Nursing home utilization: A comparative study of the Hutterian Brethren, the old order Amish, and the Mennonites

N~~S~N~ HOME ~T~~~ZAT~ON: A Comparative Study of the Hutterian Brethren, the Old Order Amish, and the Mennonites

JEFFREY LONGHOFER* U~i~efs~ty of ~issouf~-Kansas City

ABSTRACT: Though many have claimed that industrialization resulted in the emergence of nursing homes, this conjunction of events remains to be explained. This article examines the differential use of the nursing home in three agricultural communities on the Great Plains: the Old Order Amish, the Hutterian Brethren and the Alexanderwohl Mennonite. Using @e-history interviews, nursing home registries, data from fieldwork, and census records, the article demonstrates that the structure of the Mennonite ‘household formation’ required adjunct residential care for the elderly, while the Amish and Hutterian ‘community formations 'did not. This comparison shows that while all three groups experienced industrialization, only the Mennonites introduced the nursing home. The article argues that it is the internal structure of the formation that elder@ are located within that accounts for the emergence of nursing homes, not the inexorable eflects of industrialization.

The Hutterian Brethren release members from their everyday responsibilities to the community so that they may assist elderly parents or dependent colonists. In their communal world, nursing homes do not exist. The Old Order Amish negotiate retirement arrangements and reside adjacent to family in residences called the grandfather house. Their dense and compact rural communities have facilitated, without government assistance, household-based care of the aged. And only in rare circumstances have nursing homes been utilized. In 1929, the Alexanderwohl Mennonites established the Bethesda Home for the Aged in rural, south central Kansas. The aim * Direcr all correspondence to: Jeffrey Lmghofer, Rockhill Rd., Kansas City, MO 64110-2499.

Departmenr

of Sociology,

JOURNAL OF AGING STUDIES, Volume 8, Number 1, pages 95-120 Copyright @ 1994 by JAI Press Inc. All rights of reproduction in any form reserved. ISSN: 0890-4065.

University of Missouri, 5100

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of this article is to explain the presence or absence of nursing homes among several Old Order Amish (Jamesport, Missouri; Yoder and Partridge, Kansas), Hutterian Brethren (Pembina and James Valley colonies in Manitoba, Canada), and Mennonite (Goessel, Kansas) communities. I will demonstrate that the internal structures of these communities and their respective articulation with capitalism explains why the Mennonites utilize nursing homes and the Hutterites and Amish do not. I will argue that modernization theory cannot account for these differences.

THE NURSING HOME AND MODERNIZATION THEORY From 1939 to 1969, the number of institutions in the United States providing care to the elderly increased from 1200 to 19,000, and the number of beds from 25,000 to nearly one million (Moroney and Kurtz 1975, p. 81; Koff 1982, p. 40). The European Poor Laws, nineteenth century American Almshouse legislation, homes for the aged, boarding homes, and welfare policies have all been implicated; it is argued that they evolve into and account for the more recent penchant for institutionalization (Johnson and Grant 1985, pp. 5-10; Thomson 1983, pp. 63-67; Koff 1982; Dunlop 1979, pp. lOO102; Moss and Halamandrais 1977, pp. 5-8; Moroney and Kurtz 1975, p. 88). Moroney and Kurtz, for example, argue that market forces contributed to the “evolution” of the boarding house into the nursing home. They write that A constant increase in industrialization, urbanization, residential mobility, one family housing, and extension of the cash economy into all areas of life combined to alter living arrangements for older people. Extended family ties were weakened, the capacity and willingness of children to care for their parents, and the growing numbers of older people created a demand for residential alternatives. Boarding homes were an important part of the response to this demand.. .When residents moved into these settings they were likely to be in reasonably good health, but as they grew older, their health declined and mounting problems of physical functioning required assistance. Rather than lose their income and evict long-time residents, many boarding homes began to provide nursing services and eventually evolved into convalescent or nursing homes (Moroney and Kurtz 1975, pp. 91-92). One could not have found in the varied modernization literature a more thorough list of assumptions than that provided by Moroney and Kurtz: urbanization, industrialization, residential mobility, abandonment of the extended for nuclear families, and the extension of the cash economy all lead, in a linear fashion, to the modern institution for the aged. There are, however, two problems with modernization explanations that hamper our understanding of the nursing home. The first I will call the problem of ‘oppositional history.’ The second one derives from our predilection for scattering societies along a continuum from traditional to modern.

THE PROBLEM OF OPPOSITIONAL HISTORY Some account for and explain the presence of the nursing home by turning to an imagined past, a past which lacked the conditions for the emergence of the institution;

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and thereby, they posit an unproblematic and linear development from an ordered past to a disordered present (or, from a disordered past to an ordered and modern present), from a past where the elderly enjoyed a high status to a present where the institution has deprived them of that very same status (Roseberry 1989, pp. 30-31; 213). Yet studies have shown that social class, gender, the state, community, and ethnicity have significantly influenced the status and care of the elderly throughout history (Sokolovsky 1990; Estes 1991, pp. 19-36; Tassel and Stearns 1986; Gratton 1986; Foner 1984; Quadagno 1982). To simply assume, then, that nursing homes have gradually evolved from previous forms (by opposing the present to the past) tells us nothing about how, and under what historically particular conditions such institutions emerge and change. More important, this kind of analysis tends to obscure the significant differences to be found among communities and societies. As well, this oppositional writing of history may cause us to overlook or ignore important aspects of life in the past, which include, among other things, gender and economic inequality.

THE TRADITIONAL-MODERN

CONTINUUM

Some modernization arguments hold that the aged in pre-industrial, agricultural societies used land and knowledge to negotiate support in later life. As a consequence, the elderly enjoyed a high status. In turn, this status was eroded by the emerging industrial order, and the resulting loss of control over material resources.’ This argument poses a problem for how one approaches the study of old age in communities like the Amish, Hutterites, and Mennonites. The strategies used by the Hutterian Brethren and Amish to care for the elderly are not simply vestiges of a ‘tradition driven’ past soon to fall to the inevitable and eroding forces of modernity. Along with the Mennonites, these groups do not fall neatly along the ‘traditional/ modern’ continuum: all are landed farmers or wage earners and are embedded in our cash economy, although the Amish less so than the Mennonites and Hutterites. Hutterians are among the most mechanized farmers (they have, in fact, been major innovators in high technology agriculture and they don’t shrink from the use petro-chemical inputs), and they market extraordinary sums of agricultural commodities; in Manitoba, for example, their share of total pork production was, in 1989, thirty percent (Longhofer 1993a). The Mennonites resemble the Hutterites in their use of technology but are radically different in their social organization. The Amish, on the other hand, profoundly limit the use of technology. In a review of the use of the comparative method in aging studies, Quadagno has warned against arraying communities along a continuum even when they appear “superficially similar”; often, she argues, they exhibit extremely “different demographic, economic, and social patterns” (Quadagno 1989; Quadagno 1982, p. 7). As this study will show, it is not the mere absence or presence of technology, but rather, the way in which each group uniquely distributes and employs it that makes the difference in nursing home utilization. As with the introduction of new technology, labor mobility is said to follow from industrialization, so it has been argued that while children searched for work, they left parents behind. With illness, then, the ‘abandoned elderly’ had to choose residential care. Again, this poses a problem when confronted with data from these ‘traditional’ communities. Hutterian women, for example, marry and leave their home colonies to

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reside in the husband’s colony; hundreds of miles often separate parents from children. Additionally, work teams (surplus labor) are often resident on other colonies for extended periods of time. The Amish frequently marry into other church districts, miles apart (and even in different states). They hire drivers for transportation to worksites great distances from their communities. I will show that labor mobility does not lead to the abandonment of the elderly in these so-called ‘traditional’ communities. Moreover, even though the Alexanderwohl Mennonites resemble ‘modern’ rural communities in the degree of out-migration, the examination of dozens of case studies shows no causal relationship between institutionalization and the lack or presence of children living in the area. Each of the groups in this study differently organizes the labor process and their respective community structures play pivotal roles in determining the nature, extent, and influence of labor mobility on the lives of elderly people. As with labor mobility and modern technology, it is argued that the bureaucratic welfare state is a marker of the emerging industrial society. Government provisions offset the market forces responsible for the development of a class of neglected unemployed. Social Security, after all, provided the elderly an income independent of employment history, marital status, and family support; indeed, the state guaranteed the elderly an income so that they could “choose a program and pay for the services provided”(Koff 1982, p. 40). According to this view of the state, Social Security follows from a long chain of unfriendly effects of mode~ity-prolet~ianization, urbanization, labor mobility, family abandonment-that culminate in the state’s benevolent subsid~ation of nursing home care. I will show that government-~sist~ income supports have not figured at all in the Hutterite and Amish care for the aged. On the other hand, the Mennonites have embraced Social Security, Medicare, and Medicaid programs. This contrast might suggest a straightforward explanation: the aged in ‘traditional’ societies accept the benevolence of the community and household, and the elderly in ‘modern’ communities accept the benevolence of the state. I compare the Mennonites with the Hutterites and Amish in order to show that the nursing home was not an inevitable outcome of a compassionately acting state. Though the Mennonite household sometimes required adjunct assistance for the elderly, I will argue that nursing home care is only a contingent outcome. Though many have claimed that industri~ization led to the rise of the nursing home, (Johnson and Grant 2985; Koff 1982; Dunlop 1979; Moss and HaI~andra~s 1977; Moroney and Kurtz 1975) this conjunction of events remains to be explained,’ Just as others have convincingly argued that ind~t~ali~ation did not necessarily lead to the disintegration ofextended family care (Gratton 1986; Quadagno 1982; Foner 1984; Shanas 1979), nor to an abrupt change in the status of the elderly, modernization explanations of nursing home utilization are similarly flawed. It is not that modernization arguments haven’t correctly identified the social variables crucially related to the care of the aged. As Gratton noted in his study of the Boston elderly, “The demographic and familial characteristics of older people, poverty and welfare policy, and labor force activity provoke the greatest interest.. .” (Gratton 1986, p. 25). The problem, rather, is that the aged do not confront the ‘modern or industrial’ world as isolated agents: our elderly are members of discrete formations that are articulated with a uniquely configured capitalism. Linking nursing home utilization directly to the

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effects of industrialization fails to advance our understanding of the mediating social structures. And though the household is the most common structure in the United States, there are some, the Hutterites and Amish among them, whose aged members confront the outside world with the community as an important mediating influence. The aged are not located in abstract societies, nor do they confront an abstract economy. People do not hold attitudes and values about residential care outside of I will demonstrate that it is the direct historically particular social structures. articulation-unmediated by a community polity and economy-between the independent household and capitalism which resulted in Mennonite institutionalization. The internal structure of the household formation holds the key to understanding the need for nursing home care. I have avoided the problems intrinsic to modernization arguments by identifying how each formation articulates with capitalism.

OLD AGE IN SOCIAL FORMATIONS: CONCEPTUALIZATION OF MENNONITE, AMISH, AND HUTTERIAN FORMATIONS Unhappy with the empiricism of age stratification and life course research, Patricia Passuth and Vern Bengtson argued that future work in the study of aging must concern itself with “the social experience, the fluid and dynamic features of social context” (Passuth and Bengtson 1988, p. 348). Similarly, Rhoda Halperin has argued that the first step toward establishing the nature of the context “depends greatly on the type of society under consideration” (Halperin 1984, p. 160). She continues: “The way in which production units and laboring individuals change with age depends on the political, technological, and ecological contexts within which the units operate” (Halperin 1984, p. 162). Anthropologists have identified the community as one of the contexts that contribute to “successful aging” (Keith, Fry, and Ikels 1990, p. 245) and in this comparative study, I am primarily concerned with the effects of the community on nursing home utilization. Mennonite, Amish, and Hutterian Brethren exist within concrete social totalities. Their social relations are structured within formations3 of differing scope: household, community, social, and even global formations. Each formation is its own concrete totality to the extent that it contains a structured unit of material production and ideology. Shared ideas, directly and indirectly, provide a rationale for the existing organization of production and distribution and the manner in which people in the formation relate to one another. In this way, the ongoing reproduction of every formation, as a totality, is the product of a constant reciprocal correspondence between ideology and economy (Longhofer 1993). Discrete formations, as such, exist when both material and ideological reproduction of their members takes place only within a given formation. Household and community formations are located within totalities of larger scope, social and global; indeed, the larger formations provide the ‘social context’ for the reproduction of the smaller ones (Amish, Mennonite, Hutterites), and in combination with the internal structures of these household and community formations, determines their conditions of reproduction, decomposition, or transformation (Longhofer 1993; Smith 1989; Friedmann 1980, p. 160). In order to understand the development of Amish and Hutterite community formations, and Mennonite household formations, one must examine their concrete

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history in connection to the larger social formation (United States and Canadian capitalism) within which they are located. Finally, because the decomposition or transformation of formations cannot be known a priori, it is necessary to pay attention to the uniqueness and the historical particularity of the case under study (Wolf 1982, p. 76). I have explained how in the United States the household replaced the Mennonite community formation as the single most important unit through which producers gained access to land (Longhofer 1993; 1986). Special attention has been given to the internal features of the Mennonite community over its three-hundred-year history and how they understood and altocated tand in irrigation and open-field agriculture in Polish, Prussian, and Russian social formations. It has been among the central tasks of my prior work to account for the transition from community to household formations among the Alexanderwohl Mennonites. I have been, however, equally challenged to explain the persistence of communitygoverned relations to production among the historically-related Hutterian Brethren and Old Order Amish, These groups are ideal counterfactuals: the Alexanderwohl Mennonites give way to private household production in the United States, while the Old Order Amish and Hutterian Brethren continue community formations within the same political economy and the same ecology of the Great Plains. I have shown that it is necessary to focus on the internal features of these formations in order to understand why the househoId emerges in one case (the Mennonite), and remains subordinate to the community in the other two. In short, it has been the presence of inter-generational household and community mutual aid practices that provide the Amish a way to reproduce expanding populations~ at the same time, these practices provide a mechanism to redistribute wealth among households and disguise the contradiction of private accumulation. Their controlled use of technology facilitates the continued reproduction of Amish community formations by not allowing privately accumulated wealth to be spent, unrestrained, on innovative labor-saving technologies. The control of technology, then, creates the need for a supply of Amish labor, large households, and a community social division of labor. While the religious ideology of both Mennonites and Hutterites originated in the sixteenth century Anabaptist movement, the distinguishing characteristic of their communities was the differing conceptualizations of property (private vs. communal), which was embodied in their respective economic practices. The Hutterites structured their social relations of production around communal property. The Mennonites, on the other hand, rejected the notion that communal property necessarily followed from Anabaptist teaching (Vogt 1992). In addition to collective decision-making and community-based material practices (such as access to land and the organization of labor processes), Hutterian communal institutions act to centrally appropriate and distribute surpluses. Communal distribution, made possible by the common ownership of the elements of production, has been the key factor enabling them to persist as a community formation within capitalist North American agriculture; it was the presence of communal ownership and distribution within the Hutterite community formation that facilitated their continued reproduction and the absence of this distribution mechanism in the Mennonite community formation that precipitated disintegration of the Mennonite community-within the same capitalist environment.

Though the Mennonite household accumulated attempt to forge

wealth privately, there was an

a communal egalitarianism in which all were equal, but all had freely chosen this equality denying another existence.. . the pursuit of reward beyond those ordained by the community, reward of wealth, office or greater knowledge was forbidden (Urry 1983, p. 311).

The feudal extraction of surplus, household reciprocal labor, the open-field system, and religious ideology combined to subordinate the household to both the Mennonite village community and the Russian social formation4 Private a~umulation developed to a critical level only in late nineteenth century United States capit~ism where land was a commodity and advanced agricultural technology was purchased and privately owned by Mennonite farmers. In contrast to the Amish, the Alexanderwohl Mennonites, lacked the moral standard (described below) against which to judge and control the use of technology. Mennonite investments-unrestrained-in farm implements had the effect of substituting private capital for a complex household and community division of labor. In the United States, the Mennonite community formation disintegrated insofar as it no longer constituted a distinct totality-an articulated combination of material practices (village control of land) and religious ideology. The community decomposed into households whose reproduction was now governed by a different logic, that of individualistic household production. Accordingly, in the following case studies, I will show that it is the internal structure of these formations that accounts for why the nursing home is utilized among the Alexanderwohl Mennonites, but not among the Hutterites and Old Order Amish.

THE OLD ORDER AMISH’ Using life history methods (see Frank and Vanderbergh 1986, pp. 18%212), I conducted interviews in Kansas and Missouri Old Order Amish communities (spring and summer of 1992). Though the primary purpose was to establish whether or not the Amish had utilized nursing homes, the case study below explores in greater detail their community formation and care of the elderly. District Bishops from each settlement were used as key informants. Few differences (between Kansas and Missouri) were discovered in their management of old age dependency, even though each settlement differs significantly in matters relating to the social division of labor affecting old age, especially in their use of tractor power (low technology inputs assure that the elderly will continue to play an important if not crucial role in day-to-day production), and participation in Social Security and related government programs. The Amish in Yoder and Partridge, Kansas, for example, adjusted their Ordnung (unwritten rules for conduct) and adopted the tractor (late 1930s) in order to farm larger acreages, and to make up for decreased soil fertility and rainfall.6 Among the Amish in Partridge, the Bishop acknowledged that some receive income from Social Security; in contrast, no one in the Jamesport, Missouri community has filed for a Social Security claim, nor do they use tractors.

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The Jamesport Amish live in a transition zone between the Plains and the corn-belt of northwest Missouri (Gangel 1971). Their community formation consists of six church districts of approximately twenty-five to thirty families each. As is typical for most Old Order communities, the districts govern their own affairs, elect their own Bishops, and make important decisions pertaining to daily life (Kraybill 1989; Hostetler 1980). The settlement surrounds the small town of Jamesport, and when driving through the area, one is reminded of how the landscape must have looked when every farm (non-Amish included) was the size of Amish farms today, approximately eighty acres. Surrounding the community are Amish farms, saw mills, blacksmith shops, harness shops, general stores, greenhouses, and bakeries. Although tourist dollars supplement incomes, the Amish earn most of their livelihood from grain production, dairy, and raising livestock. In some church districts it is estimated that nearly fifty percent of those engaged in farming work “out” as wage laborers to augment their income. Many in Jamesport are carpenters, cabinet, and furniture makers.7 One Jamesport Bishop could recall no one in his district (or the adjoining live districts) who had been institutionalized for nursing care. Below I will first summarize a case study of a Jamesport bishop and several related households, and then present a composite of cases from Yoder and Partridge, Kansas. In their early 60s the bishop and his spouse live in a comfortable grandfather house (Grossdaadi Haus) built two years ago on their farmyard.* Their daughter and sonin-law now reside just thirty-five feet away in the house that the retired couple had raised their family in: “We were home one night and the kids came over. They had been renting a farm and the owner sold it, so, they came wondering if we were ready to retire. Up until then, we had not given it much thought, except that someday we had planned to build a Grossdaadi Haus. It was decided that night that we would build this house and they would move in next door. We started building right away.”

With labor contributed from their children, the retired couple constructed a new home, held an auction to sell their farm implements, and rented their land (on a cash basis) to their daughter and son-in-law. It is their plan to sell the farm when she and her husband can afford to buy it. The decision to build the grandfather house was a quick one. Visually the next day the plans were made and the ground was cleared. The bishop and his spouse explained that “The last girl was gone and we didn’t want to farm by ourselves. Those girls could handle horses real well and helped in the field whenever I needed it. You know it is a big job to take care of a team of horses, harness them sometimes several times a day for the field, and take care of them.”

As part of the retirement agreement between the two households, the bishop negotiated that (1) he would no longer have to face the daily task of harnessing for fieldwork, and, (2) he would not have to make trips to town to conduct business. He, along with many others interviewed in this study, placed special emphasis on the latter: they showed

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an almost universal disdain for life in the local town. One Kansas bishop remarked that, “retirement in town would be unthinkable, something close to death.” The Jamesport bishop still works everyday, however. In the field, he thought he worked “as much now as before, but not with the same responsibilities.” He also works in his machine shop repairing farm equipment. His wife is the caretaker of a large vegetable garden that is shared by the two households, and she often contributes to child care. Was any agreement made about who would care for the bishop and his wife and who would pay the expenses if they needed help? To this question, the bishop responded, “Some day they [the daughter and family next door] may have to take care of us. We plan to sell the farm to them at a reasonable price. If we don’t need any care, maybe they will get the farm at a bargain.”

The contributions that both the bishop and his spouse make to their daughter’s domestic unit are not remunerated in cash. The small distance separating the homes is to emphasize “the need to have privacy, but, be close enough to help out.” At the time of my interview, the bishop was making plans to travel to his motherin-law’s home in Ohio, where relatives were gathering to build a grandfather house. The bishop’s mother (in her 8Os),recuperating from hip surgery, is living with his sister {a few miles away in Jamesport), but she plans to return to the grandfather house (next to the sister) as soon as she recovers. When the bishop’s father had a series of strokes, he told us “no more doctors. My dad was at home in bed for several weeks. During that time, my brothers and sisters rotated staying with him every night.”

Sibling rotation to provide twenty-four care is common among the Amish when chronic or debilitating illness strikes. In Kansas, this pattern of providing care is nicely illustrated in the following case. Henry Yoder, seventy-one and from Partridge, Kansas, one of eleven brothers and sisters, recalled that for nearly two years his siblings provided around-the-clock care for their mother, who lived in a grandfather house next to a son. His siblings made arrangements to rotate: he had two shifts per week, one day and one night. Henry’s father-in-law had also required daily assistance before dying at the age of ninety-six: “we had to lift him out of bed the last two years. You get used to it, its not all that tough. You learn the frailty of man when caring for older people.”

At present Mr. Yoder’s elderly in-laws live in a grandfather house on his farm. His wife’s siblings take turns caring for his mother-in-law. Mr. Yoder’s spouse “sleeps down there [grandfather house] every fourth night.” As part of retirement negotiations between parents and offspring, Amish children will often help parents with household duties. One Yoder, Kansas bishop, for instance, has a daughter living next door who does his laundry. The bishop had recently sold forty acres to his daughter and her husband at a “discounted price” with the expectation that he wold “get help as needed.”

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The type of assistance to the aged varies according to their ability to live independently. It was clear, though, that when help was necessary, it was the responsibility of the immediate household to provide care. In Partridge, for example, a granddaughter lives with her grandmother, who has a house on the same farm with the granddaughter’s parents. A bishop’s spouse at Partridge has a sister living across the road who requires help with domestic responsibilities. In Yoder, however, the Church once held a special collection and paid for the care of a member in her home when circumstances left the dependent person alone. Among all three communities (some 250 households), only three cases of nursing home utilization were reported: one in Yoder and two in Partridge.9 As the Jamesport Bishop had emphasized, the grandfather house helps to structure domestic independence, while ensuring that assistance is “close enough in case us old people need help.” The placement of two homes on a farmstead, together with the compact nature of Amish settlements (due to horse and buggy transportation and the scale of production), makes health care in the home through sibling rotation structurally possible. The reproduction of Amish households in a community formation that constrains use of technology (no electricity, no automobiles) requires a large supply of labor. Some retired Amish, however, like the Jamesport Bishop, don’t report decreased work loads. Grandparents help their children with domestic and field work necessitated by the lack of labor-saving technology. In the case of the Jamesport Bishop, his grandchildren were too young to help the son-in-law with field work. This transfer of labor from the grandparents to the children contributes to the reproduction of the Amish community in two ways: first, the Grossdaadi Haus means that at least two households are available to help with work that requires the labor inputs of more than one household: gardening, field work, repair work, and breeding and raising horses; second, the grandparent’s non-monetized labor contributions increase the children’s productivity and precludes the need to hire labor, resulting in savings that will be applied to the eventual purchase of the farm. Amish families own property and privately accumulate wealth, but accumulation is retarded by the fact that no household can indiscriminately purchase labor-saving technology. Unrestrained use of technology would increase the productivity of a single household, and as Gavin Smith has argued in the case of all simple commodity producers, differential household productivity within a community diminishes the need for community labor and cooperation (Smith 1985, pp. 102-103). Ideological controls on the use of technology, together with pre- and post-mortem inheritance (discounted land prices, and equal division of wealth among siblings), makes their private household accumulation of wealth work toward one objective: expanding new Amish populations rather than enriching single households. In all three communities, for instance, when medical bills are incurred which exceed a household’s ability to pay, the community will mobilize to cover costs. These mutual aid practices (household and community) extract surpluses from households, redistribute wealth, and bind households and church districts together into one tightly knit, social totality. The Jamesport Amish prohibit involvement in Social Security programs and Medicare. The fact that they pay out-of-pocket for medical care was strongly emphasized. The Amish community formation absorbs young and old by not

di~nishing labor inputs through the purchase of labor-saving technology. The care of the elderly in the grandfather house is one outcome of this kind of community formation.

THE HUTTERIAN BRETHREN In 1989 and 1990, life history interviews were conducted on five Schmiedeleut Hutterian Brethren colonies in Manitoba, Canada and South Dakota. Like the Amish, most of the people interviewed seemed surprised that scholars would show an interest in such apparently ‘mundane’ and taken-for-granted practices surrounding the care of the elderly. Although the focus was mainly on two colonies-Pembina and James Valleyit was possible, because of extensive intermarriage, to gather information on more than fifteen. With key informants, I travelled from James Valley to other colonies where relatives were engaged in the care of the elderly. On these occasions, life histories were also taken. From colony to colony, there was near complete consistency in the manner that the elderly were provided for, and no case of institutionalization could be found. Below is a brief description of the Hutterian community formation, their politics, economics, and ideology. Then, a detailed case study from Pembina and discussion of several related cases on the James Valley Colony are presented. In the wake of the serf emancipation and the economic and political transformation of Russia, the Hutterian Brethren left for South Dakota in 1874. In the United States, they established agrarian colonies where land and other productive property were held in common and labor was cooperatively organized. Three major settlements and numerous colonies were established during the final decades of the nineteenth century: the Schmiedeleut, Dariusleut, and Lehrerleut settlements remain today the major divisions among Hutterites. At the9time of their arrival, there were around 700 people, and by 1917 they had established nineteen colonies (Peters 1965, pp. 42-43). More than 35,000 Hutterites now reside in 350 colonies on the Great Plains of Canada and the United States (Anderson 1989; Olsen 1987, p. 823).” Their emphasis on communal property distinguishes them from both the Old Order Amish and Mennonite. Farm work, food preparation, and consumption are strictly communal affairs, and child socialization is as much the colony’s responsibility as it is the household’s. Signi~~ant decisions are made by a council of male elders known as the Zeugbruder, and labor is organized by the heads of various productive activities: dairy, carpentry, grain, pork, turkey, gardening and food preparation. On each colony, the minister and farm boss (supervisor of day-today production) are central authority figures (Longhofer 1993a; Stephenson 1991; Ryan 1977; Hostetler 1974; Bennett 1967). The James Valley and Pembina colonies are located in Manitoba, where, like many of the Hutterian colonies, they are engaged in diversified agricultural production. And like most on the northern plains, much of their income is earned from the production of cereal grains. In addition, they also raise hogs, dairy and beef cattle, and geese. Large communal gardens provide a surplus which is often marketed locally. Each colony has a state-of-the-art communai kitchen, and at James Valley, there is a smokehouse, a canning operation, and a cheese making facility. They are almost wholly self-suf~cient.

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At the center of colony life is the school, the church, and the communal dining room. Closely surrounding these buildings are apartment-like dwelling units equipped with a minimal kitchen. The major meals are symbolically important communal affairs served in a common dining hall. When necessary, the frail elderly are served food (prepared in the communal kitchen) in their own apartments. After marriage, most women relocate to their husband’s colony, and there is constant visiting between colonies. At the time of these interviews, the James Valley colony was in the process of completing the construction of an ultra-modern, multi-million dollar daughter colony. Most colonies undergo a fission when they reach a mean size of 165170 individuals (Olsen 1987, p. 828; Ryan 1977, pp. 29-32). Women work almost exclusively in food preparation, gardening, sewing, cleaning, maintenance of households, child care, care of the elderly, and the marketing of garden products. The communal kitchen at James Valley is equipped with the conveniences of a commercial or institutional facility: walk-in coolers, canning rooms, commercial ovens and mixers. As in most areas of Hutterian production, the kitchen is a place for constant technological innovation. Each kitchen is headed by a senior woman, and everyone is expected to participate, sometimes on a rotating basis, in the production and preparation of food. Though it is neither common nor encouraged, it is possible for those in need of special care to transfer between colonies, especially when they have no immediate family members. The following case is typical of this pattern of caring for dependent members of the community. Sarah, born in the Blumengart colony in 1898, was married in her late teens to someone from James Valley, where-according to the norm-she moved to live. While in his early 4Os, her husband died from complications related to tuberculosis. Without children, family, or relatives in James Valley, Sarah asked for permission to return to her home colony of Blumengart. Soon after returning, the colony began the process of division. She joined a group that was establishing a daughter colony called Pembina. In 1990, at age 92, she was living at Pembina with a niece, the unmarried daughter of a sister. The niece, Susie, had served as head cook at Pembina for three years before being excused from those duties to help her aunt, who needed “constant attention.” On a regular basis, nieces from other colonies provided Susie relief, while unrelated colony members also contributed to Sarah’s care. The young and old in cases like Sarah’s enjoy a reciprocal exchange. One retired farm boss gave this philosophical account: “I make the wine for the village, I keep the bees, and also enjoy reading and talking about our history. Here, each of us, regardless of our age, and physical condition is important. This, I think, has something to do with keeping our older people active in the life of the colony, even if it is teaching songs to our young people, or in telling stories, over and over again.”

Likewise, one colony minister described a funeral where, the grandchild was shedding most of the tears. She had spent her early teens living with and caring for her grandmother: bathing her, cleaning her home, cooking for guests, and providing companionship.

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One fifty year old single woman said, “IVe a whole line up of nieces ready to take care of me when I’m old. I have a niece living with me now, upstairs in my unit. I’m never alone. We talk and sing together. They enjoy their time with me.”

At Pembina, Liz Maendal, one of eleven children, took care of both her parents. Seven of her sisters had married and moved to other colonies. Her three brothers live nearby. Liz described her years with her mother: “Mom was blind for twelve years, and I stayed with her. Dad died fifteen years ago on January the 3rd, leaving Mom alone. She wasn’t completely blind. It wasn’t like being completely dark. I told Dad I’d look after Mom. After Dad died, Mom and I did everything together: we prayed together, sang together. Mom couldn’t do anything in those twelve years. In fact, I had to think for her. When she was in the hospital, I always stayed with her. At home, we always slept in the same room, each in our single bed. She used to get me out of bed. She would say, ‘Liz, I got you out of bed five times already.’ I would say, Mom, how many times did you get up for eleven children. Nobody counted. No more counting, Mom, I’d say. In the morning, I’d wake her up, make her breakfast, then I’d give her a bath. I’d lift her into the bathtub and out. Then, we’d do in and sing our hymns. After singing was done, I’d read to her from the prayer book. And, then, I’d create for her some work. Mom was very weak. I’d bring her a sweater, she’d make a round three times, and she’d fall asleep. I’d encourage her in every instance that she could do something.”

One minister described how caregivers who are involved in assisting an elderly person are relieved from ordinary communal responsibilities. Liz explained that she didn’t have to cook or do dishes in the colony kitchen while she was caring for mother: “I was excused from these responsibilities.” She continued, however, “When my cook week came, I wanted to be with the other people, for a change. You can’t isolate yourself from the other people, always being at home; so every eight or nine weeks when my cook week came, I would order one of my seven sisters home [from another colony], and we’d take care of Mom together. Then, I could trail over to the kitchen and do my duty in the kitchen for one week. This way, I could get out and be with the other people, rest my mind. They [siblings] loved coming home.”

Liz, in describing her role as a single women, said that “I think that was a privilege from God that I was chosen to look after my parents, too remain unmarried. I always tell our women in the communal kitchen that, ‘any parents that God thinks highly of, they leave them an unclean jewel there to look after them when they get older.’ A lot, a lot of Hutterite girls, in each family, one or two look after them. I don% think people who don’t have children are any worse off in their old age than those who do. I’ll take you soon to an old women, Auntie Susie, who is being looked after by a niece. She is not shortcut in anything. To me,

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tree in your yard. Do you know what I mean?

Frequently, colony members will exchange residences in order to accommodate the elderly or families with young children. Liz described one such case in her own life: she reduced the workload of a mother with children by taking the apartment with a staircase. Liz recalled, “I took care downstairs. he had the [apartment],

of Mom for eight years. In the beginning, I had a house with I used to live just next door. My brother, Eddie, the baby in twins then, about a haff a year old. I told them, you take 111take yours. Then, you won’t have to trail up and down

five rooms the family, my house the stairs.”

This, Liz concluded, is “security from the cradle to the grave.” “Both material and spiritual,” added her brother-in-law, a minister at James Valley colony. Among the Hutterites, individual and household accumulation is prohibited; no one leaves the colonies with shares or productive property. Those who choose to leave the colony do so without productive property and little personal wealth. Indeed, centralized distribution among the Hutterites precludes private accumulation (Longhofer 1993). Among other things, centralized distribution prevents the transformation of privately accumulated surplus into private capital through the market and the utilization of the accumulated capital for the purchasing of equipment and the hiring of labor. This assures that everyone, young and old, has a meaningful role in the social division of labor. The centralized mechanism of production and distribution also restricts the dispersion of surplus, enabling the colonies to concentrate and centralize capital; that is, the community disperses the surplus production of individuals and households at the same time that it prevents dispersion of community property by allowing neither ownership nor alienation of surplus or property from the community. Centralization of distribution also prevents the development of capitalist wage relations and class divisions within communities. This, in turn, enables the Hutterite community to develop a harmonious division of labor-a system in which every working member of the community is productive, regardless of position or age or place in the division of labor. These internal features of the Hutterite community formation preclude the need for nursing homes. Health care in the household is possible because the colony division of labor creates flexibility (the substitution, for example, of a head cook for a elderly caregiver) in the allocation of labor, and their compact apartment dwellings encourage support from family and colony members. The communal ownership of property and distribution of the social product means that the elderly cannot reproduce themselves outside the colony: “it is security from cradle to grave.”

ALEXANDERWOHL MENNONITES In prior work, I have established (with aggregate analysis of census data, interviews, and genealogies) that elderly Alexanderwohl immigrants and their descendents (18X5-

pursing Home ~ti/jzatjo~

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1925) often built or moved houses on to their farmsteads to accommodate themselves and the families of offspring (Longhofer and Floersch 1992, pp. 102-106). Even though a hospital and home for the aged was established in 1898 in Goessel, Kansas (in the center of the Mennonite community), these early immigrants were not commonly numbered along the occupants (Schmucker 1992). After 1950, however, Mennonites began to enter the Bethesda Home for the Aged. I used several methods to examine nursing home utilization among the Mennonites. The names of the earliest residents were taken from the minutes of the board meetings (1900 to 1929). These were compared with local church records and discussed with key informants to determine if they were from the Alexanderwohl community. In 1929, the Home’s Matron began recording i~ormation (name, religion, address upon entry, date of birth, date of entry, and employment status) in a registry-used until early 1953. The Bethesda Hospital Society’s monthly newspaper, L?er Bethesda Herold, was a valuable resource, containing among other things, addresses, dates of death, and discharge information. It also published life-history interviews with residents-more than 130 during the period from 1950 to 1972. These were, in a sense, event histories-the interviewers used the entrance into the Home as the point of reference. Then, they reconstructed significant life course events leading up to the resident’s admission. In 1980, I conducted intensive interviews and a community-wide household censusincluding a census of the nursing home. Finally, in 1992, I returned to the Bethesda Home and collected information on residents who have come and gone since 1980. Throughout its history, the home has admitted approximately 900 residents. The current administrator estimates that two-thirds (90 residents) of the current population are from the three Alexande~ohl-related churches: Alexanderwohl, Tabor and Goessel. The following case studies reported in Der Bethesda Heruld illustrate how the Mennonites moved from a system of home-care, similar to that current among the Amish today, to institutional-care. Peter and Maria Balzer immigrated in 1874 and settled in one of the eight Alexanderwohl villages, Gruenfeld. The 1900 federal census shows that eight of their ten children were living with them at the time, two having died, according to church records. That same year, at age 58, Peter Balzer died. Marie remained a widow until her death in 1921. Beginning in 1903 and ending with the final disposition of the land upon Maria’s death, the Balzer farmstead of 240 acres was gradually divided among the widow and children (Longhofer 1993b). Until his marriage in October of 1910 (at age 24) to Sara Schroeder, David, the youngest Balzer son, lived with his younger sister, Margaretha, and his mother. As was common for newly married couples, David and Sarah lived with Maria (fler Bethesda Herold Dec. 1964, p. 2). They remained in her home for nearly one year. David and Sarah Balzer then built a house on the farmyard next to David’s mother, and that arrangement held until Maria’s death ten years later. They then moved their house to “their own land about a half mile north of Tabor church,” where they lived the remainder of their lives as small farmers and custodians of the nearby church (Der Bethesda Herold Dec. 1964, p. 2). They adopted one son, Elmer, who at the time the life history was recorded (November 1964), lived in Newton, Kansas, with his family. After three years of illness, David died in October of 1960. Sara left the farm and lived

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with Elmer’s family in Newton for nearly four years; then, she moved into the Bethesda Home in August of 1964. At the time of the interview, Sara had “good eyesight and hearing” and continued to sew and crochet (Der Bethesda Herold Dec. 1964, p. 2). In 1981, Sara died in the Bethesda Home after seventeen years of residence.” Mrs. Helena (Richert) Abrahams, the daughter of an 1874 immigrant couple, Heinrich and Anna (Schmidt) Richert, was born April 8,1892 in the Gnadenfeld village near Goessel, Kansas. She had been a member of both the Alexanderwohl and Goessel Mennonite churches. At the time of the interview (January 1970), she was sewing for the Mission Society of the Goessel Mennonite Church, and acknowledged the assistance of C. F. Funks, who provided her transportation to the Mission Society meetings. Helena’s father died (1895) when she was three and a half. Her mother remarried a widower, Jacob Abrahams, who relocated to her farm in the Gnadenfeld village. Helena received an eighth grade education at the Gordon grade school. According to the Der Bethesda Herold, “Being the youngest in the family she mostly worked at home, but generally there was plenty of work on the farm in those days”(Der Bethesda Herold Dec. 1970, p. 2). After her marriage, Helena and her husband, George Abrahams, spent all but the first three years of their union living with her “parents on the farm and took care of them as long as the lived.” In June of 1967 Helena’s husband suddenly died. The Der Bethesda Heroldcolumnist describes her widowhood: These were lonesome days for her. After some time she decided to move to Goessel so she would be close to church. As her health began failing, the family encouraged her to go to the Bethesda Home, which she did in the fall of 1969 (October); she had never regretted it, for it was the best place for retired citizens (Der Bethesda Herold Dee 1970, p. 5).

Helena moved to the Bethesda Home in spite of the fact that she had three children living near Goessel. Willis lived on a farm three and a half miles south of Goessel. Grace and her family lived in Newton, Kansas (twelve miles from Goessel). Elvera and her husband had five children, farmed, and lived south of Hesston, Kansas (thirty miles from Goessel). Helena stayed at the Bethesda Home for eight years, dying there in December of 1977. In other research, I have shown that between 1875 and 1925, widows, widowers, and elderly parents resided with married or unmarried children, or lived in homes adjacent to them, similar to the Grossdaadi Haus among the Amish (Longhofer and Floersch 1992, p. 106). However, these practices changed over the next decades. Examination of the Bethesda Home’s registry established that between 1929 and 1952, thirty-one of the Home’s residents (14 percent of the total resident population of 198) were Alexanderwohl Mennonites. This percentage, however, was to increase dramatically: between 1969 and 1992, nearly forty percent (192 of nearly 500 cases) of the residents were from the three Alexanderwohl churches. The strategy of living next to or with children in retirement had been virtually abandoned, so that 1980, a household census of the community (n = 375), and intensive interview data revealed the following arrangements for those retired or near retirement (age 60 and over, n = 208 households): (1) 106 were couples living alone; (2) thirty-

two were solitary households of widows or widowers; (3) seventeen were never married solitaries; (4) only four were extended, two-generation, kin-oriented households; (5) thirteen were couples or widowed persons with adult unmarried children living with them; (6) thirty-four were residents of the Bethesda Home; and finally, (7) just two were living in separate homes adjacent to (and on the same farmyard with) offspring.‘* I have shown elsewhere that, after the Mennonite village system collapsed in the United States, the private household emerged as the single most important unit of social organization through which producers gained access to land. Letters and diaries from this period dramatically illustrate the burden that farming had become: the community had ceased to play a significant role in mediating the relationship between the local villages and the larger social formation. The effects of capitalist agriculture were to have a profound influence on the subsequent history of the Alexanderwohl people (Longhofer and Floersch 1992, pp. 100-101). Mennonites purchased cars and tractors and consolidated farms. These factors, combined, led to the destruction of the local division of labor. The introduction of antibiotics increased life expectancy. This, in turn, lengthened the life-cycle phase during which children and parents lived independently-the empty nest period. The absence of community constraints on production-together with the ideology of individualism, private property, and the nuclear family-encouraged, especially after 1945, the formation of separate Mennonite household formations: one for the elderly, and one for their children’s families. The case studies from Der Bethesda Herold reveal a common trend emerging around 1945: Mennonites who retired moved to town, even while still healthy. When this move to Newton or Goessel was followed by the death of a spouse, the remaining spouse would, within a few years, become a resident of the Home. Many, after 1950, came to depend on the Bethesda Home for residential care. The Home became a solution to a problem created by the emergence of independent household formations.

COMPARATIVE ANALYSIS Mennonite, Hutterite, and Amish social formations have ideological and material (economic) components that structure their reproduction. The Mennonite community formation, unlike the Amish or Hutterite, was constituted so that capitalist ideology and economics penetrated and destroyed it. The reproduction logic of their respective formations explains the Mennonite utilization of nuking homes, For the Mennonite, there was no standard against which to judge the appropriateness of particular technologies and no community mechanism to redistribute economic resources. When Mennonites faced economic crises, they often left the countryside to work in nearby towns. By contrast, when Hutterian colonies faced economic difficulty, other colonies joined to provide necessary resources (Longhofer 1993a). Hutterians have not been forced by economic pressure to accept wage labor, and unlike the Mennonites, they have never needed to move into urban environments. Though the Amish have worked for wages, they have chosen not to live in towns. Teams of Amish carpenters venture out of the community, but outsiders are hired to drive them to and from the worksite. Today, many Amish are employed locally in small industries: in Jamesport, for example, they work in sawmills, in harness and tourist shops, and at buggy making.

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The Amish sought to reproduce expanding, densely populated, rural settlements. Unlike the Amish and Hutterites, the Mennonite household articulated directly with the capitalist economy, without the material mediation of the community. Mennonite ideology also differentiates them from the Amish and Hutterite. Mennonites have been open to the outside world. Whereas they have promoted education as a viable alternative to farming, the Amish and Hutterites have not; moreover, these latter groups have struggled, often through the courts, to maintain the autonomy of their schools. The Mennonite orientation toward the outside world is manifest in the emphasis they place on mission work to help the poor and sick.13 The Amish and Hutterian formations have placed serious limits on the nature and extent of interaction with outside groups and institutions. The combined ideology and economy of the Mennonite household had been structured so that state or government financial assistance was acceptable. Already in 1906, the Bethesda Hospital and Home was receiving operating funds from the state of KansasI By contrast, Amish and Hutterian ideology forbade state intervention.” This comparative study suggests that it is the type of formation that the elderly are reproduced within and the kind of articulation the formation has with capitalism that determines the utilization of nursing homes. Some might attribute the emergence of the nursing home to a weakening of household support among the Mennonites. After all, early in their history, Mennonites had taken care of the elderly without the use of the nursing home, as the Amish persist in doing. The Mennonite household was not weakening. The Mennonite community formation simply lacked those features that made it possible for the Amish to resist the penetration of capitalist forces. The Amish community formation, in contrast, provided for a broader social division of labor and restricted household accumulation and differentiation. Prior to 1950, Mennonites were taking care of the elderly at home or next to children. Political forces (Social Security income) and economic forces (the competitive nature of simple commodity production) had not fully fragmented, proletarianized, and differentiated Mennonite households. With the purchase of cars, tractors, combines, trucks, and fertilizers, the market gradually undermined a diversified division of labor. After 1950, Mennonites would often retire and move to town, and away from the centripetal forces which had bound them together (Longhofer 1993b). It was not that Mennonite children had abandoned their elderly, but that Mennonites had abandoned their ‘community’ formation. This left the household alone (outside of government) to assist with old age dependencies.

CONCLUSION Cross-cultural studies of aging have strengthened gerontological research by challenging us to account for the exceptions, when they occur (Keith, Fry, and Ikels 1990, p. 246; Kertzer and Schaie 1989; Nydegger 1983). In the United States, there are few groups that approach the care of the elderly like the Amish or Hutterian Brethren. Indeed, most of the literature on nursing home utilization has investigated the ways in which the individual, the medical establishment, the household, and the state have managed old-age dependencies. This study has used the comparative method to broaden our understanding of how community formations prevent institutionalization. Though the

&dings may be peculiar to the Amish and Hutterian Brethren communities, we can use the comparison with Mennonites to strengthen our unde~ta~di~g of how social structures more generalIy affect nursing home utilization. In their identification of the significant variables, modernization arguments are rich with explanatory potential: labor mobility, technology, family, and urbanization. I’ve argued that the effects of industrialization could not be used to explain the differences among the three groups studied here. First, it is necessary to conceptualize the social formations within which the elderly are situated. This isn’t the most remarkable finding, however. Others have gone beyond modernization arguments by analyzing the various social contexts of old age. Brian Gratton, for instance, has argued that a lack of family, an inability to adjust to rapid technological change, gender, and demographic shifts in household size and composition left Boston’s elderly no alternative but institutionalization. Gratton demonstrated how the elderly weren’t abandoned, and how social classes organized to assist the elderly-not only in reforming decrepit Almshouse institutions, but also, in providing income security (Gratton 1986). We learn from Gratton’s analysis that industrialization did not uniformly affect Boston’s elderly. His work also illustrates how gender, social class, and ethnicity were part of the social context that affected one’s risk of institutionalization. Others have been critical of still another important modernization argument: decline in family support required nursing homes to fill the void once occupied by caregiving children. These investigators have examined the elderIy in the context of the family and household. They‘ve known that family support did not decline. Instead, assistance was not terminated but transformed as the household~s role and position in the economy changed (Sang1 1985; Arling and McAuley 1984, p, 134; Shanas 1979). Indeed, families haven’t turned away from the responsibilities of aged parents, but have often stretched their capabilities and resources (Braithwaite 1992; Brody 1981, 1985). Demographic studies have made it clear that no monumental shift in composition from extended to nuclear families has occurred (Laslett 1972). Households have decreased in size and the ratio of adult children to parents has declined. And, as a result, fewer aged parents live with children today than in 1900, and more live alone (Smith 1979, 1986; Dahlin 1980). Scholars have interpreted the trend toward living alone (beginaing about 1950) as a manifestation of a latent desire that was blocked by insufficient household resources. These findings suggest that we should strongly avoid the tendency to make a contrast between a cozy intergeneration~ past and a present bereft of mutual aid. Mode~~ation explanations, on the other hand, place the elderly of the past into idealized extended households. Then, they assume that the absence of those households result in family abandonment. The outcome: nursing homes Ii11the vacuum. The historical study of household demography, income, composition, and intergenerational assistance has rendered the family abandonment thesis unlikely. Modernization arguments have projected an image of charity and welfare services that was one linear step beyond the family abandonment assertion; that is, institutions took over when families stepped a&de. By examining the effects of welfare on the aged, researchers have challenged the benevolent image of the welfare state. Some have argued that Social Security was veiled labor legislation designed to remove alder workers from the labor market and replace them with younger ones (Graebner 1980). Others point to social class and argue that welfare was an outcome of a working class struggle or

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an act of legitimation to reproduce the capitalist class (Myles 1984; Quadagno 1988). In Boston, Gratton found gender and ethnic differences in nineteenth century public and private homes for aged and almshouses; women were more likely than men and the Irish more likely than native Yankees to reside in such institutions.r6 There are numerous studies that contend Medicaid created dependence (Harrington et al. 1985, 1986). Medicare funding favors residential over community-based programs like home health care, Meals-On-Wheels, and Senior Centers; these programs, policymakers and practitioners have argued, promote household independence and thwart institutionalization (Weissert, Cready, and Pawelak 1989; Shapiro and Roos 1989; Palmer 1985). We have learned not to assume the benevolence of the welfare state and we have acknowledged how the state bureaucracy itself has been part of the social context for aging. Hence, the study of aging has been immensely enriched by research on the household, the state, gender, social class, and ethnicity; each, as an object of inquiry, has advanced our understanding of nursing homes. I’ve added to this list, community structure. The social organization of the Amish and Hutterian community formations promoted home care for the aged. These communities were able to draw a wider social net around the dependent elderly. Their households had not been drawn into a direct articulation with capitalism; instead, the community acted as a buffer and one outcome of its mediating influence was home care. It was the larger social network of children, relatives, and community members, made possible by their unique political economies, that assured the elderly a place at home. Amish and Hutterian elderly are not reproduced in households independent of their community structures. In contrast, the Mennonite household had separated itself from the community polity and economy so that prior to the establishment of the Bethesda Home for the Aged, the household formation alone provided for dependents. This finding (the sole reliance upon the household) is consistent with those for nineteenth century urban and rural elderly. It is not surprising, then, that researchers have discovered that household support is a strong predictor of institutionalization. For instance, after analyzing Boston’s homes for the aged, Gratton concluded that the absence of “family networks, not occupation, predicts overt dependency” (Gratton 1986, p. 125). Peter Townsend (1965) has also argued that institutionalization resulted from lack of family resources. The home health care movement has been based, moreover, upon an assumption that home health services can be used to avert institutionalization. Ironically, have we not corroborated a modernization assumption by arguing that the elderly with little or no family resources become candidates for institutional care? The literature reporting on the relationship between the household and nursing homes contains two seemingly irreconcilable conclusions: on the one hand, children haven’t abandoned their aged parents; but on the other hand, elderly are often placed in nursing homes because help was no longer available at home. How can we account for the need to have nursing homes without invoking the disintegration of the family as the cause, and at the same time accept the findings that a lack of family support results in institutionalization? The Mennonite household’s organization of care for the elderly is remarkably consistent with the urban historical record; prior to Social Security and the Bethesda Home for the Aged, Mennonites provided care at home. As birth rates declined and life expectancies increased Mennonite household composition changed

and size declined, however, the household remained the domestic unit. There was no ssructurat disintegration of the iud~p~~dent household. The changes brought on by the household’s direct articulation with capitalism exposed a basic structural limitation: sometimes dependency cannot be managed by the narrow resources of households. To argue that households are limited is not to say that they have disintegrated. The introduction of Social Security and the gradual proletarianization of agricultural labor changed household reproduction requirements; parents increasingly depended on the state and savings, and less on land and inheritance to negotiate help fram children. The market and state intrusion combined with internal changes in demography and residence to leave some elderly in need of assistance. We can argue, in the light of these ~~din~s, that a lack of family resources leads to insiitutional~atio~. Yet, this need not contradict the finding that children have not abandoned their parents, if we understand the ‘lack of family support’ as a structural limitation of the ~~~~~h~~d~ manifest under certain conditions--external and internal. It can be argued that changes external and internal ta the household necessitated a need for outside help, but it does not follow, a priori, that old-age assistance had to take the form of the residential institution (or state intervention). In other words, why was a home for the aged the only practicable alternative to the Mennonite elderly? Mennonites had no community structure, no intermediate economy or polity between the household and the larger social formation. Lacking a community structure, the Mennonites turned to instituiio~~l welfare models that had been worked out in Prussia, Russia, aud the LTnited States (Urry 1992; ~uada~o and Janzeri 1987). This ~omp~ative study suggests that the emergence of homes for the aged has at least two pr~onditions~ (1) no comm~ty economy or polity to provide a wider net for dependent elderly, and (2) an ideology which permits welfare or charity provisions. The Mennonites established a nursing home to perform the function that the Amish and Hutterian community structures continued to provide, The Bethesda Home for the Aged was similar in character and organization to private charitable homes for the aged established in other parts of the country, both rural and uiban (Gratton 1986; Haber 1977). Even though it had received some financial assistance from the state of Kansas, the bulk of its operating funds came from Mennonite contributions. Mennonite children had not so much abandoned their elderly as the elderly (for a variety reasons) gradually became a~~~torned to choosing residence in the Bethesda Home for Aged. The Mennonites had not mganized outdoor rekf as had Boston’s Irk& they had tursed to indoor relief-institu~on~~a~~~. It is plausible that the Mennonites established an institution for the aged because they had a history of subordinating the individual to the community, In Russia, the Waisenamt (Orphans and Widows Office) regulated inheritance and assisted the village elderly (Longhofer and Floersch 1992; Peters 1985). It would not seem out of the ordinary to have placed the elderly in the hands of community operated institutions; indeed, the Home for the Aged was founded upon the principle that charity was a n~%essary part of religious practice, The Wasienamt, together with their ideology of charity, set the stage for the development of an old-age institution, i7

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Incentive Fund and the National Endowment for the Humanities (FE-23259) have supported subsequent work among the Hutterites and Amish. I owe a special thanks to Morteza Ardebili, Brian Gratton, Jill Quadagno and Jaber F. Gubrium for their comments. However, without the support of Jerry Floersch, this project would not have been possible.

NOTES 1. For a critique of this perspective, see Gratton 1986, p. 12-15. 2. Realist philosophers of social science have argued that an adequate explanation of a conjunction of events (such as industrialization and the rise of nursing homes) requires an elaboration of the underlying social mechanisms that produce these events (Ardebili 1990; Bhaskar 1989, pp. 1 l-26; Outhwaite 1983; Keat and Urry 1975, pp. l-66). 3. Throughout this study, the social totalities within which these three groups are located are called, ‘formations.’ The use of ‘society’ to denote such entities is avoided on the grounds that it is incapable of capturing the complexity and multiplicity of social arrangements characteristic of any empirical case. 4. This has been described in Longhofer 1993. 5. It should be noted that there are vast differences among Old Order Amish communities in the degrees to which they control and adopt technology, enforce behavioral codes, and interact with the outside world. In the following case studies, three Midwestern (Kansas and Missouri) Old Order communities are considered. Among them, as well, there is considerable variation. 6. They had been accustomed to the conditions of production in Indiana, Ohio, and Pennsylvania (Hostetler, 1980, pp. 100-103). 7. Wage labor is not uncommon among the Old Order Amish. What is unique is the manner in which their local industries provide jobs (Kraybill 1989, pp. 190-211 and Hostetler 1980, pp. 138-146). 8. The Old Order Amish in Lancaster County, Pennsylvania are known for the composite architecture that results from the construction of attached multi-generational houses. This practice is not common among the Kansas and Missouri Amish. 9. These cases have occurred during the last past decade. With regard to one, a key informant said that his brother’s wife “lost her mind and it was too dangerous to have her at home.” She was placed in a Mennonite nursing home in Hutchinson, Kansas. The informant gave no reason for why sibling rotation was not used. In a second case (Yoder), a son had just placed his mother in a nursing home; he was reluctant to give details and seemed embarrassed about my inquiry. IO. With one exception, the Arnoldleut (New York), most of the colonies are on the Great Plains. 11, David’s brother Heinrich P. Balzer and sister Helena (Mrs. Peter. B. Fast) were also residents of the Bethesda Home (Der &&es& Herold Nov. 1970, p. 2). 12. I have reported on the relationships between inheritance practices and aging among the Alexanderwohl Mennonites (Longhofer and Floersch, 1992; Longhofer i993b). On the Great Plains (1874), they attempted to reestablish eight village communities. They had migrated as a single collectivity from Russia, negotiated with the railroads for land, and organized open-field villages. They followed strict dress codes and marriage rules, spoke Low German, established German schools, and strove to remain separate from the influence of outside groups. These cultural markers eventually gave way to public schools, English, modern dress, and interdenominational marriage. 13. The early founders of the Bethesda Hospital Society did not exclude non-Mennonites from utilizing the institution (Annual Report 1905). 14. Their subsequent acceptance of Social Security was not without precedent.

15. State intervention among the Mennonites is manifest today in the monies received by the Goessel Agape Senior Citizen Center. The Hutterite and Amish do not operate government funded centers. 16. Carole Haber (1977) has shown that Philadelphia homes for the aged were transformed from residential to medical facilities and argued that this was a first step toward the ‘medicalization of old age.’ 17. The nursing home records contain rich narrative about the struggle between two philosophies: (1) to maintain a home-like environment, and (2) provide services to the sick elderly. Until the early 1960s they had endeavored to maintain the Home as a non-medical, retirement institution. It was only after it became transformed into a skilled nursing home (1969), that its atmosphere shifted from a “home environment” to a medical facility. We are currently looking at the history of the Home’s goals, policies, residents, and changing care, to demonstrate how it underwent medicalization.

REFERENCES Anderson, L. 1989. “Hutterite Colonies and Memberships.” Paper presented at the seventeenth annual meetings of the National Historic Communal Societies Association, Yankton, South Dakota. Annual Report of Bethesda Hospital Society. May 1905. North Newton, KS: Mennonite Library and Archives. Ardebili, M. 1990. “The Realist Philosophy of Social Science.” Unpublished manuscript. Arling, G. and W. J. McAuley. 1984. “The Family, Public Policy, and Long-Term Care.” In Independent Aging: Fam~Iy and Social Systems in Perspective, edited by W. H. Quinn and G. A. Hughston. Rockville, MD: Aspen Systems. Bennett, J. 1967. Hutterian Brethren: The Agricultural Economy and Social Organization of a Communal People. Stanford, CA: Stanford University Press. Bhaskar, R. 1989. Reclaiming Reality. New York: Verso. Braithwaite, B. 1992. “Caregiving Burden.” Research on Aging 14 (1): 3-27. Brody, E. M. 1981. “Women in the Middle and Family Help to Older People.” The Gerontologist -.

21: 471480. 1985. “Parent Care as a Normative Family Stress.” The Gerontologist

25: 19-29.

Dahlin, M. 1980. “Perspectives on the Family Life of the Elderly in 1900.” The Gerontologist 20: 99-107. Her Bethesda Herold. 1902-1973, North Newton, KS: Mennonite Library and Archives. Dunlop, B. D. 1979. The Gra~th of Nursing Home Care. Lexington, MA: Lexington Books. Estes, C. 1991. “The New Poiitical Economy of Aging: Introduction and Critique.” In Criticul Perspectives on Aging: The Political and Moral Economy of Growing Old, edited by M.

Minkler and C. Estes. Amityville, NY: Baywood Publishing. Foner, N. 1984. “Age and Social Change.” In Age & Anthropological Theory, edited by D.I. Kertzer and J. Keith. Ithaca, NY: Cornell University Press. Frank, G. and R. M. Vanderburgh. 1986. “Cross-Cultural Use of Life History Methods.” In New Methods for Old-Age Research, edited by C. Fry and J. Keith. South Hadley, MA: Begin & Garvey Publishers. Friedmann, H. 1980. “Household Production and the National Economy: Concepts for the Analysis of Agrarian Formations.” Journal of Peasant Studies 7(2): 158-183. Gangel, K. 0.197 I. “The Amish of Jamesport, Missouri.” Practical Anthropology (July-Au~st): 156-165.

118

JOURNAL OF AGING STUDIES

Vol. 8/No. 1 I1 994

Graebner, W. 1980. A History of Retirement: The Meaning and Function of an American Institution, 18851978. New Haven, CT: Yale University Press. Gratton, B. 1986. Urban Elders: Family, Work, and Werfare among Boston’s Aged, 1890-1950. Philadelphia, PA: Temple University Press. Haber, C. 1977. “The Old Folks at Home: The Development of Institutionalized Care for the Aged in Nineteenth-Century Philadelphia.” Pennsylvania Magazine of History and Biography 5 1: 240-257. Halperin, R. 1984. “Age in Cultural Economics: An Evolutionary Approach.” In Age & Anthropological Theory, edited by D.I. Kertzer and J. Keith. Ithaca, NY: Cornell University Press. Harrington, C., C. Estes, P. R. Lee, and R. J. Newcomer. 1986. “Effects of State Medicaid Policies on the Aged.” 77re Gerontologist 26(4): 437443. Harrington, C., R. J. Newcomer, and C. Estes. 1985. Long Term Care of the Elderly: Public Policy Issues. Beverly Hills: Sage Publications. Hostetler, J. 1974. Hutterite Society. Baltimore, MD: The Johns Hopkins University Press. 1980. Amish Society. Baltimore, MD: The Johns Hopkins University Press. ~. Johnson, C. L. and L. A. Grant. 1985. The Nursing Home in American Society. Baltimore, MD: The Johns Hopkins University Press. Keat, R. and J. Urry. 1975. Social Theory as Science. Boston, MA: Routledge & Kegan Paul. Keith, J., C. L. Fry, and C. Ikels. 1990. “Community as Context for Successful Aging.” In The Cultural Context of Aging, edited by J. Sokolovsky. New York: Bergin & Garvey Publishers. Kertzer, D. I. and K. W. Schaie. 1989. Age Structuring in Comparative Perspective. Hillsdale, NJ: Lawrence Erlbaum Associates Publishers. Koff, T. H. 1982. Long-Term Care: An Approach to Serving the Frail Elderly. Boston, MA: Little, Brown and Co. Kraybill, D. B. 1989. The Riddle of Amish Culture. Baltimore, MD: The Johns Hopkins University Press. Laslett, P. 1972. Household and Family in Past Time. Cambridge: Cambridge University Press. Longhofer, J. 1993. “Household and Community: The Alexanderwohl Mennonites and Two Counterfactuals, the Amish and Hutterite.” Research in Economic Anthropology 14: 153188. . 1993a. “All Things in Common: The Contingent Nature of Communalism Among the Hutterites.” Journal of Mennonite Studies 11:174-193. 1993b. “Toward a Political Economy of Inheritance: Community and Household ~. Among the Mennonites.” Theory and Society 22:337-362. Longhofer, J. and J. Floersch. 1992. “Old Age and Inheritance in Two Social Formations: The Alexanderwohl Mennonites in Russia and the United States.” Journal of Aging Studies 6(2): 93-112. Longhofer, J. 1986. Land, Household, and Community: A Study of the Alexanderwohl Mennonites. Ph.D. dissertation. Department of Anthropology, University of Kansas. Moroney, R. M. and N. R. Kurtz. 1975. “The Evolution of Long-Term Care Institutions.” In Long-Term Care: A Handbook for Researchers, Planners, and Providers, edited by S. Sherwood. New York: Spectrum Publications. Moss, F. E. and V. J. Halamandaris. 1977. Two Old, Too Sick, Too Bad: Nursing Homes in America. Germantown, MD: Aspen Systems Corporation. Myles, J. 1984. Old Age in the Werfare State: The Political Economy of Public Pensions. Boston: Little, Brown and Co. Nydegger, C. 1983. “Family Ties of the Aged in Cross-Cultural Perspective.” The Gerontologist 23: 26-32.

Olsen, C. L. 1987. “The Demography of Colony Fission from 1878-1970 Among the Hutterites of North America.‘* American Anthropologist 89(4): 823-837. Outhwaite, W. 1983. “Toward a Realist Perspective.” In Beyond Method: Strategiesfor Social Research, edited by G. Morgan. Beverly Hills, CA: Sage Publications. Palmer, H. C. 1985. “The Alternatives Question.” In Long-Term Care: Perspectives from Research and Demonstrations, edited by R. J. Vogel and H. C. Palmer. Rockville, MD: Aspen Systems. Passuth, P. M. and V. L. Bengtson. 1988. “Sociological Theories of Aging: Current Perspectives and Future Directions.” In Emergent Theories of Aging, edited by J. E. Birren and V. L. Bengtson. New York: Springer Publishing Co. Peters, J. 1985. The Waisenamt: A History of~ennonite ~nheritanee Custom, Historical Series Vol. 1. Steinbach, Canada: Mennonite Village Museum. Peters, V. 1965. All Things Common: The Hutterite Way of Lge. Mi~~eapulis, MN: The University Press of Minnesota. Quadagno, J. S. 1982. Aging in Early Industrial Society: Work, Family, and Social Policy in Nineteenth-Century England, New York: Academic Press. 1988. l&e Transformation of Old Age Security: Ciass and Politics in the American -. WeFare State. Chicago: University of Chicago Press. Quandagno, J. S. and J. M. Janzen. 1987. “Old Age Security and the Family Life Course: A Case Study of Nineteenth-Century Mennonite Immigrants to Kansas.” Journal of Aging Studies l( 1): 3349. Roseberry, W. 1989. Anthropologies and Histories: Essays in Culture, History, and Political Economy. New Brunswick: Rutgers University Press. Ryan, J. 1977. The Agricultural Economy of Manitoba Hutterite Colonies. Toronto, Canada: ~ccleiland and Stewart Limited. Sangl, J. A. 1985. “The Famiiy Support System of the Elderly.“In Long-Term Care: Perspectives from Research and remonstrations, edited by R. J. Vogel, and H. C. Palmer. Rockville, MD: Aspen Systems. Schmucker, K. K. 1992. Generations of Care: A History of the Mennonite Bethesda Society. Masters Thesis, Department of History, Wichita State University. Shanas, E. 1979. “The Family as a Social Support System in Old Age,” 131eGerontologist 19(2): 169-174.

Shapiro, E. and N. P. Roos. 1989. “Predictiors and Patterns of Nursing Home and Home Care Use.” In Health Cure of the Elderly, edited by M. D. Petersen and D. L. White. Newbury Park: Sage Publications. Smith, D. S. 1979. “Life Course, Norms, and the Family System of Older Americans in 1900.” ~.

Journal of Family History 4: 285-298. 1986. “The Elderly as Historical Actors: Family and Demography.” In Old Age in a Bureaucratic Society: The Elderly, The Experts, and The State in American History,

edited by D. V. Tassel and P. N. Stearns. New York: Greenwood Press. Smith, G. 1985. “Reflections on the Social Relations of Simple Commodity Production.“JournaZ of Peasant Studies. 13(l): 99-108. 1989. Livelihood and Resistance: Peasants and the Politics of Land in Peru. Berkeley: -. University of California Press. Sokolovsky, J. 1990. 77re Cultural Context of Aging: Worldwide Perspectives. New York: Bergin & Garvey Publishers. Stephenson, P. H. 1991. 7&e Hutterian People: Ritualand Rebirth in the Evolution of Communal Life. Lanham, MD: University Press of America. Tassel, D. V. and P. N. Stearns. 1986. Old Age in a Bureaucratic Society: The Elderly, The Experts, and The State in American History. New York: Greenwood Press.

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120

Vol. 8iiNo. 1il994

Thomson, D. 1983. “Workhouse to Nursing Home: Residential Care of Elderly People in England since 1840.’ Ageing and Sociefy 3( 1): 43-69. Townsend, P. 1965. “The Effects of Family Structure on the Likelihood of Admission to an Institution in Old Age: The Application of a General Theory.” In Social Structure and the Family: Generational Relations, edited by E. Shanas and G. F. Streib. Englewood Cliffs, NJ: Prentice-Hall, Urry, J. 1983. “The Snares of Reason: Changing Mennonite Attitudes to ‘Knowledge’ in Nineteenth-Century Russia.” Comparative Studies of Socity and History 25(2): 306-322. ~. 1992. “The Cost of Community: the Funding and Economic Management of the Russian Mennonite Commonwealth Before 1914.” Journal of Mennonite Studies 10: 22-

55. Vogt, R. 1992. ‘~Mennonite Attitudes to Property.” Journal of Mennonite Studies 10: 9-21. Weissert, W. G., C. M. Cready, and J. E. Paweiak. 1989. “Home and Community Care: Three Decades of Findings.” In Health Care for the Elderly, edited by M. D. Petersen and D. L. White. Newbury Park: Sage Publications. Wolfe, E. R. 1982. Europe and the People Without a History. Berkeley, CA: University of California Press.