It is a fading fact that a prominent side-purpose of Social Security, when first enacted, was to empty the elderly out of these almshouses and poor farms, almost all of which were operated by state, county and municipal governments. This measure would be accomplished via monthly Social Security stipends that impaired older persons could use to purchase lodging and care in more hospitable board and care homes and other upgraded accommodations. It was, in fact, an explicit stipulation of the original Social Security act that individuals could not use Social Security funds in publicly supported almshouses (1) or other government residential institutions. (This ban on Social Security checks used in public facilities was lifted in the 1950 Social Security amendments due to government’s waning confidence in private nursing homes and the need for more facilities.)
Thus did America close the doors on its almshouses and, in turn, induce the rapid rise of private, for-profit (and non-profit) nursing facilities in this country. U.S. nursing homes began as mostly small board-and-care accommodations, but eventually grew to include much larger institutions, modeled on hospitals during the health-care building boom of the 1950s and 1960s.
Today, close to 90 percent of the country’s 16,100 nursing homes (2) are privately owned; about half are part of large chains; and roughly 62 percent are for-profit. America now has approximately 1.7 million nursing home beds occupied by roughly 1.5 million persons for an occupancy rate near 86 percent (down from over 90 percent 15 years ago). The average nursing home has about 107 residents. After nearly a half-century marked by spotty, uneven regulations from state to state, in 1987 the federal government enacted the Nursing Home Reform Act – also known as OBRA ’87 (Omnibus Budget Reconciliation Act, 1987) – calling for stricter nationwide standards and more stringent enforcement. The act has gone a long way in improving conditions in nursing homes, but the quality of life in many remains a widespread concern.
(1) Payne, Michael R. “How Did We End Up Here?” A Critical Inquiry Regarding the Evolution of the American Nursing Home and Ohio’s Medicaid Funding Formula: http://www.ohiolink.edu/etd/view.cgi?acc_num=miami1154010278
(2) Nursing Home Facilities- 2006 (www.cdc.gov/nchs/data/nnhsd/nursinghomefacilities2006.pdf)