A Brief History of Assisted Living
Every year in September, those of us in senior care collectively celebrate “National Assisted Living Week,” when we honor our hard-working caregivers, dedicated family members, and highly spirited residents. More than just a cause for commemoration, it is a great reminder of all that has changed and evolved over the course of senior care’s longstanding history here in America. Today, residencies in the Twin Cities and across the United States implement cutting-edge techniques that communities of the past may never have thought possible. We would like to invite you to take a dive into the history of senior care with us as we navigate our beginnings to help shape our future.
How It Started
Prior to the introduction of Medicare and what we see as the modern nursing or assisted living residence, elderly individuals with health concerns were taken in by philanthropically funded organizations which received little, if any, support from the government. It wasn’t until 1965 that Medicare programs were established to take some of the financial burden off of these organizations and provide greater opportunity for lower income individuals to obtain the care assistance they needed. However, even with an increase in funding, many residencies did not transition into nursing or intermediate care settings and instead became boarding homes, retirement homes, and adult care communities to reflect the level of care they could feasibly provide. As such, the quality of adult care fluctuated greatly from community to community.
Eventually, as these communities gained a foothold and began to cement themselves into the foundation of the American medical space, “assisted living” emerged as a popular option for elders with care needs. While it is difficult to pinpoint the exact starting point of assisted living, author of Historical Evolution of Assisted Living in the United States and Ph.D Keren Brown Wilson (2007) notes that:
[T]he first written use of the term (and my first such use of it) was in a 1985 proposal to the State of Oregon to fund a pilot study whereby the services for 20 nursing-home-level Medicaid recipients would be covered in a new residential setting. By 1988, assisted living was being used in presentations at professional meetings and in early trade publication articles. By 1991, when Hawes, Wildfire, and Lux (1991) published a national study of board and care homes, many residential care facilities that offered or arranged care were calling themselves assisted living, and the study included assisted living as an explicit subset of residential care.
That subset of residential care took on a shape of its own and became a popular model among the elderly population. By presenting privacy and autonomy as partners to care assistance rather than rivals, assisted living communities began to pop up across the nation and became many individuals’ preferred method of residential treatment.
Where It Went
By 1992, “assisted living” took up such space in the residential care conversation that the American Association of Retired Persons (AARP) sought a more specific definition of what an assisted living community actually was and what they could provide. Launching a study that included data on 63 different residencies, they were able to denote 4 emergent models of assisted living settings:
- Hybrid Model
- Characterized by an emphasis on autonomy, on the resident as an “active consumer,” with an avoidance of perceptual healthcare terms such as “facility” and a focus on personified terms like “community” and “residence”
- Hospitality Model
- Most common in metro areas and among what we’d call “private pay” tenants today, this model placed strong emphasis on housekeeping, activities, transportation, and visual appeal, particularly on public grounds, much like hotels
- Housing Model
- This model was geared primarily toward cost value and maintaining strong resource infrastructure for moderate to low income populations, and worked heavily with nonprofit organizations to ensure legal protections for tenants
- Healthcare Model
- Evolving most directly from nursing and licensed boarding homes, this model contributed greatly to the development of the assisted living space by making traditional medical practice and rigorous health measurement the precedent
What’s Going On Now
Nowadays, many decades in the making, most assisted living communities are some combination of these four models. Adult care has grown exponentially since its humble beginnings, sprouting tens of thousands of residencies across the United States, each bearing their own unique specialities and atmospheres. As of February 2024, there are approximately 36,000 assisted living communities with roughly 1.2 million beds in the United States and 2,222 communities in Minnesota alone. On top of the growth in quantity, communities of today are raising the bar on quality and efficiency, creating a much improved standard from what once was. By prioritizing accessibility through practices like virtual touring, digital marketing, and public outreach, communities are utilizing both traditional and new age strategies to make themselves available to more people and committing to performing consistently at the highest level possible.
At Dellwood Gardens, we do our best to remain at the forefront of the senior care space and hope that we contribute every day to its steady improvement. We know other communities are doing the same and, ultimately, it is our partnership and collaboration that propel this ever-changing industry forward in the right direction. It is remarkable how far senior care has come; let’s see how far we can take it.
Happy National Assisted Living Week!