Historical evolution of assisted living in the United States, 1979 to the present.

PURPOSE: This article provides a historical overview of the emergence of assisted living in the United States over a 25-year period to identify goals and key concepts that underpinned the emerging form of care. DESIGN AND METHODS: The method is historical analysis based on records and my own personal experiences in conceptualizing and implementing assisted living in Oregon and nationwide.
RESULTS: I identified four time periods: (a) 1979 to 1985, when a paradigm shift occurred on both the East and West coasts, motivated by distaste for nursing facilities and idealistic values regarding residential environments, service capacity, and consumer-centered care philosophy; (b) 1986 to 1993, when providers, consumers, and state governments became interested and four identifiable types of assisted living (hybrid, hospitality, housing, and health care) appeared, each of which informed the evolution of assisted living; (c) 1994 to 2000, a period of expansion, Wall Street money, dilution of the ideals, and emerging quality concerns; a crisis of confidence and a crossroads for assisted living; (d) 2000 to the present, a time of regrouping, slow-down in growth, and reexamination of earlier efforts to define and set standards for assisted living. IMPLICATIONS: Well-conceptualized and designed research may provide a mechanism to suggest practice, regulatory, and payment models. I recommend that researchers conduct studies from the values premises underlying the assisted living approach.