The Visiting Nurse Service of New York is one of the oldest not-for-profit home healthcare agencies in the country. Our founder, Lillian Wald, was the first public health nurse in the United States. Since 1893, VNSNY has been a vital part of New York’s public health infrastructure.
Lillian Wald’s very first home visit was to a young mother who was hemorrhaging after giving birth. At the time, the Lower East Side was the most densely populated area in the world, with more than 1,000 people crammed into each acre—most were immigrants who arrived in the United States with little more than their dreams. Disease was rampant because the connection between health and hygiene wasn’t fully understood.
Lillian Wald and her colleagues sought to strengthen this connection among their neighbors and patients. They also recognized that illness had a social and economic impact on families and often had underlying social causes.
By 1895, demand for services had grown enough for Wald to move her operation to Henry Street. In addition to caring for the sick, the Henry Street Settlement provided financial assistance and incentives such as scholarships to the community, and established social programs.
Although VNSNY’s focus is home healthcare, we still believe that healthy individuals thrive best in healthy communities. From our earliest days, VNSNY has combined the latest medical knowledge and nursing techniques with a commitment to social programs. As New York City has grown and the needs of its residents changed, so has the Visiting Nurse Service of New York.
Here is a glimpse through the decades.
Immigration through Ellis Island remained high. By 1903, the Henry Street Settlement had opened branches throughout Manhattan and the Bronx, some serving specific ethnic and immigrant populations. In 1906, nurses began caring for the black community.
By 1910, the nursing service had outgrown the Henry Street Settlement. The staff of 54 nurses also ran a convalescent home, three country homes, and first aid stations; they cared for 15,492 patients and made 143,589 home visits.
Throughout the decade, major outbreaks of polio, influenza, and diphtheria struck New York City—the influenza epidemic of 1918 alone killed more than 12,500. Wald’s agency was instrumental in providing nursing care throughout these outbreaks, as well as for caring for victims crippled by polio. In addition to treating disease, nurses began to train families to prevent disease and preserve health. Nursing service was extended to the Bronx. Geographical areas were divided into districts, with separate staffs for contagious diseases and obstetrical cases.
Immigration limits established in 1921 changed the demographics of New York City. European immigration decreased and native immigration increased, and by the late 1920s, 7 percent of New York City’s population was black (an increase from less than 2 percent in 1910). The nursing service established Healthmobiles to test for diseases like diphtheria and to administer immunizations; by the end of the decade 292,000 children had been inoculated.
By the 1920s, the number of nursing centers had grown to 18, with 164 field nurses and 28 supervisors. In 1926, more than 49,000 patients received care and the nurses made nearly 347,000 home visits. Half of the patients they saw were under age 5; 15 percent of their patients were black.
When the city learned that 65 percent of new mothers’ deaths in 1930-32 were preventable, maternal and prenatal health became a priority. Lillian Wald retired in 1933; that year, her staff of 265 made 550,000 home visits to more than 100,000 patients.
In 1944, the Visiting Nurse Service of New York was established as an agency separate from the Henry Street Settlement, devoted to home healthcare. Wartime emphasis on maternal and child health cut the infant mortality rate in half between 1941 and 1947. Physical therapy became a nursing specialty when the Association for the Aid of Crippled Children transferred its home program to VNSNY.
At the beginning of the 1950s, approximately 20 percent of VNSNY patients were elderly people with chronic conditions. Thanks to extraordinary advances in medical science post-World War II, Americans began to live longer, and by the end of the decade about 50 percent of our patients were elderly.
Changing demographics led to other initiatives as well. Naturally Occurring Retirement Communities (NORCs) were identified. Single-room occupancy hotel projects gave care to large groups of needy, often elderly, people. Within a few years, VNSNY provided services in several such facilities, and soon expanded its Housing-Based Care program to other residential settings.
VNSNY began a program of volunteer-friendly visits to the elderly in the mid-1950s, and in 1957, VNSNY hired its first mental health nurse consultant, whose role was to address the emotional problems patients faced as a result of coping with illness.
In 1962, VNSNY received a grant for a Home Aide Program, which began as a pilot program to help the sick and chronically ill with routine health and housekeeping duties. Medicare and Medicaid were signed into law in 1965. With state and federal governments responsible for financing healthcare for the elderly and low-income people in need of medical care, VNSNY was able to reduce the gap between income and expenditures, and began to develop as a multi-service agency. As funding streams changed, VNSNY began to implement a team nursing approach. Home health aides became an integral part of the home healthcare teams, and speech therapists and social workers were added to the staff.
Home healthcare was officially recognized as a viable alternative to institutional care through two laws passed in New York State in 1973 and through the National Health Insurance Law of 1974, and VNSNY established its Long Term Home Health Care Program. In 1976, VNSNY began participating in a program with the Maternity Center Association’s Childbearing Center. Mother and infant were discharged after 12 hours, and follow-up care was provided at home by VNSNY nurses. VNSNY is still involved with this program.
As early as 1981, VNSNY began to work with New York City officials to address the AIDS crisis—half of the known cases were in New York City. By 1985, VNSNY had launched an ambitious program of services, training, and support for AIDS patients; VNSNY Home Care established a variety of clinical, psychiatric, and personal services and programs, including the At-Home Options Program and the AIDS Mental Health Demonstration Program, to assist AIDS and HIV-positive individuals. In 1989, VNSNY nurses saw almost 600 adults and children with AIDS on a daily basis; by 1993 this number doubled, and VNSNY became the largest home healthcare provider for AIDS patients in the country.
In 1983, Partners in Care, which provides private care nursing, home health aides, and housekeepers, was created as a subsidiary. VNSNY also established its Hospice Program in 1983; within six years, the program had grown to serve more than 260 New Yorkers, and in 2006, VNSNY opened the first hospice residence in New York City, located on the Upper East Side.
In response to patients’ concerns about the quality of home healthcare, the National League for Nursing created the Community Health Accreditation Program (CHAP) in 1987. Agencies accredited through CHAP must meet specific criteria. Since the program’s inception, VNSNY remains the only CHAP-accredited, certified home healthcare agency in New York State.
First Steps, coordinated with Harlem Hospital and VNSNY’s Maternal/Child Health and Pediatric Care Program, was established to address substance abuse problems of drug-dependent mothers and their newborns; it soon became the fastest growing service within VNSNY Home Care.
In 1993, VNSNY also teamed up with the New York City Department of Health to provide free flu shots to seniors—the program is still running today.
1993 also saw the launch of the Center for Home Care Policy & Research (CHCPR), the first and only research center of its kind. CHCPR conducts scientifically rigorous research to promote the delivery of high-quality, cost-effective care in the home and community, and to support informed decision making by policy makers, payers, managers, practitioners, and consumers of home- and community-based services.
In 1998, the Visiting Nurse Service of New York developed VNSNY CHOICE Health Plans to help people remain safely and independently in their homes—and stay out of nursing homes—for as long as possible. VNSNY CHOICE Health Plans build on VNSNY’s rich reserves of knowledge and expertise to coordinate all the health and support services that elderly and frail New York residents need to live well at home.
Here is a glimpse from 2000 to present:
Although our focus is on home healthcare, we take seriously our Vision to be community-based, and when tragedy has hit New York, VNSNY has responded. On September 11, 2001, VNSNY nurses rushed to triage centers and local hospitals, and many social workers and mental health counselors offered their services. At the time of the attacks, VNSNY had 1,600 patients, mostly frail elderly or chronically ill, living in Lower Manhattan.
Throughout the decade, VNSNY continued to expand geographically (service to Nassau County was added in 2001, Westchester County in 2003), culturally (with programs to address the unique needs of Chinese, Orthodox Jewish, Russian, and Korean communities), and with social programs. In 2005, VNSNY launched its Nurse-Family Partnership in the South Bronx, and in 2016 launched in Nassau County.
In 2010, we introduced our Behavioral Health and Dementia Management program. The Haven, a hospice specialty care unit at Bellevue Hospital, provides specialized care for end-of-life patients whose symptoms cannot be managed at home. VNSNY CHOICE health plans became available throughout New York State in 2012, and our Chinatown Community Center opened in 2013. In 2015, VNSNY’s Chinatown Community Center provided health workshops, benefit workshops, classes, and open houses to some 8,500 clients. This total includes 3,000 members and an additional 5,000 walk-in clients.
For many of our patients, our nurses and aides provide a link to the outside world. And although their patients are their priorities, VNSNY staff responds to the needs of all community members. During and after the devastation of Superstorm Sandy, VNSNY’s Emergency Response team coordinated the efforts of thousands of staff and clinicians. More than 5,000 nurses, aides, social workers, and other staff overcame power outages, flooding, and lack of public transportation to see patients, making sure they were safe and had supplies. As the Blizzard of 2016 brought near-record snowfall to the area, our dedicated staff got right to work protecting those in need: the elderly, the ill and injured, the homebound. Our seamless response to the Blizzard of 2016 reflects VNSNY’s solid emergency preparations as well as the steadfast determination and dedication of our workforce.
In recent years, we’ve developed innovative partnerships and pilot programs with world-class hospitals and medical centers in New York City, drawing on data from our world-renowned Research Center. Demonstrated outcomes are no accident at VNSNY—the result of investments in an approach to care we call Bringing Medicine Home. We partner with healthcare providers to bring rigorous clinical discipline to the practice of healthcare at home. Our commitment to outcomes is further demonstrated by our co-creating evidence-based programs that improve quality and reduce avoidable hospitalizations and emergent care.
Nearly 125 years after VNSNY founder Lillian Wald first reached out to impoverished immigrants on Manhattan’s Lower East Side, our determination to address the needs of our community’s underserved and vulnerable populations is undiminished. VNSNY continues to promote the health and well-being of our patients and families by providing high-quality, cost-effective health care in the home and community. Now more than ever, we’re here for you.
Interested in learning more about Our History? Read about Lillian Wald.