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Encyclopedia Dubuque

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Category:Nursing Homes

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NURSING HOMES. Without a federal assistance program to help pay for the care of elderly or disabled, most states sent their impoverished citizens to "poor farms" or "almshouses." The homes were known for their dilapidated facilities and inadequate care, and states appeared to encourage the stigma as a motivating factor to keep people from relying on them. Some immigrant communities established organizations that helped newcomers and the aging instead of using public services.

The New Deal helped promote the idea that elderly citizens should receive federal benefits on the basis of need. Social Security is now universal, and only tangentially needs-based.

The Social Security Act was signed by President Franklin Delano Roosevelt on August 14, 1935. The act provided matching grants to each state for Old Age Assistance (OAA) to retired workers. To discourage almshouse living, however, people living in public institutions were not eligible for the payments. That paved the way for the opening of a variety of private old-age homes, so that people could live in a care facility and still collect the Old Age Assistance payments.

The Hospital Survey and Construction Act, known as Hill-Burton, provided funding for constructing state-of-the-art hospitals. In the 1920s, hospitals began to be seen as "Houses of Hope," whereas before they were places where poor people recuperated or died. The Depression and World War II, however, limited the number of facilities that could live up to that ideal, so by the time WWII ended, there was an enormous backlog of need in almost every community for modern health care facilities.

Significant amendments to the Social Security Act included a requirement that states must establish some form of licensing for nursing homes. They also lifted a ban on providing benefits to residents of public facilities and channeled federal moneys to health service providers.

A change in federal law provided grants for the construction of nursing homes "in conjunction with a hospital" in an attempt to raise the quality of care. The change meant that the physical construction of nursing homes began to be modeled after hospitals. It also transformed nursing homes from being part of the welfare system to being part of the health care system. (http://www.pbs.org/newshour/health/nursinghomes/timeline.html)

Nursing homes in Dubuque have included: