Social Services

The eligibility requirements of major programs for the elderly influence our understanding of what it means to be ‘‘old’’ in America today. At sixty-two years of age an American is eligible to begin collecting Social Security benefits. Eligibility for most programs funded under the Older Americans Act begins at age sixty. Medicare eligibility begins at age sixty-five. So, for twenty-first-century Americans, ‘‘old age’’ might begin in the early- to mid-sixties.

Lacking programs and policies to define them as ‘‘old,’’ elderly people prior to the twentieth century were judged by their individual attributes. Infirmity, more than chronology, was the hallmark of old age. Services for the elderly were based not on their age but on their needs. Consequently, destitute elderly people might have been found in early nineteenth century almshouses along with children and young adults.

Beginning in the 1830s, this notion of a homogeneous class of needy Americans was challenged. Reformers who served the urban poor became interested in more efficient use of their resources and decided to focus on those most capable of reform, ‘‘the redeemable poor.’’ The elderly were not included in this category. In 1855, for example, the New York Association for Improving the Condition of the Poor resolved, ‘‘to give no aid to persons who, from infirmity, imbecility, old age, or any other cause are likely to continue unable to earn their own support and consequently to be permanently dependent’’ (italics added). Urban Charity Organization Societies (COSs) took the same position. In 1892, Amos Warner expounded on the hopelessness of work with the aged, ‘‘In work with the aged one is conscious that for the individuals dealt with there is no possibility of success’’ (Haber, p. 40).

So, while COS and other philanthropies were providing rehabilitative and educational services to the young, elderly people were confined to public almshouses. Over time they made up a growing proportion of the almshouse population and so (particularly among charity professionals) age came to be associated with destitution.

In 1902 Homer Folks, New York City’s Commissioner of Charities, announced a new name for the city almshouse, the Home for the Aged and Infirm. Folks intended to send the message that the residents of this facility were not the lazy able-bodied, but simply too old or sick to earn a living. In time, institutions like the home came to be seen as the most appropriate setting for needy elders.

As ‘‘homes’’ or ‘‘asylums’’ were populated by the elderly and infirm, they took on a more medical focus. The line between hospital and almshouse blurred and ‘‘old age homes’’ began to employ physicians and nurses, setting the stage for the expansion of facilities we now call nursing homes.

African Americans were generally denied access to these and other public sources of assistance. Using a ‘‘self-help’’ model, ‘‘benevolent societies’’ were organized to provide assistance to needy African Americans. In the antebellum era, African American elders often lived in abject poverty. Benevolent societies were formed, primarily in northern urban communities, to help them in times of need. Society members paid annual dues and in return were given sickness and death benefits. The number of these societies quickly mushroomed. Philadelphia alone had over one hundred societies serving over seven thousand members. During the latter part of the nineteenth century the resources of benevolent societies were strained by the aging of their members. Ultimately they were replaced by insurance firms with greater financial reserves. Nonetheless, the benevolent societies represented a significant resource to meet the needs of elderly African Americans (Pollard).

In sum, the nineteenth century saw an evolution in the treatment of indigent elders. They were initially grouped with other groups of ‘‘worthy poor,’’ but over time the elderly came to be distinguished from other indigents. Agencies that focused on the ‘‘redeemable poor’’ gave up on elderly people, reserving their energy and resources for young people with some hope of employment. Needy elderly people increasingly found themselves ‘‘warehoused’’ in institutional settings—precursors of twenty-first-century nursing homes.

Formal services for the elderly consisted primarily of institutional care. Informal arrangements, such as those provided by the benevolent societies, and through churches and families, constituted the primary source of services for needy elders who lived in the community. The twentieth century saw two significant social trends that were to permanently alter patterns of elder care in the United States: the widespread entry of women into paid employment, and the dramatic increase in life expectancy.