1800-1990: Changes In Urban/Rural U.S. Population

Source: U.S. Census Bureau

There was a very large shift from rural living to urban living throughout the US population from 1800 to 1990. As we discuss this change, we will focus on what this means for seniors and senior health care.

In 1800, 94 percent of the US Population lived in a rural setting. During this period, mass or long-distance travel happened primarily by boat. Most families were self-sufficient. A trip to town was about buying staples, not groceries. In fact, the first grocery store would not open until 1916 – when Piggly Wiggly opened in Memphis.1 Living in an urban setting was not standard in 1800. It was a lifestyle that would be slow to change. Homesteads and farms had everything that a family needed and people were self-reliant. Even senior care was provided by the family.

Going to town meant walking, riding a horse, or riding in a wagon drawn by a horse. The first automobile was a century away, so even going ten miles by horse took most of the day. From 1800 to 1820, only 6 to 7 percent of people lived in urban settings. Senior health care was left to the family and doctor. The life expectancy of a man ranged from 33 years to 47 in 1900, and very few people made it to old age. Only four percent of people born in 1900 made it to age 85 and 10 to 12 percent to age 65. Old age and senior care were rare. This would change as medical advancements helped people live longer and more productive lives.

Cities and Their Appeal

One of the things that changed where people lived was the convenience of cities. In the 20th century, railroads and streetcars were the most affordable ways to travel any distance. People no longer depended on horses for transportation. Even in 1850, only 15 percent of the US population lived in an urban setting. The rapid expansion of the West also began to slow. Children left home and moved to the city, where they would work a job rather than on the farm.2

In terms of senior care, the depletion of labor – children leaving home – meant that those who remained had to do more. There were fewer people around to care for mom, dad, grandma, and grandpa. The family unit shrank, and the distance between siblings grew. That shift would appear later in the urban setting. Who would take care of mom or dad once the children all left home? Medicare and Medicaid did not begin until 1965, and the idea of a nursing home as we know it today began in the 1970s.

Also, the definition of senior care started becoming recognizable after 1987, when the Nursing Reform Act became law. Before 1965, older adults without sufficient means were sent to poorhouses – a place of subpar living standards, abuse, and disease. Those blights in senior care would not be replaced until after the Great Depression – 1929 to 1939. Then the poorhouse would become a paler version of a board and care home today.3 Those events happened after a sufficient percentage of the rural population became urbanized.

In 1860, one-fifth of the US population lived in urban settings, and the call of the city grew stronger. By 1870, more than 25 percent of people lived in cities. By 1900, 40 percent of the population lived in the cities. In 1920, the ratio increased to almost 50:50. Up to this time, rural areas lacked major conveniences such as electricity. The standards of living were different between the city and the country. The Rural Electrification Administration was born in 1934. In 1920, 50 percent of urban homes had electricity. That boon opened up the door for further conveniences, such as electric washing machines and small appliances. Thus, life became easier in the city.4

By 1960, rural living greatly diminished. Only 37 percent of the population lived rurally. Part of this shift happened due to the expansion of cities and a new phenomenon called urban sprawl. The invention of the automobile would drive changes from rural living to urban living. People could now live in the suburbs of a city, drive to work, and drive to the grocery store.

The shift in health care also reflected this. It was easier for a doctor to stay in one spot than to make house calls, so people began going to the doctor. By 1990, 75 percent of the US population lived in an urban location. In 1980, less than one percent of doctors made house calls.

As mentioned, after 1965 when Medicare became law, nursing homes increased and in 1987 they became better managed through changes to the legal system. Hospice care did not begin until 1974, and its presence today is thanks to the Connecticut Hospice which served as a provider of end-of-life-care for people throughout the New Haven area.

The shift from rural living to urban living was slow and was fueled by innovations such as the assembly line, which opened up jobs for the masses. The advent of the automobile and the gentrification of urban homes led to modernized living. Along the way, the seeds of current senior health care were planted, grown, and honed. That shift mirrors the change in the family unit and takes on the burden of an increasing lifespan thanks to advancements in medicine.