00:00 The podcast episode is about the history of nursing homes and the decline of multi-generational households in America.

04:47 Nursing homes evolved from alms houses or poor houses in the late 18th and early 19th century to provide care for elderly individuals who had no one to take care of them and couldn't afford other forms of care.

09:35 Nursing homes in the late 19th and early 20th century provided care for elderly individuals who were considered "worthy poor" and couldn't afford private nursing homes, but were not alcoholics or drug addicts, and were expected to pay for their room and board.

15:31 In the early 20th century, elderly individuals without anywhere else to go, including those who were mentally infirm, were often placed in mental hospitals alongside patients with severe mental illness, but this began to change with the arrival of Francis Perkins and the implementation of Social Security in 1935.

20:38 The implementation of Social Security in 1935 led to the creation of old age insurance and old age assistance, which provided financial support for elderly individuals and incentivized the growth of private living facilities for the elderly.

25:13 In the 1950s, Congress stepped in to regulate nursing homes and ensure their safety, leading to the rise of larger, more corporate facilities that could afford necessary upgrades and meet government guidelines.

29:51 In the 70s and 80s, nursing homes were so bad that a reform act was implemented in 1987 to ensure that residents were treated with dignity and had a say in their daily lives, but nobody knows what to do about nursing homes.

35:56 The birth of assisted living facilities in the 80s and 90s provided a more comfortable and independent alternative to nursing homes, but they are expensive and not regulated by the US government like nursing homes are.

40:59 Private equity firms taking over nursing homes leads to a decline in health outcomes for residents due to their focus on corporate profits, and the current push is towards providing care rather than treating elderly people as customers; there are about 1.4 million Americans in residential nursing homes and another 1.7 million cycling through skilled nursing facilities, making up 4.5% of all Americans over 65 and 10% of all Americans over 85; the cost of nursing homes can be high, with private rooms in New York averaging $400 a night, and Medicaid requires individuals to liquidate their assets to pay for nursing home care, while assisted living is often paid for out of pocket.

46:16 Elderly individuals without family or money in the United States are often left on their own, with limited access to paid services or assistance, and may face eviction from nursing homes if they cannot afford to pay for care.

51:07 When looking for a nursing home, it is important to do thorough research, including reading inspections and reports, talking to residents, and looking at statistics on things like patient readmissions and allegations of abuse.

55:57 The hosts read a listener's email and mention that they would love to hear from listeners about past episodes.