Evolution of Programs & Services Timeline

Evolution of Programs & Services Timeline

LTC 310 / Social & Community Related Programs & Services

Evolution of Programs and Services Timeline

There was no such thing as long-term care, nursing facilities, or assisted living in the first century of our country’s history. Much of the time, society lived in rural areas and cared for their own until death. During this time, conditions were deplorable and not much in terms of home health care or nursing homes were available until the early 1900s which were funded with public donations or government resources. “With the advent of Social Security in 1936, a nursing home per diem stipend was included in the Social Security retirement income and this government subsidy spurred the construction of nursing homes all across the country” (NCPC, 2018). Over the last 50 years, there has been a steady change in the way of long-term care and the use of nursing care facilities. This timeline will provide an overview of how programs and services have evolved as well as examples of programs and services that have evolved and an explanation of the changes that have taken place.

Evolution of Program and Services

The aging population has grown considerably over the past fifty years. In 1965, the Older Americans Act (OOA) was passed which helped to provide funds for critical services that kept the older population health and independent. Some of the OAA services included meals, job training, senior centers, health promotion, benefits enrollment, caregiver support, transportation, and more. The 1970’s denoted a period where a large number of the population were entering nursing homes; this growth raised concerns about the sustainability of the long-term care system.

In 1973 the OAA decided to establish and update the Area Agencies of Aging. This agency also works together with the Senior Community Service Employment Program (NCOA, n.d.). This employment program allows members of the community to get involved with different programs to help the aging communities with every day activities as well as taking meals to them for the ones who are unable to cook. In the past fifty years, programs and services have evolved considerably. There are so many programs and services that have updated their care and services for the aging population. The government also has programs and services for the aging population so they are able to obtain health coverage to receive the care they require. Some of these programs include Medicaid and Medicare. Some additional programs and services for individuals requiring long-term care include low income housing for individuals with disabilities and/or who are on a fixed income or of a certain age that would qualify them. State and Federal Governments has played a huge role in the financing of long-term care. The increasing aging population exacerbates the importance of this specific required care.

Home Health Care

Home health care began in the later part of the 1800s as a service of city health departments called visiting nurse services (Penn Nursing, (n.d.).  During this period visiting nurses would make the house calls instead of doctors and would also be separate from the government. In1909, the Metropolitan Life Insurance Company (MLI) came up with the idea of nursing care insurance (Penn Nursing, (n.d.). Metropolitan Life Insurance Company’s main goal was to get more people to buy insurance by helping people get well. In 1935, the creation of Old Age Assistance or what is now known as Social Security which secured care for the chronically ill and disabled. Over the years, there was an increase of private nursing homes which was an alternative to home health care. Home health care was included in the Medicare, Medicaid, and the Older Americans Act initiated in the 1960s (Penn Nursing, (n.d.). In the 1980s and 1990s Medicare and Medicaid, looked for ways to reduce costs, this is when it was decided to move long-term care residents from nursing homes to home-based care (Pratt, 20150122, p. 195). October 1, 1997, the Balanced Budget Act of 1997 radically transformed the Medicare home-care benefit enacted in 1965 (Penn Nursing, (n.d.).

Medicaid and Medicare

According Center for Medicare and Medicaid Services (2019), “On July 30, 1965, President Lyndon B. Johnson signed into law legislation that established the Medicare and Medicaid programs. For 50 years, these programs have been protecting the health and well-being of millions of American families, saving lives, and improving the economic security of our nation. Though Medicare and Medicaid started as basic insurance programs for Americans who didn’t have health insurance, they’ve changed over the years to provide more and more Americans with access to the quality and affordable health care they need.” Over the years, congress has made changes to the Medicare such as making it more eligible, more benefits for drug prescription. For example, in 1972, Medicare expanded to cover the disabled, people with end-stage renal disease (ESRD) requiring dialysis or kidney transplant, and people 65 or older that select Medicare coverage (Center for Medicare and Medicaid Services, 2019). Then, to dig into Medicaid in the past it would only supply medical insurance to those who receive cash assistance. In today’s world of medical coverage from Medicaid, it’s covering a larger group of people such as low-income families, people with disabilities, pregnant women, and people who requires long-term care. Medicaid and Medicare have evolved tremendously from when it first began and currently it is benefiting a variety of people in their states from using the Medicare and Medicaid program services that’s offered to those who are eligible for the health insurance coverage.


Several aspects have contributed to the complex issues with long-term care. In recent years, it has gained strength and support throughout the country providing elevated program and support services to the individuals requiring long-term care. This timeline has provided an overview of how programs and services evolved over the last fifty years. It has also provided how home health care and Medicaid and Medicare has expanded and evolved as well as the changes that continue to take place.


Center for Medicare and Medicaid Services (2019). History of Medicare and Medicaid. Retrieved from https://www.cms.gov/About-CMS/Agency-information/History/

National Council on Aging (NCOA). (n.d.). Older Americans Act (OAA). Retrieved from https://www.ncoa.org/public-policy-action/older-americans-act/

National Care Planning Council (NCPC). (2018, March 20). The Evolution of Long-Term Care Services. Retrieved August 19, 2019, from https://www.longtermcarelink.net/articles/The-Evolution-of-Long-Term-Care-Services.html

Pratt, J. (20150122). Long-Term Care, 4th Edition. Retrieved from https://bookshelf.vitalsource.com/books/9781284091342

University of Pennsylvania School of Nursing. (n.d.). Home Care. Retrieved August 20, 2019, from https://www.nursing.upenn.edu/nhhc/home-care/