Before the middle of the 20th
century, “the poorhouse” wasn’t an abstract concept.
Through the World War II era,
mostly county governments in the U. S. provided much of the care for the
indigent and elderly folks who could not afford medical care or couldn’t take
care of themselves.
The facilities—“poorhouses” or, in some areas, “poor
farms”—were often marginal or wretched.
They were systematically closed
by mid-century, in tandem with a massive, federally-sponsored buildout of
hospitals after WWII. In 1954 the federal government started providing funds so
hospitals could build separate custodial units for patients who needed an
extended period of “recovery,” and people who couldn’t take care of themselves
increasingly ended up in extended stays in the expanded hospital facilities.
That was the beginning of modern nursing homes.(1)
In the present time, economic
constraints in the hospital health care system are reducing a patient’s time in
hospital, and steadily pushing the indigent, elderly, helpless and terminal
people toward retirement homes, nursing homes, hospice care, private care or no
care.
(1) Atul Gawande, Being Mortal: Medicine and What Matters in
the End (New York: Metropolitan Books, Henry Holt and Company, 2014),
68-71.
Copyright © Richard Carl Subber
2015
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