There is involved also the relation which they should bear to the public almshouse. The theory of almshouse administration has been that the conditions must be made less attractive than the home which the average hardwork ing member of the community can provide for himself in his old age. Otherwise there will be no inducement to make such provision, and the number of those who accept the public bounty will tend constantly to increase. In an ideal administration sufficient discrimination might be introduced so that those who become public dependents solely through misfortune can be surrounded with a somewhat greater degree of comfort than is provided for the shiftless, the intemperate, and the improvident. It would then become a question whether the almshouse thus conducted might not care for all who cannot be kept at home by their own relatives, either with or without private assistance.
The actual situation in most communities of the more advanced states is that there is little, if any, formal classi fication in the almshouse ; although there are in the smaller almshouses an individualizing of inmates and a natural grouping according to personal affinities which is better i than any other classification could be, and there is also increased diversification among institutions.
Within the past twenty-five years the standard of com fort in almshouses has steadily improved, while at the same time there is no tendency that can be discovered to increased abuse of the public bounty. In fact, there are probably to-day fewer almshouse inmates who should be cared for by their relatives than there were a quarter of a century ago, when the discomforts and privations of the almshouse were much greater. This fortunate result is brought about by a more general introduction of the prac tice of making some investigation when application for admission is made and the exercise of wider discrimi nation both in admissions and discharges. The actual population of the almshouse has not only not kept pace with the increased population, but has, in New York and some of the other more populous states, actually dimin ished. This is, of course, due in part to the removal from the county almshouses of children and of many special classes of defectives, such as the insane, the epileptic, and the feeble-minded, who are now cared for in state institu tions ; but even after due allowance for this has been made, it still remains clear that the increased decency and comfort of the almshouse have not led to increased pau perization, and that it is perfectly possible for the com munity to provide adequate deterrent checks against such tendencies other than the repellent plan of making the almshouse a place of actual physical discomfort and pri vation. It is probable that the prejudice against the alms
house, while it is useful in stimulating every possible effort to avoid becoming public dependents, has the marked disadvantage of keeping in a state of actual want and suffering outside the almshouse some who would be distinctly better off within it. The duty of the charitable would seem to be to emphasize the fact that it is no disgrace to accept public care if it is necessary ; the disgrace, where there is any, lying only in the course of action that leads to dependency, rather than in the particular method by which that dependency is relieved.
There is not sufficient accommodation in the private homes for aged persons to receive all who are entitled to better care than the almshouse affords, nor is this press ure caused by a general tendency to get rid of the care of the aged persons by shunting such responsibility to the public or to private institutions. In other words, there is still considerable margin for the wise institutional care of aged relatives before the danger point of demorali zation is reached, and there are doubtless several thousand persons in the United States for whom admission should be secured either to a well-managed private institution or to a reformed and improved almshouse, unless, indeed, the plan of providing funds to pay the board of these persons in private families is preferred. There is much to be said in favor of this alternative ; but the discussion is beyond the scope of the present chapter, since in either case the beneficiary would not remain a member of the family to which he naturally belongs.
A similar series of questions arises in regard to the social effects of medical institutions, but they are easily answered. Hospitals, whether public or private, homes for convalescents, and institutions for the treatment of special kinds of diseases, such as alcoholism, insanity, and consumption, do not as a rule have a tendency to break up families prematurely or improperly. When the patient is curable the brief stay in a hospital or other institution, by restoring health, permits a continuance of family relations. One exception may be noted in some of the state hos pitals for the insane where there are many slightly de mented old people who could be cared for with perfect ease at home or even in the county institutions. The high reputation of these hospitals is responsible for the readiness of relatives to send such patients to them.