In 1903, Homer Folks, commissioner of New York City's charities, announced a new policy for the City Almshouse. The institution would now be called the Home for the Aged and Infirm. Writing in the pages of Charities, Folks explained the reason. The change of name, he asserted, was based on the improved character of the inmates. In contrast to poorhouses of the past, New York's asylum was not filled with the lazy, corrupt, or able-bodied. Most of the residents were simply old and ailing. They had entered the poorhouse in order to receive badly needed food, shelter, and medical attention. “Observation and experience lead me to the conclusion,” Folks declared, “that we should regard the people with more consideration than we have been accustomed to give the inmates of the almshouse.” The adoption of a new name for the institution was thus intended to bring dignity to such aged sufferers. The institutionalized elderly would no longer be treated as disgraced paupers.

Folks's new policy was based on far more than the kindly sentiments of one charitable commissioner. It was not only the New York City Almshouse that appeared to be dominated by the old; almost every large city reported similar inmate populations. Nor was Folks unique in suggesting that “homes” might be created to shelter the aged and infirm. Throughout the nineteenth century, such private asylums had been established across the country, attracting the once middle-class elderly who had become incapable of providing for themselves.