Much like today, care of the sick at home a hundred years ago was provided by a complex assortment of private, voluntary, and public organizations. From these beginnings have come our American concept of home care and many of its controversies. Throughout this history, the home has remained a fascinating setting for caregiving where patient outcome is determined by a complex assortment of variables. Nurses were, and continue to be, central to the successes and failures of this enterprise. Theirs is an informative past that provides more than simply a sense of deja- vu.
The aim of this study is an analysis of the history of caring for the sick at home between the 1880's and the depression of the 1930's and an examination of the ways in which these data can inform present policy, practice, care delivery and ultimately patient outcome. Accomplishing the aim of this project requires collection, analysis and interpretation of data from a wide variety of excellent sources. Nurses caring for the sick at home were either visiting nurses hired by philanthropic organizations to care for the sick poor or private duty nurses employed primarily by middle and upper class families. To uncover their history entails reviewing the records of geographically and organizationally diverse examples of these home-based nursing services, nurses' written memoirs, letters, texts, journal articles, photographs, case records, articles in the popular press, interviews with individual participants and several landmark studies of nursing and health care. In addition, the historical collections of the American Nurses Association, the National Organization for Public Health Nursing, the Metropolitan Life Insurance Company and the Rockefeller Foundation are the major archival resources for this investigation. The personal papers of Lillian Wald, Mary Gardner, and Adelaide Nutting also provide valuable information for study. These data will be collected and organized using a protocol appropriate to the viewpoint of social history. A structure of interpretation will be created that examines the history of home-based nursing care with in the interlocking contexts of social attitudes, medical advancements, demographic changes, and economic realities. As an analysis of contemporary home care from a historical perspective, this study will provide both a sense of origins and, more importantly, a perspective that can be used to anticipate and guide the making of nursing's contemporary plans.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
Project #
Application #
Study Section
Nursing Research Study Section (NURS)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pennsylvania
Schools of Nursing
United States
Zip Code
Buhler-Wilkerson, K (1993) Bringing care to the people: Lillian Wald's legacy to public health nursing. Am J Public Health 83:1778-86
Buhler-Wilkerson, K (1991) Home care the American way: an historical analysis. Home Health Care Serv Q 12:5-17