I hope you have enjoyed our new audio podcast, “Aging is a Trip,” which takes a candid yet lighthearted look at many aspects of aging and retirement.
Dr. Karen Wilson
In a recent two-part interview, I had the pleasure of speaking with Dr. Keren Wilson, a gerontologist who played a pivotal role in shaping assisted living in the United States. Dr. Wilson opened Oregon’s first assisted living facility in 1981 and has spent decades improving care options for older adults.
In 2001 she founded the Jessie F. Richardson Foundation to expand access to elder care in underserved regions of Oregon. More recently she launched AGE+, a nonprofit that helps vulnerable seniors in rural Oregon with housing and care—people who don’t qualify for subsidized housing or Medicaid but are close to poverty and need affordable housing and support services.
The “poor house” and the history of aging in the U.S.
Our conversation covered developments in gerontology, advances in technology, and the senior living industry’s response to the COVID-19 pandemic. We also discussed the history of elder care in the United States and how models of care have changed over time.
When the country was founded, families generally cared for their aging relatives. If no family could provide care, elders became wards of the county and were placed in foster homes. As the population aged, counties opened group homes for indigent seniors, which eventually evolved into poor houses or poor farms across the nation.
By the mid-20th century, medical advances such as antibiotics extended life spans and increased the duration of disability. At the same time, more women entered the workforce during World War II, reducing the number of family caregivers. These shifts created demand for boarding homes that provided basic care for older adults.
The creation of Medicare and Medicaid in 1965 shifted much of the financial responsibility for elder care away from counties. Boarding homes converted into nursing homes to qualify for federal funding, and new facilities were often built with institutional, hospital-like designs rather than the homelike environments residents had previously known.
Today the industry is, in many ways, returning to more home-like models of care. Designers and providers are moving away from sterile, clinical settings and toward environments that feel more residential. Co-housing arrangements and independent living communities for retirees are growing in popularity—options that were uncommon before Medicare reshaped the sector.
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The birth of the assisted living concept
In 1988 the Oregon facility Dr. Wilson established became the first licensed assisted living community in the U.S. serving Medicaid patients. During the 1980s she developed the core principles of assisted living, drawing inspiration from her mother’s experience in a nursing home and from the needs she observed in residents and staff.
Assisted living focuses on maximizing autonomy and dignity in a residential setting. Residents keep control over daily choices such as room temperature, meal times, bedtime, and personal belongings—including furniture and pets—while receiving supportive services like housekeeping, meal assistance, help with dressing and bathing, and medication management.
>> Related: Improving the Image of Nursing Care & Assisted Living
Hearing what people are saying
Throughout her career Dr. Wilson emphasized the importance of listening: to her mother’s observations, to employees on the front lines, and most importantly to residents themselves. When caring for human lives, being responsive to concerns is essential.
This willingness to listen is a key takeaway from our conversation. The senior living industry should continually seek input from those most affected by its decisions—residents, families, and staff. These stakeholders live with the consequences of policies and management choices, and their perspectives are critical to improving care and services.
There are many positive developments in senior living today, in large part due to the dedication of leaders like Dr. Wilson. But like any service-oriented field, the industry must remain attentive to feedback and adapt. Opportunities to solicit and act on residents’ constructive input can lead to meaningful improvements in daily life and long-term outcomes.
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