Defying Decline: Transitioning to Eloise Poor House, Asylum, and Hospital Complex During the U.S. Great Depression
The history of residential care in the United States has undergone dramatic transformations over the past two centuries, yet gerontologists and social workers argue that the current residential care system continues to fail us (Kane and West 2005). While transitions to residential care reveal valuable insights about the particular debates and dilemmas relating to older adult care and care practices in a particular time and place, little is known about residential care transitions in the early twentieth century. This study examines the transitions of twenty-one older adults during the 1930s and 1940s from home-based assistance through the Luella Hannan Memorial Home to residential care at the massive 902-acre complex that made up Eloise Poor House, Asylum, and Hospital of Wayne County in Detroit, Michigan.
Using SPSS software, 21 out of 822 total case files archived in the Luella Hannan Memorial Foundation Collection were identified with some relationship to Eloise. The 21 files consist of 2,813 total pages and include thousands of primary source documents of detailed social work case notes describing years of interactions and conversations with clients, as well as medical reports and psychiatric evaluations, legal memos, estate documents, photos, shopping lists, ambulance receipts, burial fees, and marriage, birth, and death certificates. These documents were then approached qualitatively through narrative content analysis and ethnographic analysis with a set of questions drawn from the material that related to the older adults’ Hannan-to-Eloise transitions.
Three findings emphasized in this study include, first, that hospital transfers constituted over half of the Hannan-to-Eloise transitions and served as the site of significant conflict, confusion, and lack of consensus among people involved in the transitions—particularly for older persons and for Hannan case workers. Second, older adults expressed wishes against going to Eloise and used a range of strategies to avoid being transferred. Third, this research reveals specific cases of Hannan social workers advocating for older adults during the transition process, at times against the recommendations of family members, landlords and landladies, hospital physicians and medical staff, judges, police officers, and social workers from other county institutions.
Conclusion and Implications:
This study argues that these findings are historically positioned within a critical paradigm shift in the United States regarding older adult care and care practices during the 1930s and 1940s due to the rise of hospitalization, institutionalization, and the demographic rise of elder residents in poorhouses. Contributing, in part, to social work literature on the history of residential care, these cases reveal an exception to the dominant portrayal of social workers involved in transitions during the era as limited to one of placing individuals in the appropriate institution. Drawing from Massachusetts General Hospital physician Richard Cabot’s advocacy for medical social work in the early twentieth century and Historian of Medicine Charles Rosenberg’s critique of the marginalization of social work in the rise of the modern hospital system (1987), current implications for social work research, policy, and practice include continuing efforts to change the historically disenfranchised role of both older adults and social workers in medical care teams.