It was not until the 1930s that things began to change for older people in need. The Social Security Act of 1935, part of President Franklin D. Roosevelt’s New Deal, provided monthly payments to those over the age of 65. Although the payments were relatively small, they were an important step. Some older people were able to leave the almshouses and live on their own. Others were able to enter private facilities.

There was an unforeseen downside. Private facilities were unregulated, which meant that many were poorly run—dirty, overcrowded, unresponsive to residents’ needs. Public facilities were at least regulated, but part of the Social Security legislation mandated that recipients were not eligible to live in them; only the truly indigent could stay in public homes.

By the 1950s, Congress realized that the situation needed to change. The Social Security Act was amended so that recipients could be eligible for public accommodations. The Medical Facilities Survey and Construction Act of 1954 mandated the construction of public facilities for the elderly.