Philip Y. Kao PhD thesis - Research@StAndrews:FullText

are formal staffing requirements for an establishment to be certified as a SNF. For
example, qualified nurses must be on hand twenty-four hours a day. Therapists also
helped residents in the SNF with strategies dealing with how to cope with vision
impairment, fall prevention, and customised speech therapy development programmes.
This is not the place to delve into the history of nursing homes, but it is important to
contextualize when the rise of CCRCs took hold over the landscape of American ageing
and retirement. 1
In 1980, the Civil Rights of Institutionalized Persons Act (CRIPA) was passed in order to
establish standards regarding the quality of life, health and safety of persons living in
state institutions. This federal law sought to protect the civil rights of people in places
such as juvenile facilities, prisons, psychiatric hospitals, and nursing homes. The federal
Nursing Home Reform Act (NHRA), known today as Title 42 Part 483 of the Code of
Federal Regulations, was passed in 1987. According to NHRA, nursing homes must
ensure that their residents are protected against physical and mental abuse, corporal
punishment, involuntary seclusion, and the use of physical and/or chemical restraints
that are not part of prescribed medical treatment. The NHRA sought to set minimal
standards so that nursing homes, and particularly SNFs, had adequate staff and that
they were providing appropriate skilled and non-skilled services. These laws ensure
that nursing homes residents have privacy, and are not abused or neglected in any way.
Moreover, the NHRA also requires nursing homes to communicate honestly and upfront
with their residents about fees and treatment plans, and to allow residents to
participate (somehow) in the administration of the nursing home.
The CCRC model emerges from a history of traditional religious and community-based
models of senior living. One can see historical analogies in the case of the Indian
ashram, early Christian almshouses, or even the poorhouses dedicated to some of the
elderly immediately after the American Civil War. The modern-day CCRC really
flourished and began developing across the United States in the late 1970s. According to
a 2009 report put out by the Ziegler National CCRC Listing and Profile, there are about
nineteen hundred CCRCs in the United States. The majority of which were purpose-built
CCRCs. The report also states that about half of the CCRCs in operation today are faith-
1 See Carole Haber and Brian Gratton’s Old Age and the Search for Security: An American
Social History for a good discussion of the history of nursing homes in the U.S.
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