PMID: 12394334

Issn Print: 0884-741X

Publication Date: 2002/10/01


Print

No Place Like HOME: A History of Nursing and Home Care in the U.S.

KAREN BUHLER-WILKERSON

    loading  Checking for direct PDF access through Ovid

Excerpt

In early 19th-century America, care for the sick was part of domestic life guided by family traditions and the advice found in the medical or nursing manuals of the era. When families hired physicians or nurses, professional care was delivered in the patient’s home, most often with the help of female assistants, or occasionally a servant. Yet, for those without family or financial resources, few healthcare options were available.
The earliest U.S. efforts to care for the sick at home (1813) were motivated by a tradition of religious benevolence among wealthy ladies of Charleston, SC, who entered homes of the poor and dependent to provide care and domestic comfort.
Although caring for the poor was an obligation of their class, the ladies were nevertheless confronted by the customary challenges and questions regarding home care:
Since nursing’s origins, records kept by the Ladies Benevolent Society (LBS) demonstrated these central dilemmas of caring for the sick at home.
Along with these three critical questions, the LBS also struggled with family circumstances and chronic illness. Families and their home life were unpredictable and often uncontrollable, yet were a vital determinant of the outcomes of care. First and foremost, the chronically ill challenged both the mission and economics of the LBS.
They quickly discovered that discharging the needy chronically ill violated a sense of benevolent duty, while maintaining such patients as part of the caseload threatened the longevity of the organization. Even worse, the LBS found it impossible to distinguish who were the most deserving among the chronically ill. Ultimately, care was limited to the acute phase of illness and eventually the LBS resorted to medical certification of necessity.
The ladies were forced to conclude that some problems simply should not be cared for at home. The mid-century opening of Charleston’s first hospital offered an alternative to the complexities of care at home and demand for home care began to decline. Charleston’s efforts to determine how best to deliver home care, especially to the poor and chronically ill, remains an excellent prototype for issues that would loom larger and longer on the healthcare landscape of the United States.
By the end of the 19th century, urbanization, industrialization, immigration, and the constant danger of infectious diseases were transforming most large cities into increasingly unhealthy places to live. The relationship between poverty and illness was indisputable and popularization of the germ theory of disease provided further motivation to protect society from uncontrolled disease.
    loading  Loading Related Articles