Skip to main content
Log in

The Decline of American Orphanages and the Rise of Nursing Homes: An Untold Story of Women and Death

  • Published:
Ageing International Aims and scope Submit manuscript

Abstract

In the last 100 years, American orphanages have dramatically declined at the same time as nursing homes have seen exponential growth. This paper reviews the common understanding and assumptions about these two distinct histories and asks: why have these national responses been so different when the populations at the center of them are so similar? Among several reasons offered for these differences two unique factors that promote the institutionalization of the elderly are commonly omitted. These are: the gendered nature of institutionalized elderly populations and the stigma and social burden of death and dying. These two influences, separately and together, are either overlooked or underestimated for their impact on historical and policy outcomes. It is crucial for the future of elder care and research that these factors are recognized so that policies have a precise – and more helpful - focus on the actual challenges faced by these populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Achenbaum & Carr (2014). A brief history of aging services in the United States. Generations: Journal of the American Society on Aging. http://www.asaging.org/blog/brief-history-aging-services-united-states. Accessed 5 Nov 2018

  • Aries, P. (1962). Centuries of childhood: A social history of family life. New York: Vintage.

    Google Scholar 

  • Aries, P. (1975). Western attitudes toward death. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Barnett, O., Miller-Perrin, C. L., & Perrin, R. D. (2007). Abuse of elders. In S. J. Ferguson (Ed.), 2007 Shifting the center: Understanding contemporary families (3rd ed., pp. 647–666). San Francisco: McGraw-Hill.

    Google Scholar 

  • Bengsten, V. L. (2001). Beyond the nuclear family: The increasing importance of multigenerational bonds. Journal of Marriage and Family, 63, 1–16.

    Article  Google Scholar 

  • Bohm. (2001). Striving for quality Care in America's nursing homes: Tracing the history of nursing homes and noting the effect of recent Federal Government Initiatives to ensure quality Care in the Nursing Home Setting. DePaul Journal of Healthcare Law, 4(2), 317–366.

    Google Scholar 

  • Boudreaux, K. C., & Boudreaux, D. J. (1999). Social security, social workers, and the care of dependent children. In R. B. McKenzie (Ed.), Rethinking orphanages for the 21stcentury (pp. 171–191). Thousand Oaks: Sage.

    Chapter  Google Scholar 

  • Buhler-Wilkerson, K. (2001). No place like home: A history of nursing and home care in the United States. Baltimore: John Hopkins University Press.

    Google Scholar 

  • Bagnall, A.M., & Eval, G. (2016) "Forever Children" and Autonomous children: Comparing the deinstitutionalisation of psychiatric patients and developmentally disabled individuals in the United States. Advances in Medical Sociology 17: 27-61.

  • Cherlin, A. J. (2007). The deinstitutionalization of American marriage. In S. J. Ferguson (Ed.), Shifting the center: Understanding contemporary families (pp. 183–201). San Francisco: McGraw-Hill.

    Google Scholar 

  • Else-Quest, N. M., & Shibley Hyde, J. (2018). The psychology of women and gender: Half the human experience (9th ed.). Thousand Oaks: Sage.

    Google Scholar 

  • FATE. (n.d.). The History of Nursing Homes. Foundation for the Aid of the Elderly: Sacamento.

  • Fingerman, K. L., Kim, K., Tennant, P. S., Birditt, K. S., & Zarit, S. H. (2016). Intergenerational support in a daily context. The Gerontologist, 56(5), 896–908.

    Article  Google Scholar 

  • Gorer, G. (1955). The pornography of death. Encounter, 5(October), 49–52.

    Google Scholar 

  • Grob, G. N. (1995). The paradox of deinstitutionalization. Society, 32(5), 51–59.

    Article  Google Scholar 

  • Grundy, E. (2005). Reciprocity in relationships: Socio-economic and health influences on intergenerational exchanges between third age parents and their adult children in Great Britain. British Journal of Sociology, 56, 233–255.

    Article  Google Scholar 

  • Gustafson, E. (1972). Dying: The career of the nursing home patient. Journal of Health and Social Behavior, 13(Sept), 226–235.

    Article  Google Scholar 

  • Hacsi, T. A. (1997). Second Home: Orphan asylums and poor families in America. Cambridge: Harvard University Press.

    Book  Google Scholar 

  • Hacsi. (2009). Orphanages as a national institution: History and its lessons. In R. B. McKenzie (Ed.), Home away from Home: The forgotten history of orphanages (pp. 227–248). New York: Encounter Books.

    Google Scholar 

  • Harris-Kojetin L., Sengupta M., & Park-Lee E. (2016) Long-term care providers and services users in the United States: Data from the National Study of Long-Term Care Providers, 2013–2014. National Center for Health Statistics. VitalHealth Stat 3 (38).

  • Hawes, C., & Phillips, C. D. (1986). The changing structure of the nursing home industry and the impact of ownership on quality, cost and access. In Institute of Medicine (US) Committee on implications of For-Profit enterprise in Health Care. In B. H. Gray (Ed.), For-profit enterprises in healthcare (pp. 1–52). Washington DC: National Academies Press.

    Google Scholar 

  • Hill Collins, P. (2007). Shifting the center: Race, class, and feminist theorizing about motherhood. In S. J. Ferguson (Ed.), 2007 Shifting the Center: Understanding contemporary families (3rd ed., pp. 371–389). San Francisco: McGraw-Hill.

    Google Scholar 

  • Institute of Medicine (1986) Committee on nursing home regulations. Washington, National Academy Press. Improving the quality of care in nursing homes. Pub.No. 10M-88-10

  • Jones, M. B. (1993). Decline of the American Orphanage, 1941–1980. Social Service Review, 67(3), 459–480.

    Article  Google Scholar 

  • Jim Mansell, (2006) Deinstitutionalisation and community living: Progress, problems and priorities. Journal of Intellectual & Developmental Disability 31 (2):65-76

    Article  Google Scholar 

  • Kellehear, A. (2007). A social history of dying. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Kellehear, A. (2011). The care of older people at the end of life: An historical perspective. In M. Gott & C. Ingleton (Eds.), Living with Ageing and Dying: Palliative and end of life care for older people. Oxford: Oxford University Press [19–28].

    Google Scholar 

  • Lee, D. R. (1999). A public choice analysis of child care dollars. In R. B. McKenzie (Ed.), Rethinking Orphanages for the twenty-first Century (pp. 193–206). Thousand Oaks: Sage.

    Chapter  Google Scholar 

  • Legal Momentum. (2018). Women in Poverty in America. New York: Legal Momentum https://www.legalmomentum.org/women-and-poverty-america. Accessed 5 Nov 2018

  • Lerman, P. (1985). Deinstitutionalization and welfare policies. The Annals of the American Academy of Political and Social Science, 479(May), 132–155.

    Article  Google Scholar 

  • Lindsey, D., & Stuart, P. H. (2009). Orphanages in history and the modern child welfare setting: An overview. In R. B. McKenzie (Ed.), Home away from Home: The forgotten history of orphanages (pp. 1–21). New York: Encounter Books.

    Google Scholar 

  • London, R. D. (1999). The 1994 Orphanages Debate: A study in the politics of annihilation. In R. B. McKenzie (Ed.), Rethinking Orphanages for the twenty-first Century (pp. 79–102). Thousand Oaks: Sage.

    Chapter  Google Scholar 

  • Matthews, S. (1979). The social world of old women: Management of self identity. Beverly Hills: Sage.

    Google Scholar 

  • McKenzie, R. B. (1999). Rethinking Orphanages: An introduction. In R. B. McKenzie (Ed.), Rethinking Orphanages for the twenty-first Century (pp. 1–20). Thousand Oaks: Sage.

    Google Scholar 

  • Minnesota Department of Human Services (1995). Orphanages: An historical overview. Minneapolis, MN., MDHS.

  • Moriarty, E.M. (1999) The nation's child welfare problems as viewed from the bench. In R.B. McKenzie (ed) Rethinking Orphanages for the 21st Century. Thousand Oaks, Sage. [39-45]

  • Olson, L. K. (2006). The inner world of nursing homes. The Gerontologist, 46(2), 293–297.

    Article  Google Scholar 

  • Posner, J. (1976). Death as a courtesy stigma. Essence, 1(1), 39–50.

    Google Scholar 

  • Pratt, J. R. (2010). Long term care: Managing across the continuum. Sudbury: Jones and Bartlett Publishers.

    Google Scholar 

  • Pyke, K. D., & Bengsten, V. L. (1996). Caring more or less: Individualist and collectivist systems of family eldercare. Journal of Marriage and the Family, 58, 379–392.

    Article  Google Scholar 

  • Rymph, C. E. (2017). Raising government children: A history of foster care and the American welfare state. Chapel Hill: University of North Carolina Press.

    Book  Google Scholar 

  • Rapp, R (1992) Family and Class in Contemporary America: Notes toward an understanding of ideology. In B. Thorne and M. Yalom (eds) Rethinking the Family: Some feminist questions. Boston, Northeastern University Press [49-70]

  • Sherr, L., Roberts, K. J., & Gandhi, N. (2017). Child violence experiences in institutionalised/orphanage care. Psychology, Health & Medicine, 22(sup1), 31–57.

    Article  Google Scholar 

  • Stillion, J. (2007). Perspectives on the sex differential in death. Death Education, 8(4), 237–256.

    Article  Google Scholar 

  • Vern L. Bengtson, (2001) Beyond the Nuclear Family: The Increasing Importance of Multigenerational Bonds. THE BURGESS AWARD LECTURE*. Journal of Marriage and Family 63 (1):1-16

    Article  Google Scholar 

  • Waldrop, D. P. (2011). Denying and defying death: The culture of dying in twenty-first Century America. The Gerontologist, 51(4), 571–576.

    Article  Google Scholar 

  • Watson, S. D. (2010). From Almshouses to Nursing Homes and Community Care: Lessons from Medicaid’s History. Georgia State University Law Review, 26(3), 937–969.

    Google Scholar 

  • World Health Organization. (2001). The World Health Report 2001 – Mental Health: New understanding, New hope. Geneva: WHO http://www.who.int/whr/2001/media_centre/press_release/en/. Accessed 5 Nov 2018

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jennifer Rothchild.

Ethics declarations

Conflict of interest

None

Informed Consent

None

Ethical Treatment of Experimental Subjects (Animal and Human)

None

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kellehear, A., Rothchild, J., Defant, G. et al. The Decline of American Orphanages and the Rise of Nursing Homes: An Untold Story of Women and Death. Ageing Int 45, 121–135 (2020). https://doi.org/10.1007/s12126-019-09361-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12126-019-09361-x

Keywords

Navigation