Historical Evolution of Assisted Living

If you are considering an assisted living option for yourself, or if you are an adult child trying to help a parent determine the most suitable living environment, assisted living may be on your list of options. With that said, you may not really know all that much about assisted living in the United States. This article is designed to provide you some essential and helpful information about the historical evolution of assisted living in our country.

Genesis of Assisted Living

What has evolved into assisted living facilities in today’s world can trace its origins back to 1965 and enactment of Medicare and Medicaid. Prior to 1965, there were residential settings for older individuals that needed assistance with day to day living tasks or who had certain types of health issues. Those facilities more focused on older people who needed some assistance with certain tasks of day to day living oftentimes were called boarding homes or homes for the aged. 

The enactment of Medicare and Medicaid did result in some of these boarding facilities and homes for the aged converting into nursing care homes. Not all such facilities made this transition. It is these facilities that did become medical care or nursing care centers that continued on the pathway to what are now known as assisted living communities in the 21st century.

The Name Game: Monikers of Assisted Living Facilities From 1965 Onward

In order to trace the historical evolution of assisted living in the United States, it behooves us to appreciate at least some of the different names these types of facilities utilized after the enactment of Medicare and Medicaid. What are now most commonly known as assisted living facilities used more than 30 different names after the enactment of Medicare and Medicaid. These include:

  • Residential care
  • Community care
  • Personal care
  • Domiciliary care
  • Supervisory care
  • Sheltered care
  • Adult foster care
  • Board and care
  • Family care
  • Group care
  • Boarding care

First Use of Term Assisted Living

While the concepts underpinning assisted living are not new, the term itself is of relatively recent origin. The first written use of the term assisted living appears to trace back to the state of Oregon in 1985. A pilot study was created in that state in which funding was provided for 20 individuals to receive services in a residential setting. 

Assisted Living Defined in the 21st Century

The reality is that an exact definition of assisted living is a bit elusive today. There has never been a single, nationally accepted definition of assisted living in the United States. As a consequence, assisted living oftentimes is recognized by the assistance provided to residents rather than by a precise definition. Examples of what typically is offered by U.S. assisted living facilities includes:

  • Room and board
  • Assistance with activities of daily living (sometimes referred to as ADLs) that include:
  • Bathing
  • Dressing
  • Grooming 
  • Eating
  • Transportation
  • Housekeeping
  • Laundry
  • Obtaining medications
  • Supervision of medications
  • Accessing social services

Philosophy of Assisted Living

Those individuals who have come to favor assisted living as a residential alternative for older Americans have asserted a philosophy that they believe is useful in understanding assisted living itself:

Assisted living is dedicated to maximizing functional capability and autonomy, and utilizing the environment as an aid for independence and socialization that makes assisted living distinguishable for other types of supportive living. 

Paradigm of Assisted Living

A paradigm of assisted living was created in 1990 that is still useful today in understand this type of long-term care option. This paradigm is comprised of four parts:

  • Assisted living is a setting where a person can create his or her own place.
  • Assisted living is responsive to the needs of individuals at different levels of physical and mental abilities.
  • Assisted living encourages sharing the responsibility with residents and their family members.
  • Assisted living provides autonomy and independence to residents.

U.S. Department of Housing and Urban Development and Assisted Living

The U.S. Department of Housing and Urban Development has been involved in assisted living programs in some communities as well. That federal agency has developed its own definition of assisted living that has proven itself helpful.

Assisted living is described as a public facility, proprietary facility, or facility of a private nonprofit corporation that is used for the care of the frail and elderly and that:

  • Is licensed and regulated by state and if these is no state law providing for such licensing and regulation by the state, by the municipality or other political subdivision in which the facility is located.
  • Makes available to residents supportive services to assist residents in carrying out activities of daily living.
  • Provides separate dwelling units for residents.

With this overview, you are in a better position to understand what is available through an assisted living community. You also get a clearer picture of what is not part of an assisted living program.