User Rating: 5 / 5

Star ActiveStar ActiveStar ActiveStar ActiveStar Active

Medical care enjoyed an exciting time of advancement in the 18th century, with healthcare professionals making strides in the treatment of scurvy, the invention of bifocals, and more. Among elderly populations, medical care was often the responsibility of an individual’s extended family.

It’s important to note that the word “elderly” meant something vastly different in the 18th century than it does today. During the U.S. Liberty Era or the period between 1750 and 1800, the average life expectancy was only 36 years. That’s not to say many individuals didn’t make it to their golden years: George Washington died in 1799 at the age of 67, for example, while Benjamin Franklin turned 84 in 1790, the year of his death.


Both founding fathers were likely cared for by family members during their later years. Families were ultimately responsible for senior medical care beginning about 2,000 years ago, and the tradition continued into the 18th century. It wasn’t until the mid-1800s that nursing homes and similar facilities for the elderly were introduced, although the first hospitals were established in the 1700s.

18th Century Hospitals and Nurses

Pennsylvania Hospital, the first hospital in the U.S., was founded by Benjamin Franklin and Dr. Thomas Bond in 1751, and its main building was built in 1756. Also home to the country’s first medical library, the hospital stands to this day on Spruce Street in Philadelphia. But it wasn’t always held with high regard — Pennsylvania Hospital, like the facilities that would follow it, primarily functioned as an asylum/poorhouse. Hospital facilities weren’t deemed reputable or safe until sometime in the 1800s.


Also in Philadelphia, the Friends’ Almshouse was founded in 1713, and it served seniors and various people in need. Within poorhouses, a variety of “undeserving poor” were housed, from the elderly to orphans, drunks, and the mentally ill. Nursing was not yet a profession at this time, and nursing duties at poorhouses and early hospitals were performed by nuns and/or military personnel.


Within home healthcare settings, nursing in the 18th century was considered a domestic duty wherein one cared for members of the extended family, especially the elderly and infirm. The societal view of nursing began to change in the mid-1800s, as nurses were hired to care for sick family members and were paid a cash wage. The U.S. Army established its nursing corps in 1901, and nurses played a major role in the field during World War II. At the time, about 30% of active duty army nurses were volunteers.

The Rise of Nursing Homes

The elderly were considered honorable members of the population in the 1700s. Following the French Revolution in the 1790s, towns across France held periodic festivals honoring their elders. Much of the art of the time reflected the experience and wisdom of the elderly through realistic painted portraits, and civic symbols, such as urns and willows, began to appear on grave markers of the elderly.


In some ways, we have lost some of that integrity and respect for our elders in the modern era. As family members age and require more frequent healthcare, many people place their elderly relatives in nursing homes and assisted living facilities more than ever before in history. As of 2012, more than 1.3 million Americans were living in nursing homes, according to the Institute on Aging.


Unfortunately, nursing homes today share some commonalities with the poorhouses and asylums of the 18th century. Early hospitals were rife with abuse and cases of neglect, and elder abuse remains a reality into the modern era. A special investigation by the House Government Reform Committee between January 1999 and January 2001 revealed more than 9,000 instances of elder abuse in U.S. nursing homes. Approximately one out of every three nursing homes had reported some type of elder abuse during that time.

An Increasing Elderly Population

With the advent of vaccinations and improved healthcare and hygiene, global life expectancy has increased over time. Today, there are more elderly individuals than ever before, and the numbers continue to climb. Western Governors University reports that: “By the year 2030, the number of people over 60 years of age will increase by 56 percent, from 900 million to 1.5 billion. In the United States alone, the number of Americans over the age of 65 is expected to double from roughly 50 million today to nearly 100 million by 2060.”


The growing elderly population equates a need for medical policy updates and facility upgrades. There may be a need to revamp the existing Residents’ Bill of Rights for nursing home residents, for instance. Guaranteed by the federal Nursing Home Reform Law of 1987, the Residents’ Bill of Rights lays out a variety of policies that nursing homes must adhere to. Among nursing home, patient rights are the right to privacy and the right to live in a caring environment free from abuse, mistreatment, and neglect.


Medical care for the elderly has evolved considerably since the 18th century. Long gone are the days of poorhouses and a remarkably short life expectancy, yet challenges remain, especially where nursing homes are concerned. By advocating for harsh punishments in cases of elderly abuse and ensuring that resident rights are respected, we can ensure the safety of our aging loved ones, even when we must turn their medical care over to the professionals.

About the Author:
Frankie Wallace contributes to a wide variety of blogs and writes about many different topics, including politics and the environment. 
Wallace currently resides in Boise, Idaho and is a recent graduate of the University of Montana.