Legend has it that Prince Shotoku first built it in Shitennoji in Osaka as one of the Shikain (four institutions) following the example of the Sui Dynasty in ancient China, and that it is related to the origin of Respect-for-Senior-Citizens Day; Shikain is together the combination of Hidenin, Keidenin (for religion, music), Seyakuin (free pharmacy), and Ryobyoin (free hospital).
聖徳太子が隋に倣い大阪の四天王寺に四箇院の一つとして建てられたのが日本での最初とする伝承があり、敬老の日の由来の俗説の一つである（四箇院とは悲田院に敬田院・施薬院・療病院を合せたものである）。