At the same time, the United States had become an urban society. At the start of the twentieth century, 40% of the population lived in the cities, and by the end of the century over 75% of the population were city-dwellers. (Changes in Urban/Rural U.S. Population) Some of these people were coming from the rural areas, and others from the flood of immigrants entering the country for the first time.
As the population of the cities swelled, only the rich could afford to build new buildings, and they abandoned homes in the city centers to move farther out. For everyone else, this meant that more and more people had to pack themselves into the buildings that already existed in the central cities, creating the tenements. Rooms in old buildings were divided and subdivided into apartments that sometimes didn't even have a window, until, as the New York City health department put it, "There are numerous examples of tenement-houses in which are lodged several hundred people that have a prorata allotment of ground area scarcely equal to two square yards upon the city lot, court-yards and all included." (Jacob Riis, How the Other Half Lives, 1890)
This had an impact on the care of older family members:
"The cost of maintaining an aged relative in the country is so small as to seem an insignificant burden. In the crowded tenement houses of modern cities the situation is very different. Here, as industry is now organized, there is little for an aged person to do. The positions for which men or women over sixty- five years of age are suited are few, and there is always an excess of old men and women looking for such positions. Furthermore, the cost of maintaining an aged relative in the city is an appreciable item in a wage earner's budget, and even when the burden is cheerfully borne, it means so much less for other necessary family expenditures." (Seager, 1910)
The structure and size of families was changing. City families were much smaller than country families. In the country, a large family was an economic asset, but city children were economic liabilities. They had to be housed and supported, but couldn't contribute to the support of the family for many years. It was not economical to have a lot of children, and the shrinking size of families would continue to have an impact far into the future, when fewer children would be available to provide for their aging parents.
City-dwellers also overwhelmingly worked for others, rather than for themselves, in jobs they could not do indefinitely. Many working class jobs required physical strength and endurance, and employees would be let go when they no longer were able to do the work. Some jobs were dangerous, and injuries could create involuntary "early retirement". These "long term care" recipients lost their salary, and were financially dependent on their wives and children, who often could not earn enough to support the family. (Jane Addams, 1899) (Federal Writer's Project, 1939)
For the first time, older people faced the prospect of being unemployed, a word which wasn't even in the dictionary before 1888. (Social Security, 1937) If older people couldn't work, they had to depend on their families even more. In this new society, unemployed and unemployable older men and women could become a significant financial burden on their families.