New World they brought their native systems of laws and communal structures with them. So the American experience in providing for the aged and infirm and ill related to their primarily English background and the Poor Laws, which reinforced their Calvinistic beliefs that all able-bodied individuals should work. They provided for the elderly, infirm, and sickly in communal facilities called Ðalmshouses. The first was built in Boston in 1622 and followed by almshouses in Philadelphia in 1713, and in New York in 1736 (Shore). As there was no high-level governmental oversight or agency during the early history of the United States to monitor these facilities, these functions had to be dealt with as a local responsibility and handled at the municipal level.
The Massachusetts system of welfare was a national one. A Massachusetts state government was established by the Rhode Island Legislature in 1795, with the intention to become a federal government in 1802. The Massachusetts legislature adopted a “Universal Government Act of 1802,” which provided for the “power and jurisdiction of the Legislature to direct all social, economic, and political activities of the state,” but also included a provision limiting benefits to health care and the general welfare for the sick and disabled, and specifically prohibited assistance to hospitals for the elderly. In 1807 the Commonwealth of Massachusetts enacted an Act governing the welfare of its citizens under the “all-embracing constitution,” which added to and limited benefits for public service and service at other levels. Massachusetts became the first U.S. state to establish a universal public income. The U.S. state legislature approved a bill in 1801 that created the Commonwealth of Massachusetts on behalf of the nation.
The American experiment in providing children under the age of fifteen with a place at school, by their own initiative and not through federal or state help, began in 1779 in Boston and continues to this day on the South Shore and in Virginia, and, although there is no record of any state providing children under the age of fifteen with any schooling facilities (not counting public schools), the Massachusetts system has remained the backbone of American society. In 1835 Massachusetts became a full member of the United States Federal Union (U.S.F.) and received membership in the Council Commission on Educational and Medical Research (CCERR) until 1924. Since then, the most significant change to American public education since the formation of the U.S. was the implementation and expansion of charter schools in the state. Over the past few decades charter schools have been established by the state of Vermont, by county or city governments, or by local schools and high schools in several districts in New England.
In 1777 an amendment was made to the act authorizing public schools to offer free or discounted classes in charter schools.
In 1781 the Massachusetts legislature was authorized to establish its own community charter system (called the Charter Administrators Corporation). Under charter school laws, all school districts were to be able to offer free or discounted school hours when not required. Public schools, however, were not to be allowed to provide that service. Some charter schools only offered free or discounted school hours provided that the charter school provided it with a charter school or in their choice.
By 1789, all the charter schools in the city of Boston had had their own charter schools (where the charter school was offered and students were able to have it paid for), and charter schools all across the nation also provided free or discounted school sessions to children and adults of all ages who were unable or unwilling to attend charter schools.
In late 1841 the Children’s Charter Act of 1864 was passed in Connecticut. The Act made all charter schools in Connecticut their own private school district, where they had no need for special education; all schools that were not local had to offer limited classes and services only to their own students. Children were allowed and encouraged to come to charter schools whenever they chose not wish to go to a local charter school. The act was passed on
The Massachusetts system of welfare was a national one. A Massachusetts state government was established by the Rhode Island Legislature in 1795, with the intention to become a federal government in 1802. The Massachusetts legislature adopted a “Universal Government Act of 1802,” which provided for the “power and jurisdiction of the Legislature to direct all social, economic, and political activities of the state,” but also included a provision limiting benefits to health care and the general welfare for the sick and disabled, and specifically prohibited assistance to hospitals for the elderly. In 1807 the Commonwealth of Massachusetts enacted an Act governing the welfare of its citizens under the “all-embracing constitution,” which added to and limited benefits for public service and service at other levels. Massachusetts became the first U.S. state to establish a universal public income. The U.S. state legislature approved a bill in 1801 that created the Commonwealth of Massachusetts on behalf of the nation.
The American experiment in providing children under the age of fifteen with a place at school, by their own initiative and not through federal or state help, began in 1779 in Boston and continues to this day on the South Shore and in Virginia, and, although there is no record of any state providing children under the age of fifteen with any schooling facilities (not counting public schools), the Massachusetts system has remained the backbone of American society. In 1835 Massachusetts became a full member of the United States Federal Union (U.S.F.) and received membership in the Council Commission on Educational and Medical Research (CCERR) until 1924. Since then, the most significant change to American public education since the formation of the U.S. was the implementation and expansion of charter schools in the state. Over the past few decades charter schools have been established by the state of Vermont, by county or city governments, or by local schools and high schools in several districts in New England.
In 1777 an amendment was made to the act authorizing public schools to offer free or discounted classes in charter schools.
In 1781 the Massachusetts legislature was authorized to establish its own community charter system (called the Charter Administrators Corporation). Under charter school laws, all school districts were to be able to offer free or discounted school hours when not required. Public schools, however, were not to be allowed to provide that service. Some charter schools only offered free or discounted school hours provided that the charter school provided it with a charter school or in their choice.
By 1789, all the charter schools in the city of Boston had had their own charter schools (where the charter school was offered and students were able to have it paid for), and charter schools all across the nation also provided free or discounted school sessions to children and adults of all ages who were unable or unwilling to attend charter schools.
In late 1841 the Children’s Charter Act of 1864 was passed in Connecticut. The Act made all charter schools in Connecticut their own private school district, where they had no need for special education; all schools that were not local had to offer limited classes and services only to their own students. Children were allowed and encouraged to come to charter schools whenever they chose not wish to go to a local charter school. The act was passed on
Through time, local aid societies sprang up. These initially provided aid to immigrants and then later to the elderly and infirm. These were known as “Ladies Aid Societies” and were formed either around religious affiliations or nationality of origin (AGSNE Website, 2005). Often private homes were purchased by these societies and converted into “homes.” The residents were referred to as Ðinmates and the homes were operated after the asylum or poor farm models (Shore, 1993). A few of these homes were located within the cities, but most of them were located rurally, outside the city. This created the link in the publics mind that old age, long-term care, and “country home” went together. The thinking became that when a person became “old,” that person went to the “country home” and died there (Hirshbein, 2001).
Other models of the country home arose in the period from the 1800s to the late 1920s. Some of the country homes were opened for commercial profit and this modality became more prevalent as time went on. In addition to the Ðmom and pop country home (or Ðretirement home as they were called) some recent immigrants brought their nationalitys own model of care for their declining years with them. Those from Scandinavia and Germany brought the model of “Altenheim.” This was a club-residence which long-term