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Friday, January 4, 2019

Caring For Yesterday's Elders

CARE ON THE PLATEAU--The new Margaret Pratt Community facility in Bradford is the latest addition to a number of public and private locations that offer elders a home away from home. It opened in December 2018. (JO staff photo)

OLD AS THE HILLS--This 92-year-old Vermonter is typical of those older residents who relied on assets, health, and most importantly, family to provide care for them in their elder years.  Entitled "Oldest Man In Town," this Depression-era photo was taken by Louise Rosskam. (Farm Security Administration)     
Journal Opinion Dec. 26, 2018

 “It is an old custom for New Englanders to live to be as old as the hills.”

Edwin Valentine Mitchell,  It’s An Old New England Custom, 1946

In his chapter on growing old, Mitchell identifies examples of New Englanders who lived to be 100 or older. If he were writing today, he could easily selected local residents to match.  

On December 14, the Margaret Pratt Community assisted living facility opened on the plateau overlooking the plain where Pratt lived out her life. Its opening led me to think about how Americans have cared for their elders in times past. The following will focus on that topic from Colonial days to the passage of the Older Americans Act in 1965. 

The population of colonial New England was young, with only a minority reaching old age. Actually, if individuals lived to be 50, they had a pretty good chance of reaching 70. That is because of the high death rate among infants and women of child-bearing age. Research shows that New Englanders survived to old age in numbers unequaled elsewhere in both the colonies and England.

That society’s attitude toward elders was both complicated and often contradicting. Many positions of power and privilege were held by elderly men. These positions were generally denied to elderly women or men of the lower classes.  

There was generally no such thing as retirement. Even in their declining years, elders were expected to be “up and doing,” performing  tasks. This was especially important when towns offered charity to impoverished older persons. 

Property and children were keys to an elder’s security. Property usually passed to an eldest son, often in exchange for the care of his parents in their final years. One elderly farmer was quoted as offering his entire estate to any relative who would “find and provide for me wholesome and sufficient food, raiment, lodging, attendance, washing and other necessities, as well in sickness and weakness of old age as in health.”

As couples often had children late in life, there were often unmarried sons and daughter who provided care. In my 7th great grandparent’s house in Newburyport, Massachusetts is an adult-sized cradle used with ill or senile elders during their “sleeping period.”

An elder’s reluctance to pass land to the younger generation often led to resentment. Many of the early residents of our area came seeking the land that was denied them in southern New England.

Local 19th century biographies contain numerous examples of elders who lived in intergenerational homes with younger members of their families caring for them in their final years. Arrangements varied depending on the strength of family ties. A number of them are listed in Newbury,  were, according to one newspaper account, on January 1, 1894, “there were 43 persons past 80 years of age living in that town.”     

One Bradford woman was described as “passing the peaceful afternoon of her useful and somewhat protracted life at her old home in  Bradford with her beloved son.” Propertied individuals with no children might find a farm family who, for the property, undertook their support.    

These arrangements, however, did not always work out for the elder. In 1911, a notice appeared in several Vermont newspapers detailing the plight of Orrin Rice of Springfield. Born in 1820 and  “at one time one of the most prosperous farmers,” Rice had deeded his farm to his daughter with the understanding that he should be cared for. His son-in-law “made a failure of the farm and the poor nonagenarian ended his days at the town farm.” Rice was my great-great grandfather.

Indigent elders, like Rice, who had no means or a family to offer them shelter, sometimes had to resort to the humiliation of going on the public dole. Beginning in the 1830s, local towns established these under the titles of town farm or poor farm. Elders had to share space with the orphans, the poor, the mentally and physically disabled and the ill.  

The Overseer of the Poor and a resident manager were responsible for these establishments and made an attempt to make the farm self-sufficient. “Inmates” were expected to work as much as possible.

Admitting that one was unable to care for self was a measure of last report. One Stowe resident was quoted as saying “I’ll starve or freeze to death…before I will go to that accused poorhouse.” Being a  resident meant that one’s name and personal expenses to the taxpayers was published in the annual report of the town, adding to one’s humiliation.

The development of the county farm system in New Hampshire relieved local towns from the need to maintain town farms. The Grafton County farm began being established in 1867.  In Vermont, poor farms declined after 1880 as other helping organizations and agencies were created. 

Organizational homes for the elderly began when Philadelphia’s Indigent Widows’ and Single Women’s Society established one in 1823. By the mid-nineteenth century, fraternal, religious and trade organizations began opening nonprofit homes for their elder members.

In New Hampshire, the Odd Fellows and Rebecca groups opened a home in Concord in 1887.  The Masonic and Eastern Star Home was established in Manchester in 1904. The Vermont Eastern Star Home in Randolph opened in 1922 and served elderly members until 1988. The Gill Odd Fellows Home in Ludlow opened in 1896.

 About the same time, there were several non-profit homes for the elders created by civic-minded groups. In 1874, the Invalids’ Home was established in Keene by members of the Unitarian Church.  It was the first residential care facility in the state and offered “housing, comfort and aid to the lonely and forlorn women of the community.” In Vermont, the Burlington Home for Aged Women opened in 1888,  the Old Ladies’ Home opened in Rutland in 1890 and the  Brattleboro Home for the Aged and Disabled and the St. Johnsbury Home for Aged Women both were established in 1892. 

There were also a number of benevolent societies offering, among other benefits, old age assistance.  Members paid monthly dues when young and healthy to receive help when needed. The St. Andrew’s Benevolent Society of Vermont, chartered in 1892 and headquartered in Groton, had chapters around the state. Modern Woodmen of America was another example of this type of fraternal benevolent group.   

The local home nursing movement began in the two states in the 1890s, often offered first by large businesses to their employees and their families. In the 1920s, local classes on home nursing were held by the Red Cross and Home Demonstration groups under the auspice of the Orange County Farm Bureau.

To meet the needs of aging Civil War veterans both states established soldiers’ homes. Vermont opened its home in Bennington in 1887 and within the first ten years admitted 286 veterans.  New Hampshire open one in 1890 in Tilton and within the first two years admitted 143 veterans.

As with the poor farms, some elders resisted leaving their families and going to be cared for at public expense. While that was too shameful, receiving a veteran’s pension from the national government was not. Beginning in 1861, the Federal government began awarding pensions to disabled veterans and widows and orphans of the deceased. Veterans sometimes waited until they were elderly to apply for these benefits. 

In 1893, 28 years after the end of the war, there were 9,705 pensioners in New Hampshire and 10,069 in Vermont. Veterans’ benefits consumed 37% of the federal budget. The political clout of veterans’ groups kept benefits assured.

At the same time, there was considerable reluctance to offer compulsory old-age benefits to all elderly Americans, a benefit many Europeans enjoyed. Private pension benefits were offered by some companies, but many Americans relied on the traditional support from savings, property and family. This was at a time when the length of life was increasing and the length of employment was decreasing.  Retirement, forced or voluntary, was more likely, especially in more urbanized settings. 

At that time, progressive groups began to lobby for universal old-age benefits. A 1909 bill to extend veterans’ benefits to all Americans was proposed.  In 1911, Socialist Congressman Victor Bergen submitted an old age pension bill creating a government pension for all Americans at age 60 ”sufficient for their support.” One hundred Barre area citizens submitted a petition in support of the bill.  These bills never made it out of Congressional committees.

The Barre Daily Times supported these propositions: “The problem of dignified old age with some measure of independence  is one that troubles the sleep of half of humanity. But in our bustling country we seem to have left it to solve itself, while in Europe, governments, employers and above all, the people combined to find at least a partial solution.”

The idea of a government pension for all was denounced as a corrupt form of socialism, amoral and “destructive to the spirit of enterprise.” Neither major political party supported the idea.

Attitudes began to change, however,  in the 1920s with the rapid growth of poverty among elders. Poverty rates among elders increased from 23 percent in 1910 to 33 percent in 1922 and with the outbreak of the Great Depression, 40% by 1930 and 50% by 1935.

Major groups such as the Fraternal Order of Eagles set out to secure old age pensions, beginning at the state level.  By 1933, many states offered pensions.  In 1931, New Hampshire adopted a plan for residents 70 years and older who had been residents of their county for at least 15 years. In 1935, Vermont adopted a plan for those 65 and older, with citizenship and residency requirement.  Administered by the local Overseer of the Poor, the monthly benefit was $30 for individuals and $45 for couples.

In 1935, President Franklin D. Roosevelt introduced a proposal for a government pension program modeled after well-established European programs. With bipartisan support, including that of  Republican U. S. Sen. Henry Keyes of Haverhill, the bill became law. The resulting Social Security program created a federal safety net for those 65 and older based on payroll taxes paid during earlier employment.

The first person to receive an old-age monthly Social Security benefit check was 65-year old Ida Fuller of Ludlow, Vermont. On Jan. 3I, 1940, she received her first check for $22.54. Fuller continued to receive monthly checks under her death at age 100.         

Roosevelt chose not to include health care as part of Social Security because it was so controversial.  Opponents raised fears of government intrusion into the doctor-patient relationship and warned of “nationalized doctors.” In the late 1940s, President Harry S. Truman raised the issue of a health care benefit. Branding it as “un-American and “socialized medicine,” conservatives and the American Medical Association brought an end to his proposals. 

During the 1960 campaign, candidate John F. Kennedy promoted health care legislation.  He said the program was desperately  needed in “every city and town , every hospital and clinic, every neighborhood and rest home in America—wherever our older citizens live out their lives in want and despair under the shadow of illness.”  He wanted to build on a very limited health insurance that had passed in 1960, but was impacting only one percent of the elderly poor.

When he assumed the office of President,  Lyndon Johnson vowed to fulfill Kennedy’s promises. Proposals were, as they had been before, bottled up in Senate committees chaired by conservatives. The  landslide election of Democrats in 1964 opened the door for change.

 In 1965, Congress pass and Johnson signed into law the bill that led to Medicare and Medicaid. Those program, enhanced by additional benefits, have radically changed  health care for America’s aging adults. That year the Congress also passed the Older Americans Act. This was the first comprehensive federal program to provide home and community-based services for elders, especially for those who wish to remain in their own homes. 

The 2010 census revealed there were 8,694 New Hampshire residents who were 90 or older, with 232 at 100 years or older.  Vermont had 4,589 residents above 90 years with 133 listed as centenarians. In 2016, it was reported that Vermont had 14,000 residents age 85 and older. As that number continues to rise, New Hampshire and Vermont follow Maine in having residents with the highest median age. 

Most elders, even these of advanced age, hope to live out their lives in their own homes. Services such as senior centers, senior housing, adult day services, home-delivered meals and visiting nurses help to make that possible for many. As always, the keys to elder care are family, good health and assets. When those are not available, government programs make elder care generally available to even the poorest.

For those  who cannot live at home,  there are private and government facilities available. Even when one’s resources run out, and they are supported by what my Dad called “the federal gravy train”, there is quality care available.

The Margaret Pratt Community  facility joins the Atkinson House in Newbury, the Blue Spruce Home and Oasis in Bradford and On the Green and the Grafton County Nursing Home in Haverhill in providing care for the aged.  At age 76, and with a view to the future, I join those who are grateful that all these programs are available. Happy New Year.