Topics on Aging

By Juan Gallo

What are assisted living facilities, and what is their history?

September 5, 2022

What are assisted living facilities, and what is their history?
In celebration of National Assisted Living Week later this month, I want to explore assisted living facilities, or care centers, as we call them.

Simply put, assisted living facilities are designed to serve adults who need help with everyday activities like walking, eating or bathing but don’t need 24/7 nursing care.

Heart2Heart was founded as a bridge between residents of assisted living facilities and caring volunteers in South Florida. Since the pandemic, we’ve expanded our outreach to help seniors in new ways and new settings.

Despite their prevalence, assisted living facilities are a fairly modern concept. As a country, we’ve had different answers to how to help seniors in need of extra care as they get older.

However, our work in care centers remains at the core of what we do. And for good reason. We are still moved to counter the national statistic that 60% of residents will never receive a visit from family or friends once they move into a care center.

We know that more and more seniors are choosing to age in place. However there are still 918,700 assisted living residents nationwide, living in 28,900 different communities. Florida alone has 2,400 assisted living communities.

History of assisted living facilities

Despite their prevalence, assisted living facilities are a fairly modern concept. As a country, we’ve had different answers to how to help seniors in need of extra care as they get older.

In 1935, Congress passed the Social Security Act, which included the Old Age Assistance program. Leaders wanted to eliminate the terrible conditions of almshouses, where many older Americans without resources ended up. So they barred residents of almshouses from receiving the Old Age Assistance funds.

Instead, older Americans moved into private old age homes, which flourished with government funds.

Nursing homes came about in 1946, when Congress passed the Hill-Burton Act. The idea was to increase the health standards provided to residents and allow the government to regulate the facilities.

The tradeoff was the fact that nursing homes were built more like hospitals rather than comfortable homes.

In the 1970s, the private sector built even more nursing homes. This was largely spurred by the 1965 creation of Medicare and Medicaid, which paid for the care of low-income seniors. Unfortunately, the conditions and reputation of nursing homes took a hit during that expansion.

Keren Brown Wilson is credited for the concept of assisted living facilities. Her goal was to create a space where seniors could claim some independence but still receive the care they needed.

Park Place opened in 1981 in Portland, Oregon. This first modern assisted living facility featured private rooms that locked, 24-hour staffing and common spaces for social activities.

Modern challenges

Most recently, assisted living facilities encountered a new crisis during the pandemic. As a country, we saw how susceptible senior residents were to deadly communicable diseases. I think we’re still seeing the consequences of that crisis play out.

However, as a society, we need assisted living facilities to provide for seniors who need extra care and don’t have relatives who can take on that responsibility for them.

We’ll continue to explore this topic this month, diving into cultural considerations and how to make tough decisions about placing a loved one in a care center.

Read more about:
Juan Gallo
Juan Gallo is the CEO of Heart2Heart Outreach, where he oversees the mobilization of volunteers to provide hope, share love and restore purpose to the lives of the aging population across South Florida.

He also serves as a local pastor and as an adjunct professor at Trinity International University, where he is teaching a course on diversity and aging. Juan has a master’s degree in counseling and psychology and is a licensed mental health counselor intern.


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This blog is a frank conversation about what it means to age in our society.

I want us to consider what a wider range of diverse experiences when we talk about aging. I want to reflect on how we, as a community, want our neighbors and our mothers and fathers and our grandparents to live out their latter decades of life. I want us to consider each one of their voices as we strive to meet their needs.

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