Prior to the 20th century, care for the aged was largely the responsibility of the family. Before the industrial revolution the aged were not considered a separate class needing special care. During the 19th century the processes of industrialization of agriculture and manufacturing, increased mobility of families and urbanization resulted in the disruption of social institutions. The family has become a one or two generation social unit instead of a 3 or 4 generation unit with unmarried adult relatives doing household work. Social, economic, and medical advances have extended life expectancy of people, thus aggravating the problem.
Initially social legislation was based on the belief that poverty and unemployment are voluntary. This resulted in often harsh or punitive action with minimal medical care and little social and intellectual stimulation. Elders were institutionalized in almshouses, poorhouses and sometimes public hospitals. By the last half of the 19th century specialized institutions for orphans, feeble-minded and the sick were admitting the aged and conditions began to improve.