almshouse

almshouse, in the United States, a locally administered public institution that provided housing and health care to people who were of limited financial means and were otherwise disadvantaged. Almshouses radically declined in number in the United States during the mid-20th century, being replaced by other forms of social services, and they have, in name, all but disappeared today.

Dating to the 17th century, the almshouse was often used as a dumping ground for a wide range of disadvantaged and vulnerable people, including those experiencing homelessness, poverty, illness, disability, and discrimination. People convicted of relatively minor crimes were also sent to almshouses, as were orphaned, abused, and neglected children. Almshouses were often operated in conjunction with a farm, and they met costs through the sale of farm produce.

After the turn of the 20th century, almshouses—which by this time were more commonly known as county homes—incurred widespread criticism for a number of problems, among them their failure to provide differentiated treatment to their residents, their provision of minimal medical and nursing care, their low sanitation and safety standards, and their residents’ physical and mental deterioration, caused by the neglect and incompetence of the homes’ operators. These evils were gradually but not altogether eliminated by transferring many residents to specialized state institutions that could better care for their needs, a process that had begun in the middle of the 19th century. Moreover, the Social Security Act of 1935 enabled some elderly people who qualified for assistance to leave county homes. From a peak of probably 135,000 in the early 1930s, the population of such homes in the United States dropped to an estimated 88,000 in 1940 and to 72,000 in 1950. Residents in 1950 consisted largely of the elderly. Closings and consolidations reduced the number of homes from 2,200 in 1923 to approximately 1,200 in 1950.

The Social Security Act’s prohibition against federally aided old-age assistance to residents of public institutions reflected a conviction that county homes were unnecessary. However, various developments after 1935, particularly the rapid growth of commercial nursing homes, indicated that many elderly people required sheltered care—or at least home-supervised care—and that, in the absence of other facilities, those people without sufficient financial means would need some kind of local public institution. Recognition of this need came in the 1940s, a time of increasing public awareness of the lack of adequate facilities for those people experiencing chronic illness. As a result, a number of U.S. states passed legislation encouraging the conversion of county homes to other types of institutions and forms of social support. In addition, social security benefits and, later, Medicaid substantially lessened reliance on public homes until they became effectively obsolete.