ABSTRACT
The evolution of long-term care in Philadelphia between 1945 and 1965 was shaped by rapid growth of an aging population and greater prevalence of chronic illness and disability. What did emerge between 1945 and 1965, however, was a localized array of long-term care services. While any shifts in federal policy had a modest impact, the local sectors of public, private, non-profit, voluntary, or commercial long-term care services made significant modifications and innovations in their response to the long-term sick. In striking contrast to acute care, developments in long-term care, whether institutional or community-based, remained outside the physician-hospital nexus. Growth in federal financing for institutional long-term care carried with it greater emphasis on physician control. Conflicts between the social welfare-based dormitory role of Riverview against its health care responsibility for chronic illness care confused politicians, who had difficulty comprehending and supporting the modern health care mission.
