What is home care?  Perhaps surprisingly, this question doesn’t have a short, easy answer!  Paige and I were talking about this recently, and in our discussion, I wondered about the history of this seemingly ‘new’ service that makes such a difference in so many people’s lives.  Paige looked around and found this book,  “No Place Like Home:  A History of Nursing and Home Care in the United States”.  (Thank you, Paige!)  I started reading it, and I’m a big history fan – so I want to share what I am finding.  If you are interested in the history of things in our society, I hope you’ll visit our “History” tab from time to time, where you will find another entry in the story of home care.

The author of this book is Karen Buhler-Wilkerson, a professor of community health and director of the Center for the Study of the History of Nursing at the University of Pennsylvania School of Nursing.  The book was published in 2001 by Johns Hopkins University Press.  The following is a summary.

Ms. Buhler-Wilkerson shows us the beginning of the story of nursing and home care in the post-Civil War period in the US.  During that time, when someone was sick, families cared for their loved ones at home.  When families hired doctors or nurses, they came to the patient’s home, most often assisted by female family members.  If someone did not have family or financial resources there were little, if any, health care options available at all.

In the Northern states after the Civil War, there were large concentrations of immigrants and industry, which brought about a great deal of poverty and illness.  With lots of people coming to the United States for a better life, there grew many separations of people, and there were distrust and suspicion between groups, particularly toward so many immigrants.  Charitable organizations sprang up to address causes and cures for poverty in the cities.  These societies were typically formed by middle and upper-class women, such as the Ladies Benevolent Societies, even the Methodist Deaconess movements, to bring health and care to the poor to try to help them come out of their living conditions.  Soon it was clear that there was a strong relationship between the living conditions in the nineteenth century US cities and diseases like smallpox, measles, and tuberculosis.

Many of those organizations began to send trained nurses to the homes of the sick.  They modeled their work on district nursing in England, developed by William Rathbone.  Mr. Rathbone was a wealthy Quaker philanthropist and businessman.  When his wife was ill, he hired a nurse, Mary Robinson, to care for her in their home.  He was so impressed by the nurse’s ability to effect change in his wife’s suffering in the comfort of their home that he persuaded the nurse to take part in an experiment of caring for the sick poor, to see if their living circumstances would likewise improve.  Ms. Robinson agreed to do this for three months, and although it was difficult, at the end of those three months both she and Rathbone declared the effort successful.  Rathbone stated, “the hopeless were restored to health, breadwinners and mothers were restored to independence, and the spread of weakness and disease was halted.”  Rathbone determined that a nursing program should be started on a widespread basis, and there was an ample supply of trained nurses.  So, for help with this goal, Rathbone sought out Florence Nightingale.  (To be continued…)

“My view you know,

is that the ultimate destination of all nursing

is the nursing of the sick in their own homes….

I look to the abolition of all hospitals….

But no use to talk about the year 2000.”

Florence Nightingale

June 1867