Editor’s note: This is the first in a three-part series on the Dallas County Care Facility, for many years known as the county farm. The past, present and future of the 526-acre tract of public property will be examined in turn.

"I love these people."

Those were the words last week of Karen Smith, 74, longtime administrator of the Dallas County Care Facility, which wrapped up its final business this month when the last of its residents were placed in other care settings and a final inventory was made of the building before turning it over to county authorities and locking the doors on 150 years of Dallas County history.

Smith retired in 2006 after running the Dallas County facility for 32 years. Her husband’s parents, Homer and Effie Smith, ran the farm from 1951 until she took over in 1974, so in a sense Smith is a repository of more than 60 years of the history and memories of the county farm, covering most of the post-World War II period and approaching the natural limit of any living human memory.

For the further reaches of the farm’s history, for most of the first 100 years following its founding in 1869, you must turn to what remains among county records and the archives of the Perry Chief and other area newspapers and libraries.

A fire at the facility in the 1960s damaged or destroyed many of the earliest records housed at the farm, so the evidence is patchy and incomplete.

Old-school sustainability

According to "The History of Dallas County," published in 1879, the county purchased 160 acres of farmland from Cyrus Hemphill on June 9, 1869, "for about $4,000." A building was erected on the east side of today’s Iowa Highway 169, and this became the first seat of the county poor farm.

"More land was afterward purchased by the county, adjoining the first quarter-section purchased," the history reads, "increasing the amount to two hundred acres, and the necessary improvements have since been made year by year."

The county history also notes a report on the farm by one "Lem. Warford" from February, 1875. According to Warford, "The fences are in good repair, buildings all new and in good order. The dwelling-house is 30 by 45 feet. There are 13 rooms in the house and a good cellar under the house."

A new "dwelling-house" was built in 1894 on the present site on the west side of the road, and the farm continued to grow in acreage in the early years of the twentieth century. According to Robert F. Wood’s 1907 book, "Past and Present of Dallas County, Iowa," "Additional land has been purchased, and improvements made until now the farm consists of 500 acres of land, with residence buildings, water tower and tank, barns, hospital, laundry, heat and light plant, etc., the entire farm equipped as fully and completely as can be imagined and valued at $84,425.24."

In 1904 the farm reached its present size of 526 acres, making it the largest county farm in Iowa. "This is the county home for the insane, the feeble minded and the poor," Wood wrote. "The county has spared no expense in making this a model institution, and all who visit it are favorably impressed with its ideal equipment and splendid management."

It was always a working farm, producing a self-sustaining income and feeding itself on its own meat, poultry, eggs and garden produce until well into the early 1970s, after which county subsidies gradually grew. Even then the farm continued to yield beef, pigs, poultry, rabbits and sheep and always had a very large garden. Generations of visitors marveled at the immense stores of canned and preserved foods in the pantries.

Visiting in 1907, Wood particularly commends the farm’s director, J. W. "Jap" Reynolds, who began supervising the farm and home in 1897 with his wife Maggie. According to Wood, "Jap, the steward, is fat and of a sunshiny temperament," a "genial, warm-hearted, hospitable man" who is "not only liberal, generous, honest and companionable, but is, moreover, peculiarly well fitted to take charge of such an undertaking as the management of one of the best farms of this kind in the state."

Wood also praises the "good judgment of Mr. Reynolds" for bringing improvements to the facility, such as "the new addition costing $10,000, the new barn costing $5,500, cement walks, water works, electric light plant, purchase of more land and innumerable improvements."

Along with praise, Wood also began what became a standard element in stories about the poor farm: briefly profiling and moralizing on notable residents. Surveying a few of these "paupers" and "hopelessly insane" residents, Wood concludes:

"There are many other peculiar and remarkable characters here. They brood over the past and seem to feel that the world has grievously wronged them. They often cherish troubles, real or imaginary, and probably have never learned the lesson to forgive and forget. These stricken and unfortunate patients with unhealthful minds and morbid thoughts, the paupers who have become incapacitated through age or infirmity from earning a living, are all humanely cared for at the poor farm, which is conducted in a manner that is a credit to all who are in charge."

There are gaps in the records. G. W. Harmon was the steward or superintendent of the facility from 1917 to 1942. A new building was built in 1936 by laborers in the Works Project Administration, a Depression-era jobs program sponsored by Franklin D. Roosevelt. The home served as the Dallas County Hospital from 1934 to 1954, when the hospital in Perry took that title.

According to an account by two newspaper reporters who visited the "Dallas County Home and Hospital" in the late 1930s or early 1940s, "The warden is always master of his insane patients—and they know it. It has to be this way so he will have control of them. He maintains his mastery by firm verbal means. It isn’t necessary to resort to physical punishment."

The warden at that time, a certain Mr. Rad Miller, guided his visitors through the facility. "Insane persons usually live longer than normal persons, our guide said, because they have nothing to worry them and thus take life so easily. The ages of the patients varied from 29 to 80 some odd years. One Negro who looked no older than 50 is in his late 80s."

The profiles were apparently irresistible.

Miller’s duties varied, according to the report. "In addition to being in charge of the insane, Miller is also head of the pauper’s ward," and of these Miller said, "Most of these men are former farmers and railroad men. Not having saved any money during their working years they have had to seek shelter in the poor home. Miller said that ‘booze’ has put more men in the home than any other single cause."

An odd cloud now and then passes across the sunny skies of earlier reports. Miller told his guests, "Occasionally a patient becomes unruly and is locked in a darkened room, which is a quick, painless cure. As a rule they have little disciplining to do, Miller stated." Such glimpses of what used to stand for treatment of the mentally ill are sobering.

Modern Psychology

"I love these people."

Karen Smith language is not the usual language of modern social workers but might be very close in spirit to the original public attitude that founded the county poor farm in 1869. The poor farm was a direct, concrete expression—in bricks and mortar and crops and livestock—of the social values of the early Europeans settlers who homesteaded Dallas County.

The ethos can be summed up in two words: Christian charity. But Christian charity Iowa-style needed to be supplemented with two more words: hard work.

Jesus said, "Whatever you do to the least of my brothers, you do to me." The idea is simple and so are the words, though maybe heard so often and for so long they do not have much purchase on our actions now. And at the same time, we have the apostle reminding us "that if any would not work, neither should he eat."

The usual language of social workers today does not rely much on words like "love" but talks instead of delivering services to consumers, of managing cases and reimbursing providers, of performance metrics and multi-system coordination. It is the language of efficiency maximizers and outcome optimizers and cost controllers.

Love—or charity, which is the same word—might still be at the back of social workers’ language, dwelling there as an original motive. After all, people do not normally choose human-services careers like nursing and social work for the high pay and glamorous trappings but because they care about other people.

But the technical and managerial machinery that came to surround the original mission of the county farm became so complex and governed by such a labyrinth of local, state and federal rules and regulations—the same can be said, of course, of virtually every sphere of our modern lives—that simply navigating the system’s intricacies demanded not a Mother Teresa but a major in public administration and health care financing.

The charitable motive was still overt in Wood’s 1907 book, which said the Dallas County poor farm "is not only one of the best pieces of property in the county but is also a monument to the spirit of charity and sympathy for the unfortunate that has always characterized the people of Dallas county."

But change came in time to the county farm. The Depression-era rise of social legislation, the post-World War II dominance of the managerial class and its business-model worldview, the development of mental health treatments, from lobotomies and shock therapy in the 1940s and 1950s to powerful antipsychotic medications after that—all had far-reaching effects on the Dallas County poor farm.

Some of the landmarks of this history are worth reviewing, starting with the Social Security Act of 1935, enacted the year before the county farm built its first major addition since 1894. Bitterly opposed by some elements of American society, Social Security for the first time gave the elderly poor a measure of material security, a gap between them and the poor farm.

The Social Security Amendments of 1965 provided federal health insurance for the elderly and the poor, Medicare and Medicaid. Title XIX of the amendment funded healthcare providers in the US, including hospitals and nursing homes and more recently group homes, community health centers and managed care plans.

Medicaid is second only to public schools as the largest line in state budgets, and the federal share of Medicaid is the largest source of federal funding for the states.

Federal Medicaid dollars are allocated as matching funds, so the more a state spends on Medicaid, the larger the federal contribution to that spending. In 1994 the US Department of Health and Human Services waived some requirements of Medicaid law in order to make it easier for states to provide home and community-based services for people who choose to receive their long-term services outside of institutions like the county home.

Expenditures for the 1915(c) waivers, as they are called, were authorized by Congress in 1981 and are now a crucial source of funding for community-based alternatives to institutionalization, making up the largest part of payment for long-term services and supports.

They were also crucial in the gradually shrinking funding for the Dallas County Farm and Care Home.

Another decisive turn was the Olmstead Law. In a landmark interpretation of the 1990 Americans with Disabilities Act (ADA), the Supreme Court ruled in 1999 people with disabilities have a right to receive care in the most integrated setting appropriate and that unnecessary institutionalization violates the ADA. All states must now comply with the decision.

These changes in laws and social attitudes lead to the current state of affairs at the former Dallas County Poor Farm.

There is plenty more history to explore, even among the sketchy records that survive, and there are details of the farming operation today’s community-based, small-scale growers could benefit from.

But it will be helpful first to look at the more immediate causes of the care facility’s closure.