History of Long Term Care
Early Long Term Care
From the 12th through the 15th centuries nearly 700 shelters for the aged, were built in England. These institutions housed populations similar to those deemed long-term residents in today's facilities: the aged, those without means of support in their own homes, and the handicapped.
Precursors of Today's Administrator in Training Programs
In England, before 1453, long-term care facilities were associated with monasteries, but were administered jointly by persons appointed jointly by the king and the local bishop. Did long-term care administrators receive training for their jobs in those days? Probably so, in an apprenticeship system not unlike the administrator in training program required by most states today!
Early Federal and State Facility Inspection Programs
In 1536 King Henry VIII, in a dispute with the Catholic Church, closed all the monasteries and their long term care facilities. In 1546 the King appointed a board of local citizens to oversee the management of long term care facilities throughout England. In 1601 the first Queen Elizabeth required each local community to care for the elderly in their own homes as long as possible, then to provide care in a facility. In 1722 England enacted the Poor Law (equivalent to today's Medicaid law) believing that sick and poor elderly could better be cared for in institutions than at home.
Long Term Care in the American Colonies
The American colonies followed the English pattern, establishing similar institutions for the poor in Philadelphia (1722), New York City (1734) and Charleston, South Carolina (1735). Subsequently, most American cities and counties established homes for the aged, which flourished over the 18th and 19th centuries.
Trends: Early 20th Century
Early in the 20th Century the United States became a primarily industrialized society. This increased the pressure to establish long-term care facilities for older Americans because aging workers in cities had fewer children to care for them. Industrial wages were too low then as now, to allow typical workers to save enough for their old age. The trend toward longer life spans and increased health care needs began early in the 20th century.
Establishing the Current Federal and State Long Term Care Programs
The federal government came to the rescue of our parents who were increasingly living longer, but without sufficient savings. Legislation was enacted beginning with the Social Security Act of 1935. Old age survivors benefits, health benefits (Medicare, 1965) and benefits for the handicapped were progressively added during the 1950s and 1960s. Today this is known as the Old Age Survivors Disability Health Insurance (OASDHI) and deductions to pay for it are taken from each of our paychecks.
From 'Mom and Pops' to Sophisticated Five Million Dollar Facilities
Mom and Pops
Social Security checks placed money into the hands of the elderly which enabled them to purchase care in what became known as the Mom and Pop homes of the1940s, 1950s, and 1960s.
Federal legislation in the 1950s offered attractive subsidies to anyone who would erect a nursing home, thereby setting off a building boom that produced thousands of nursing homes.
Policies for the Building Boom Facilities
By the early 1960s so many new nursing homes had been built that, in effect, a new unregulated industry was created. The U.S. Senate held hearings and Congress began developing policies, called the 'Conditions of Participation' to assure that each elderly person whose medical expenses were being paid by Medicare received high quality care. Today these are called the 'Federal Requirements and Guidelines to Surveyors.'
Setting Today's Education Requirements for Long Term Care Administrators
A Congressionally appointed Commission met in 1968 and recommended what today are known as the five Domains of Practice which persons must study in order to become licensed nursing home administrators: management, personnel, finance, regulations and resident care.