History of Nursing Homes Essay
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Today, there are approximately 16,100 nursing homes in the U. S. with approximately 1. 5 million residents (www. cdc. gov). However historically, the sick, disabled, and aged were cared for at home by family members. Changes in technology and social changes have created a shift in how we care for our elderly and disabled, and there is evolution in geriatric care that continues today (Morris, 1995). Nurses have had a huge role in revolutionizing the care for our elderly and for creating what is the modern nursing home.
Caring for the old age, or geriatric nursing, is often not viewed as being as prestigious as other specialties in nursing. Despite the growing elderly population and the fact that 46% of all Registered Nurses will be providing direct care to the elderly, the majority of nursing students still do not receive any specialized content in geriatric nursing (Ebersole & Touhy, 2006). Later on, we will discuss the development of geriatric nursing as a specialty and as it relates to the history of long-term care.
In the sixteenth century, we began to see institutions developed to care for a variety of people in need.
This did not just include the elderly or disabled, but any dependent poor, sick, orphaned children, widows, insane, and even minor criminals. These institutions could be considered a predecessor to the nursing homes that eventually followed (Morris, 1995). Poor laws in Europe gave rise to these institutions referred to as workhouses, almshouses, or poorhouses. They provided very minimal nursing care, and the care was often provided by “pauper nurses” who were not trained and usually inmates themselves, often alcoholics. Agnes Jones, a Nightingale trained nurse visited a Liverpool Infirmary in 1864 and reported “deplorable” conditions.
She was forced to dismiss 35 pauper nurses for drunkenness and stated that bed clothes had not been washed for months (Ebersole & Touhy, 2006). These poorhouses were common in the United States as well and often had the same deplorable conditions. Carolyn Bartlett Crane, the Chairman of Charity Organization Department of Women’s Civic Improvement League of Kalamazoo, MI attempted to address these problems first with the Michigan State Nurses’ Association in 1906 and again with the Nurses’ Associated Alumni of the United States in 1907 with pleas for nursing care in these almshouses.
In her 1907 paper, “Almshouse Nursing: the Human Need; the Professional Opportunity”, she described the county almshouse as a “hospital with the hospital part left out. ” She went on to talk about how the specialization of institutions for certain groups, such as asylums and orphanages, left the elderly and infirm to be the majority of those left with no other options besides the poorhouses (as cited in Ebersole & Touhy, 2006 p. 8). Little progress was made. In 1912, the American Nurses’ Association Board of Directors appointed an Almshouse Committee to oversee housing in these institutions.
Progress continued to be slow. From 1910 to 1920 focus was taken away from elder care due to the war (Ebersole& Touhy, 2006). An article published in the American Journal of Nursing in 1930 by Munson, R. N. discussed the conditions in the almshouses and lack of quality nursing care. She states, “Modern nursing in England and in this country was started with the purpose of ‘cleaning up’ just such conditions in hospitals as are still found in almshouses. ” She proposed that these small almshouses be consolidated into larger facilities that are better managed (1930).
Morris describes the factors that have led to the need for the care that nursing homes provide today. They describe an area of healthcare when a person is not acutely ill and in need of hospital care, but is perhaps chronically ill and cannot return independently to live in his or her home. This “middle” is ever changing and is affected by two factors: technology and social change. As we discussed earlier, care for the elderly and infirm had largely been done by individual families. Poorhouses and almshouses arose to meet the need for anyone who did not have family to care for them or means to care for themselves.
The need increased in the U. S. as the immigrant population rose and there was a shift from extended to nuclear families. A child born in 1900 had a life expectancy of only forty-seven years old. As medical technology, for example, infection control, rapidly developed, the population of elderly people increased. With the rise in aged population, there was an increase in chronic disabilities associated with age (1995). In the nineteenth and twentieth centuries, living standards increased. The poorhouses began to become a thing of the past as there was a movement to specialize care for certain groups.
For example: asylums for mentally ill, TB sanatoriums, veterans’ hospitals, and orphanages. There was homecare provided by public health nurses, but many refused to care for the chronically ill (Morris, 1995). As mentioned earlier, the elderly and infirm were among the last left in the poorhouses. Thanks to the efforts of many, including many nurses, there was a push to provide better care and bring trained nurses into these almshouses. By 1940, increased expectations for care and the Social Security Act led to the rise of the modern nursing home.
The Social Security Act provided a means for elderly who could no longer work and widows to have financial means to pay for care. Entrepreneurs quickly took advantage and homes for the elderly were often as much for profit as for care. By the 1960s, scandals and patient neglect led to increased regulation and public control over expansion (Morris, 1995). Medicare and Medicaid provided more money for care of the elderly and also further increased government control. Rapid increases in technology and new treatments led to a further rise in the aged and vulnerable population and increasing costs.
Nursing homes became linked to local hospitals and doctor referrals. Some homes specialized their services to include services for cognitive impairment or active rehabilitation. Government reimbursement and regulation became more complicated. Nursing homes became less “homes” and more medical facilities. They operated with a limited nursing staff and very little physician presence. It continues today that nursing homes face contradictory pressures to accept sicker and more difficult patients while at the same time maintaining a “home-like” atmosphere.
All this while limiting costs (Morris, 1995). As more specialized care for the elderly developed, it was apparent that the needs of the elderly were not as simple as taking the principles of nursing care and applying them to the aged. Geriatric nursing has only become recognized as a specialty within the past fifty years. However, the origins of gerontological nursing can be traced all the way back to Florence Nightingale who once was a superintendent in an institution we would call a nursing home today.
The clinical study of the aged can be traced back much further to Hippocrates. A Viennese physician, Ignatiz Nascher coined the word “geriatrics” in a 1909 New York Medical Journal article. In 1935, a physician named Marjorie Warren established an elderly concentrated practice with a concentration on environment, rehabilitation and motivational methods (Ebersole & Touhy, 2006). Geriatric nursing is a unique specialty in that it was developed by nurses themselves. Other nursing specialties were first developed in medicine and then carried over to nursing.
The reason for this difference is that medicine so often concentrates on curing illness and prolonging life. As Ebersole states, “Old people often have little life left and therefore are unattractive subjects. ” Nurses, in contrast, have always sought to prevent illness and alleviate suffering (Ebersole & Touhy, 2006). It seems fitting that nursing, and not medicine, would give birth to this specialty and that is something that nurse’s should take pride in. However, as mentioned earlier, geriatric nursing is often considered the least prestigious of nursing concentrations.
With the continued rise of the elderly population as the baby-boomer generation ages, nurses should be prepared to care for elderly in some capacity no matter which specialty they choose. It is unfortunate that nursing schools often provide little material on geriatrics as a unique population. Care for the elderly has continued to make slow, but consistent progress even in more recent years. Although we are leaps and bounds from the almshouse, there has still been serious abuse and neglect in nursing homes and cries for change in the way we house and care for our elderly.
In addition to more people receiving homecare services that allow them to live at home longer, there are other movements to change the nursing home itself. William Thomas describes an alternative concept that hopes to revolutionize long-term care, the Eden Alternative. He states, “The modern American nursing home is being crushed between the intrinsic weaknesses of the institution and the rising expectations of a new generation of elders. We are witnesses to its destruction. Like the leper colony, the tuberculosis sanitarium and insane asylum, the nursing home is about to be heaved onto the ash heap of history (Thomas, 2003 p. 42). ”
In 1992, the Eden Alternative began as a grant project in New York. It has changed over the years, but is based on a set of principles that aim to make facilities more like homes. The focus is on treating the residents as unique individuals first and patients second. Some changes that differ from traditional nursing homes include environmental changes like carpets, plants, and allowing pets and personal items, single rooms, and family style meals. Staff at Eden facilities do not dress in scrubs and whenever possible, a child daycare is on site to increase staff satisfaction as well as bringing more life into the facility.
Currently only about 2% of U. S. nursing homes have adopted this new format despite the statistics showing significant reductions in behavioral incidents, decubitus ulcers, bedfast residents, use of restraints, and staff absenteeism. There was also an increase in census (Thomas, 2003). Going a step beyond the Eden Alternative, an even more recent development has been the “Green House” with a focus on smaller being better. These homes aim to blend seamlessly into a community and house up to eight residents in what is more than a home-like atmosphere, but very much a home.
The technology would still be utilized, but as in the original Eden model, it should be woven into daily life without interfering with it. So far, Green Houses have been able to meet the increasing challenges of providing state of the art care and keeping costs down while complying with state and federal regulations (Thomas, 2003). In conclusion, the nursing home and geriatric nursing have developed to meet the needs of a changing society with ever increasing medical advances and a larger than ever population of elderly.
Nurses have been a huge part in the development of what has become the modern nursing home. As the geriatric nursing specialty has grown, there has also been greater understanding of the unique needs of our aging population. It is clear that despite the advances made, there is still much dissatisfaction in how we care for our elderly population and a lot of room for improvement. New alternatives are being developed and it will be fascinating to be in the field of nursing to witness the changes that are yet to come.