Senior Living History: 1960s

Building on Existing Help for Seniors

When the decade began, many older adults struggled to afford medical care. In 1960, Congress expanded the Old Age Assistance program and created Medical Assistance for the Aged (MAA), also known as “Kerr-Mills.” This short-lived program helped low and moderate-income seniors who weren't poor enough for welfare but couldn't afford medical expenses.

States received federal matching funds to provide care. However, participation was uneven across states as it was voluntary. While Kerr-Mills helped thousands of seniors, it also led to skyrocketing costs.

Nursing Home Boom

With guaranteed government payments, construction of nursing homes boomed during the 60s. Yet, despite the construction surge, demand continued to outpace supply.

The expansion of Social Security benefits in the early 1960s (including lowering the retirement age from 65 to 62) meant more older adults had income to at least partially pay for care which further drove the demand.

Nursing Home Quality Concerns Grew

As nursing homes multiplied, quality problems became more and more evident. Deadly nursing home fires made headlines throughout the late 50s and 60s, with a 1963 fire in Fitchville, Ohio claiming 63 lives.

A new category of nursing home called Intermediate Care Facilities (ICF) also began in the late 1960s. These were facilities that cared for residents who did not need 24-hour-a-day nursing services, but needed custodial care.

Because the definition of an ICF was not clear, states used it as a catch-all for any nursing home unable to meet standards to get a federal match on their expenditures. It wasn’t until 1971, when ICF standards were finally agreed upon and included in Medicaid.

In 1961, the Senate created the Special Committee on Aging, chaired by Senator Frank Moss, to investigate nursing home problems. Four years later in 1965, hearings revealed alarming inconsistencies in state standards and enforcement efforts.

Medicare and Medicaid Were Created

One of the decade's most significant developments came in 1965, when President Lyndon Johnson signed legislation creating Medicare and Medicaid.2

Medicare was established after decades of debate about national health insurance for seniors. President Kennedy had championed the idea (partially inspired by his father's very expensive stroke treatment). However, he faced strong opposition from the insurance industry, the American Medical Association, and many Republicans.

After Kennedy's assassination, Johnson successfully pushed the program through as part of his Great Society agenda. Medicare was designed primarily to cover hospital costs (Part A) and outpatient medical services (Part B).

But Medicare costs went wild. First-year costs for nursing home coverage were estimated at $25 million to $50 million but reached $275 million—more than five times the projection.

Medicaid Expanded on the Kerr-Mills Act

Unlike the careful planning involved for Medicare, Medicaid was added late in the legislative process without thorough financial analysis. It expanded Kerr-Mills to cover not just seniors but also the blind, disabled, and families with children.

Medicaid became the primary payer for nursing home care, with states required to cover these services to receive federal matching funds. This created a problematic incentive structure as states shifted people from state-funded community care to nursing homes that compensated them, reducing their costs while increasing overall spending.

Medicaid costs exploded. According to the Ways and Means Chairman Wilbur Mills, the first-year costs in New York State alone matched the projected national increase of $250 million.3

The Older Americans Act

Another landmark 1965 law, the Older Americans Act, created the Administration on Aging and a network of federal, state, and local agencies focused on services for seniors aging at home. This helped aging-related community planning, services, and training. This “Aging Network” provided meals, transportation, and social services to help seniors remain independent.

Despite its potential to reduce nursing home admissions by supporting community-based care, the Aging Network never received funding comparable to Medicare and Medicaid.

Moss Amendments Enacted

In 1967, Congress passed the Moss Amendments, to strengthen fire and nursing home standards. Facilities now had to meet national fire safety standards and skilled nursing facilities needed at least one full-time Registered Nurse (RN) on staff.

For the first time, nursing homes were obligated by federal law to disclose ownership information to make it easier to identify fraud and abuse.

Earlier-Version Assisted Living Facilities Begin

Due to the shortcomings and lack of oversight found in traditional nursing homes in the 1960s, we also see the reputation of nursing homes being tarnished. The sprouting of what were to become assisted living communities emerged.

These assisted living places offered necessary health care in a more home-like setting. Services were offered under the name “residential care” or “continuing care communities.” They were perfect for  seniors who didn’t require skilled nursing care, but needed help with activities of daily living (ADLs).

This model was also fueled by seniors who wanted more individualized and supportive care than could be found in nursing homes. The formal concept of assisted living facilities really emerged in the mid-1970s and was designed to assist seniors while supporting their independence.

Later, these assisted living centers offered private or semi-private suites, a variety of social activities, and tailor-made care plans for individuals. We can see that this era marked a shift in senior living, with an expansion of care communities and a new focus on maintaining and improving senior quality of life.

The Age Discrimination in Employment Act (ADEA)

In 1967, thanks to AARP’s backing, The Age Discrimination in Employment Act (ADEA) became law. This law prohibited age discrimination against people 40 to 65 years old in the workplace.4

Ageism today remains a problem for businesses small and large with nearly one third of cases not being reported, according to SeniorLiving.org’s workplace age discrimination statistics and guide.

(Ageism unfortunately exists beyond the workplace. Signs of ageism in health care are common for older adults facing issues in hospitals, nursing homes, doctor offices, and the like, and can unfortunately have dangerous outcomes.)

Wall Street Gets Involved

By decade's end, nursing homes had become big business. In 1966 there were less than a dozen publicly-traded nursing home chains. Three years later, in 1969, there were 58, and by 1970 there were 90. The best known, the so-called “Fevered Fifty,” promised investors returns of 20 to 25 percent a year.5

This easy-money-getting bubble burst by 1971. Causes included poor management, unrealistic expectations, and fraud scandals. The most notorious example being Four Seasons Nursing Centers.

Private Equity (PE) firms moved in seeing huge profits to be had from owning nursing homes. By 2012, PEs increased skilled nursing home facilities’ rate of new admissions, but at the same time, their five-star rankings decreased.

Senior Lifestyle in the 60s

The history of senior living in the 1960s also included fun times. Leisure activities included neighborhood gatherings, church events, and potlucks. Many enjoyed popular television shows including “Gunsmoke, “The Lawrence Welk Show,” and  “The Ed Sullivan Show.” One of the highlights of the decades was watching an astronaut take the first step on the moon.

While the younger generation embraced Elvis, The Beatles, and rock and roll, seniors often preferred Perry Como or Frank Sinatra. When it came to the movies, The Sound of Music, The Graduate, and Butch Cassidy and the Sundance Kid were very popular. Transportation involved primarily trips in family cars as airfare travel was quite expensive at the time.

The Vietnam War and Civil Rights Movement were often featured on evening news broadcasts. Progressive women were becoming frustrated as they wanted equal pay and more rights. Discussions about equality, evolving attitudes about personal freedom, and the changing social landscape were part and parcel of many living room discussions.

Some older adults held traditional views about patriotism and authority while other seniors wholeheartedly supported their daughters in miniskirts and the hippies who protested for peace and a more egalitarian society.7

Seniors gained more visibility as a demographic with specific needs during the 1960s. The decade's reforms established frameworks that have changed and evolved, but still guide senior care decisions years later.