A History of Elder Care

History of Elder Care

Humans are inherently caring. Recently, archaeologists unearthed bones of an early human who lived approximately 500,000 years ago. Analysis showed the bones belonged to an aged and disabled man who would have had trouble walking or carrying the slightest load. To live as long as he did despite his disability, he must have had support from others in his group, which suggests that that senior care is at least half a million years old and that caring and empathy are core human traits.

In Ancient Greece and Rome, elderly people who required care had to rely on their children or extended family. In Ancient Greece, Athenian law required that children care for their aging parents, and the punishment was loss of citizenship (the second most severe punishment for Athenians, besides execution).

Senior care was ultimately the responsibility of the elder’s family, and the arrangement did not change much for 2,000 years.

Medieval Islamic World

Some of the only real progress made in the understanding of aging and senior care between antiquity and the enlightenment occurred in the Islamic world, where incredible advances in science were being made while Europe was mired in the dark ages. In 1025 CE, the Arabic writing “Canon of Medicine,” one of the earliest known texts to describe care for the elderly and one of the most influential medical texts ever, was completed by Ibn Sīnā.

The Dark Ages

During the Dark Ages in Europe, old age was frequently seen as a positive evil, and old people were often denigrated and feared (as demonstrated by the frequent witch trials). Art during the period, which invariably conveyed religious themes, portrayed the elderly as grotesque, as part of an effort to discourage materialism and attachment to the body.

The Age of Enlightenment

But, during the Age of Enlightenment, as reflected in art of the time, society seems to have to have grown to appreciate the elder and the benefits of aging. In the Renaissance and the Age of Enlightenment, the best paintings of older people evoke the experience, wisdom and even beauty of the subject who is being painted. Following the French Revolution, in town and villages across France, festivals were developed to honor local elders.

The 19th Century

The 1800′s saw major changes both for humanity and seniors specifically. In Europe and North America, governments came to realize they had some sort of obligation to insure that indigent seniors at least had somewhere to live and something to eat.

“Workhouses” and “poorhouses” were built for seniors with no means and no family to take them in. While they were intended to be charitable, these so called workhouses or poorhouses were rather awful places to live. The seniors who resided in them were referred to as “inmates.” They were segregated by sex, forced to wear uniforms, and, if feasible, required to participate in work to upkeep the property. These poorhouses also often housed orphans, disabled people, mentally ill people and alcoholics.

In “History of Long Term Care,” Karen Stephenson writes that conditions “ranged from barely tolerable to horrific.” In 1901, an astounding 10% of elderly English men lived in workhouses.

History of Senior Housing

Gradually, care became more specialized, though not necessarily much better.

A law was passed that forbade housing orphans in poorhouses. Asylums opened for the mentally ill, while residences for indigent seniors developed. In 1823, the Philadelphia’s Indigent Widows’ and Single Women’s Society, one of the first homes for the elderly, opened in the U.S.

While elderly people were no longer forced into the poorhouse, these homes were oppressively institutional and still had much to be desired. America was rapidly industrializing and it was thought the efficiency of the factory could be applied to caring for seniors.

The kernels of the modern care system developed in the mid-1800′s. As an alternatives to state-run institutions for the elderly, fraternal organizations, tradesmen and religious groups began to open nonprofit homes for seniors. Examples of these groups include the German Benevolent Society, the Odd Fellows, Masons and Knights of Columbus. Young members of these groups would pay into a pool that would operate much like a pension plan today. The homes that they operated were often quite nice, and some still operate today.

In the 20th century, aging became, for the first time, an area of study in its own right. The terms “gerontology” (study of aging) and “geriatrics” (medical care for aging people) were both coined in the first decade of the century. Interestingly, Alzheimer’s disease was first identified and described in the same decade.

Furthermore, governments across the world Western world began instituting social welfare programs that provided income to older people who were no longer able to work. The first pension for retired workers was instituted in Germany in the 1880s but other nations were slow to follow. It was the Great Depression that provided impetus for the U.S. to finally create its own “old age pension,” and in 1935, Social Security was passed under the leadership of Franklin Delano Roosevelt. Now, nearly every developed nation provides a pension for retired workers. And just 30 years later in 1965, Medicare and Medicaid were formed, helping to ensure that seniors had access to medical care no matter what their means.

Today, the elderly population is increasing rapidly. Every day, 8,000 Americans from the Baby Boom join the 40 million Americans who are already 65+. This boom in the aging population, along with the need for alternatives to the classic institutional nursing homes, prompted many types of senior care to flourish across the U.S. and the rest of the developed world. To provide intermediate care for those who don’t need a nursing home but cannot live independently, assisted living communities have sprouted up all over the U.S. Other are types of senior care and senior housing have appeared and flourished too, including in-home care, memory care, continuing care retirement communities (CCRCs) and respite care.

Age related health issues are being made a priority too. For example, Obama administration has made Alzheimer’s disease research a priority and set an optimistic goal of finding a cure for Alzheimer’s by 2025, dedicating significant funding to the mission.

Milestones of Elder Care

500,000 years BCE: First evidence of senior care (bones of elderly, disabled early human discovered in 2013)
3100 BCE-332 BCE: Egyptian Pharaohs buried with walking sticks (canes)
1900 BCE-1600 BCE: Elderly men from the Bronze age buried with copper axes, suggesting veneration
700 BCE: Ancient Etruscans created dentures out of human and animal teeth
44 BCE: Roman philosopher Cicero writes his treatise “On Old Age”
104: Roman Egyptian census records show many multi-generational households
600: Latin poet Maximianus writes “On Old Age and Love”
1025: The Arabic text “Canon of Medicine,” one of first texts to describe caring for elderly, is completed by Ibn Sīnā
1200: Icelandic law exempts those over 70 from fasts
1632: Historical Austrian census records show 8.7% of women were widows and 4% of men were widowers
1790s: Following the French Revolution, villages and towns across France hold festivals to honor elders
1823: One of the first homes for the aged opens in the U.S. (Philadelphia’s Indigent Widows’ and Single Women’s Society)
1853: One of the earliest guides to aging is published (“On the Decline of Life,” a book on “the best means of attaining a healthful old age” by Barnard Van Oven)
1880s: Germany is first nation to institute Old Age Pension
1893: Visiting Nurse Society formed to provide charitable in-home care to indigent seniors
1898: Oldest known living person, Misao Okawa is born
1901: 10% of elderly English men and 6% of elderly English women confined to workhouses (or “poorhouses”)
1906: Alzheimer’s disease is first described by German psychiatrist, Alois Alzheimer’s
1909: The term “geriatrics” is coined by Austrian doctor, Ignatz Nascher
1933: First lightweight, collapsible wheelchair invented
1935: Social Security passes as part of FDR’s New Deal
1946: Great Britain enacts free health care for elderly citizens through National Health Service
1965: Medicare and Medicaid instituted, prompting the rise of nursing homes
1974: First hospice in U.S. opens
1981: First recognized assisted living facility opens in U.S.
1993: Nicknamed “Dementiaville,” De Hogeweyk, a revolutionary new dementia care “village” opens in Holland
2010: Baby Boom becoming “Silver Tsunami,” as 40 million Americans age to 65+
2012: 5.4 million Americans are living with Alzheimer’s disease
2013: New law in China says adult children must visit their elderly parents
2015: 50th anniversary of Medicare and Medicaid

Sources:

“A History of Old Age” Pat Thane, Oxford Press, 2005
“History of Long Term Care” Karen Stephenson, self-published online book
“The History of Nursing Homes” Foundation for the Elderly

What facts about the history of caring for our elders were you surprised to see? Share your thoughts with us on elder care in the comments below.