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The Visiting Nurse Service of New York isn’t just the largest not-for-profit home health care agency in the country. It is also the oldest. Our founder, Lillian Wald, was the first public health nurse in the United States. From the beginning, her mission—and that of our organization—has been to put the patient first while emphasizing the value to a community of the nurse, and to recognize the relationship between public health nursing and social problems that accompany illness. In fact, Wald found this correlation to be so strong that within two years of beginning her visiting nurse career, she moved her operation to a building on Henry Street. This building—which became the Henry Street Settlement—was part home for herself and her staff of six, part dispensary, and part social center for the poor on the Lower East Side, offering classes and a playground for children.
Lillian Wald changed the face of nursing in other ways, as well. Armed with data documenting that nursing care saved lives, in 1909 she persuaded the Metropolitan Insurance Company to hire visiting nurses to care for policyholders during illness. Within two years, the insurance company had extended its nursing service across the country. Over the next 20 years, the Henry Street Settlement received 30 to 40 percent of its income from insurance payments.
By the time Wald retired in 1933, her staff had grown to 265 nurses who made 550,000 home visits annually to 100,000 patients, and who cared for one-fourth of the city’s pneumonia cases and one-third of its maternity patients.
In the mid-1940s, the social services and nursing activities of Wald’s organization were separated into distinct entities. The Visiting Nurse Service of New York became a freestanding agency that adapted to the changing face of America and New York in the years after World War II.
Extraordinary advances in medical science meant Americans were living longer, which led to increased demand for services and care for geriatric patients. Approximately 20 percent of VNSNY patients in 1950 were elderly people with chronic conditions, such as heart disease, arthritis, and cancer conditions—and by the end of the decade, that number had increased to 50 percent.
The 1950s also saw the rise of increased awareness of mental and emotional health. Childhood growth and development, the problems of exceptional children, and the migration to the suburbs affected the way health care was delivered. Specialization among doctors emerged, yet specialized hospitals, such as those for tuberculosis patients and the mentally ill, closed due to lack of funds. These patients were added to the home caseload, and VNSNY established its mental health services in the late 1950s.
During the 1960s, continued population growth, technological advances, and changing social values brought about changes in health care. Legislation for Medicare and Medicaid was enacted. VNSNY received a grant in 1962 to establish a Home Aide Program, and as a result of Medicare funding, home health aides became a familiar part of the home health care team.
Throughout the 1970s, VNSNY expanded its training programs for nurses and nurse practitioners. Eva Reese, VNSNY’s executive director, began to assess the agency’s role in the future of New York’s health care. She envisioned a multi-service organization, with substantial expansion of programs and services. Her grasp of the future was mirrored in two pieces of New York State legislation that affected home health agencies and reimbursable home health expenses.
By the 1980s, VNSNY instituted a corporate structure with four subsidiaries: VNS Home Care (which provided acute and long-term care, maternal and pediatric care, hospice care, and prevention), Partners in Care (a not-for-profit subsidiary that integrated home health aide services with a patient’s needs), Family Care Services, and the National Center for Home Care Education and Research (since discontinued).
The AIDS epidemic escalated sharply during the 1980s, and VNSNY became the largest home health care provider for AIDS patients in the country.
In the 1990s, VNSNY established the Center for Home Care Policy & Research. Created during the agency’s centennial year, the Center adds to the knowledge about home and community-based care.
If Lillian Wald were alive today, what would be her thoughts on the agency she founded? VNSNY's Chief Executive Officer, Carol Raphael, says, “Lillian Wald would be proud of our ability to be flexible and to adapt to a fast-changing environment.”