The Way We Were

grant_millerFor anyone in the senior living and care industry, knowing the history of the business is an important part of understanding the way senior living facilities are structured and how they function today, as well as predicting and guiding the trends of the future.

For anyone who is new to the business – or is simply in need of a history review – here is a look at the paradigm shifts that have defined the senior living and care industry.

Elder care in the United States effectively stayed the same for nearly two hundred years. From the colonial period until the early part of the 20th century, people over the age of 60 who had health issues or had no one to look after them faced two basic options:

  • Living at the almshouse (charitable housing – often frequented by the poor)


  • Paying to live in a “boarding home” (they went by many names but were just private homes).

By the 1930s, the almshouses had already begun transitioning into for-profit institutions, and the 1935 Social Security Act cemented this change by subsidizing institutional housing.

By the 1970’s, the status quo remained unchanged – if you had money, you could live in a private home with a caretaker; if you were poor, you went to an institution—often called “old folks homes” or nursing homes.   Memory care came under the heading of “senility” and you were just kept from the general population as much as possible.

By the late 1970s, however, it was becoming apparent that the institutionalized setting of nursing homes was no longer acceptable. As advancements in medicine allowed seniors to age in place, people began questioning the nursing home model, and the need for change was evident.

In 1981, Park Place – what would become the first nationally recognized Assisted Living facility – opened in Portland, Oregon. By 1986, the Assisted Living (AL) model included 24-hour staffing to provide residents with personal and health-related services, as well as a community area and activities designed to facilitate social interaction. Between the mid-90s and 2000, the number of assisted living communities grew practically exponentially.

The senior community today has more options than ever before when it comes to long-term care. Independent Living (IL) communities provide housing for seniors who for all intents and purposes live, as the name implies, independently. Many communities consist of private homes or apartments and offer only basic assistance with home maintenance. The underlying goal of many of these communities is to eliminate the social isolation that affects many seniors.

Skilled Nursing Facilities (SNF) provide the most comprehensive care of all the senior housing options.  Also known as nursing homes, SNFs are often a last resort for many seniors.  SNFs can provide the 24/7 support that is needed for those in declining health who need more intensive medical interventions.

The Continuing Care Retirement Communities (CCRCs) offer aging seniors the most options.  They offer the “continuum of care” from independent living through assisted living to skilled nursing and memory care.  The goal of these communities is to provide all levels of living and care to help ease the transition when ailing health necessitates a move to a higher level of care and to provide a sense of community while helping aging seniors to keep living independently as long as possible.

Today, the dynamics of senior living and care are continuing to evolve. Upper-end communities are moving toward hospitality-oriented care, in which the ‘resident’ is treated like a ‘guest’ at a high-end hotel, and the amenities reflect this opulence in care.

What does the future hold in store for the senior living and senior care industry? Forté will continue to explore and foster new ideas in this arena and use them to keep communities informed and up to date.

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