In a recent article in the Journal of the Society of Architectural Historians, Willa Granger, Ph.D., an assistant professor at Florida Atlantic University’s Dorothy F. Schmidt College of Arts and Letters, explores the evolution of nursing homes in the United States. Her research focuses on how these facilities transitioned from small, local operations to large, standardized institutions tied to federal policy and corporate interests.
Granger’s work centers on the Americana Corporation, a for-profit eldercare company from Illinois that in the 1960s developed a model for suburban, hospital-adjacent nursing homes. These facilities were purpose-built, single-story structures with neocolonial designs on the exterior and clinical, hospital-style layouts inside. The company adopted business strategies from the motel industry, using real estate development, standardization, and franchising to expand rapidly across the Midwest.
By 1969, Americana had established more than 30 locations in nine states. The company’s growth was fueled by federal programs such as the Hill-Burton Act, Social Security, and Medicare, which encouraged and normalized this new approach to eldercare. According to Granger’s findings, these programs, intended to support aging Americans, also contributed to the rise of a professionalized and privatized nursing home industry.
“This is not just a story about nursing homes. It is a story about how buildings mediate care, how federal policy influences physical space, and how the structure of eldercare became a mirror of midcentury American life – its promises, its anxieties and its enduring contradictions,” said Granger.
Americana’s approach contrasted with earlier operators like Leonard Tilkin, who ran understaffed and substandard facilities in converted historic homes. Granger argues that architecture became central to the politics of eldercare, with companies like Americana meeting new safety and licensing standards but also shifting toward corporate models that emphasized scale and compliance over community connection.
“Americana shows how architecture was used not just to house people, but to create an entire system of care – one shaped by regulation, profit and a vision of aging that was both medicalized and marketable,” said Granger.
Granger’s article is among the first comprehensive architectural histories of U.S. nursing homes. She suggests that understanding the origins of these systems is crucial as the country faces an aging population and ongoing challenges in long-term care.
“As the U.S. faces a rapidly aging population and mounting pressures on long-term care, the origins of the modern nursing home reveal how deeply our built environments reflect the values – and blind spots – of their time,” said Granger. “History reminds us that decisions about architecture, policy and profit are never neutral; they shape the everyday lives of vulnerable people. Understanding where these systems came from is essential if we hope to imagine and build something better.”
