The concept of a residence set aside solely for the elderly and infirm was unknown until the nineteenth century. Before that, it was understood that elderly people would be taken in by family once they were unable to care for themselves. Those who had no family could rely on servants if they had the financial resources, but for those who were alone and poor the only choice was the local almshouse.
As the Industrial Revolution brought more people to cities, families spread out and often people had no local extended family to fall back upon when they were in need. The result was a growing number of single and widowed people who had no one to take care of them in their old age. The first homes for the elderly were established by churches and women’s groups, catering to widows and single women who had limited resources. Homes such as the Indigent Widows’ and Single Women’s Society in Philadelphia and the Home for Aged Women in Boston were a far better option than an almshouse. These early homes were not open to all. Many of them required entrance fees, and some asked for certificates of good character. Requirements like these shut out the neediest, who were still relegated to the almshouse.
By the beginning of the twentieth century, sensibilities about caring for the poor and incapacitated had begun to change. Specialized facilities were built for children, the mentally ill, and younger infirm individuals. But little was done for the elderly, and they merely became a larger percentage of the almshouse population. In 1880, one third of the residents of almshouses in the United States were elderly; by 1923, two thirds were elderly.