Neighborhood Visiting Nurse Association records
Held at: University of Pennsylvania: Barbara Bates Center for the Study of The History of Nursing [Contact Us]Claire Fagin Hall, 418 Curie Boulevard, Floor 2U, Philadelphia, PA, 19104-4217
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In May 1912, a group of church women interested in local charities met at the home of Mrs. Charles Walton to discuss local health and social needs. They had the desire to coordinate efforts toward establishing an agency for home health care. In the end, they organized a new agency named Neighborhood League in June 1912. Dr. G. H. S. Jameson was selected as President along with five members to constitute an Executive Committee. The League, headquartered in Wayne, PA, provided the first visiting nurse in October 1912, at a starting salary of $750. She cared for infants who suffered from summer complaints: diseases of the pelvic organs, brain, nerves, kidney, and bladder, as well as typhoid fever. The first year saw 101 patients treated, and the treasurer's report showed a budget of $1,213.93. A social worker for family counseling was employed in October 1913, and the many activities of the League included family case work and public health nursing.
In 1914, in cooperation with the Radnor School District, school nursing was initiated for health inspection and education. The school district paid for the nurse's salary and the League provided the nurse headquarters in the League's offices.
By 1921, a well-baby clinic was established in which the nurse provided inspections for illness and deformities, advice in care of the baby, formula changes, and immunizations. By 1923, the nursing staff consisted of three registered nurses, one in general nursing and obstetrics, one in general and school nursing, and one in child health. The nursing staff was called upon to provide nursing services in the April 1930 Devon Disaster when an explosion erupted at the Fireworks Manufacturing Company. For several weeks the nurses provided emergency services, treated the wounded, supplied food and shelter, and assured those who had lost their homes that aid would be forthcoming. The disaster demonstrated to the community the value and need for the Neighborhood League.
Financial support for the agency came from faithful friends; patient fees which averaged ten to fifty cents; and material donations from various guilds, churches and individuals. From June 1919 through 1953, a contract with the Metropolitan Life Insurance Company offered to certain insured policy holders a fee-per-visit basis for home nursing services. The United Charities Campaign, the precursor of the United Way, also provided monies. The Neighborhood League was reorganized in July 1948, which enabled it to carry on more effectively a program of health and family service without sacrificing its leadership in community planning nor diminishing its devotion to community health and welfare. The reorganization provided for two functional divisions, Public Health Nursing and Family Services. Each had its own policy-making committee, budget, and professional director.
The League had actually a third division, which consisted of the Neighborhood Shop, the Woman's Exchange, and the Junior Service Board. The Neighborhood Shop started in 1925 for the disposal of clothing, furniture, and miscellaneous bric-a-brac given by grateful patients. The proceeds from the sales were donated to the nursing services. The store flourished, and by 1954, four shops were in operation and staffed permanently by volunteers. In 1931 at the height of the Depression, the Woman's Exchange was founded under the auspices of members of the League who were concerned with the financial plight of depression families. In the Woman's Exchange Shop, women could find an outlet for their home-cooked food and handmade merchandise, thus augmenting their incomes.
The Junior Service Board was organized in January 1934 to aid the League in community work. It provided a scholarship fund to aid students entering nursing and/or aid League nursing staff looking for further education. Volunteer members assisted in the dental and well-baby clinics, provided transportation for patients and the elderly, and planned social events for nursing home guests. Thanksgiving and Christmas baskets of food were also given annually to needy families. The Board's annual fundraising activities included fashion show and luncheon, bridge parties, and the Tinsel Ball.
In 1957, the Woman's Exchange and the League Shops separated, each taking on its own board and chairman. Then in 1973, the Woman's Exchange, Neighborhood Shops, and Junior Service Board all became auxiliaries to the Nursing Service.
By 1964, the nursing service area extended beyond the Wayne area, including both Delaware and Chester County. The nursing staff increased from one nurse in 1912 to four in 1964 while visits went from 1,499 to 4,043. Also with the advent of Medicare, the League merged with the Community Nurse Association of Malvern, Paoli and Berwyn. The new organization, which was formed in January 1965, was called the Neighborhood League of Upper Main Line. It in turn merged in 1980 with the Central Chester County VNA and was renamed the Home Health Services of Chester County and Vicinity. In 1985, it changed its name to Home Health, Inc., and then in 1988, it became the Neighborhood Visiting Nurse Association.
Community Nurse Association of Malvern, Paoli, Berwyn, 1919-1965
During World War I (1919), a flu epidemic reached such great proportions that the Red Cross House in Paoli was used as a hospital. The House was staffed with a registered nurse and volunteers to provide nursing care and it soon became apparent that the community needed to organize a permanent nursing service. Thus a visiting nurse service was established under the auspices of the Red Cross in Paoli in 1919. This affiliation with the Red Cross, however, was financially unacceptable as people who contributed $1 to the Red Cross Drive then thought they were entitled to free care. So the officers of the visiting nurse service decided to withdraw from the Red Cross and establish the Community Nurse Association of Malvern, Paoli, and Berwyn. In 1930, the association was incorporated and became a member of the Community Chest of Philadelphia. In January 1, 1965, the Community Nurse Association merged with the Neighborhood League.
Neighborhood League of Upper Main Line, 1965-1980
With the merging of the Neighborhood League and the Community Nurse Association of Malvern, Paoli, and Berwyn, the organization became known as the Neighborhood League of Upper Main Line. Medicare Certification in 1966 provided for reimbursement of services to the elderly. Services expanded to include physical, occupational, speech, and home health aide. An objective of the home care service was to enable the elderly population with acute or chronic illnesses to be able to maintain themselves in their home environment. Demonstration programs were initiated, such as "24 Hour Home Health Services" (1979-1980) and "Radnor Nutrition Program" (1977-1979).
The home health care field, following the implementation of Medicare, became big business. In 1977, health care was one of the largest industries in the country. Various operators who had remained uninterested in the field when it was relatively low-profit, now became involved as the dollar potential soared. Two additional types of agencies were in operation. One was a proprietary for-profit organization, while the second was a not-for-profit organization that sought to break even but did pay out high salaries to the owners/employees. These organizations competed for full-fee patients and referred patients who were unable to pay such charges to voluntary agencies. The Neighborhood League Board members then became active in advocating legislation for proper regulations to protect voluntary agencies from these unfair practices.
Elizabeth Zimmerman Cathcart, RN, MPH, was Executive Director of the organization for Home Health Services (1974-1985). She had the foresight to recognize the dramatic changes in the technical and social nature of the health services. In the late '70s, with double-digit inflation, "cost-containment" became a household word. The trend toward greater expectations of home health agencies and less funding for these services also began. Competition for patients and other factors propelled Cathcart to take a leadership role in the merger of two voluntary, non-profit home health agencies, the Neighborhood League and the Visiting Nurse Association of Central Chester County. For her leadership in community work, she received the Legion of Honor Award from the Chapel of the Four Chaplains in 1978.
West Chester Visiting Nurse Association (Social Service Society), 1914-1961
The West Chester Visiting Nurse Association was founded as a Social Service Society in 1914 through the vision and generosity of Jane T. Achelis. The Social Service Society was named so because the first nurse was not a professional registered nurse, thus the organization did not qualify for visiting nurse status. In 1916, the society was raised to visiting nurse status with the employment of a professional nurse who graduated from Chester County. In 1918, the nursing staff along with volunteers provided the nursing care needed during the flu epidemic. This demonstrated the need for a community nursing service and financial contributions increased. By 1921, one physician stated he could "not practice without the assistance of a visiting nurse."
The organization provided various services. During World War I the home health service work was done for the Red Cross. In the Depression years, all state emergency services were provided. For the World War II period, the staff assumed other responsibilities.
In the '50s, consideration was given to merging with the Downingtown Visiting Nurse Association for the purpose of increasing and improving health care services to the wide-spread community each was then serving. Approval for consolidation was granted by the Common Pleas Court in October 1961.
Visiting Nurse Association of Downingtown, 1916-1961
The Downingtown Visiting Nurse Association was an outgrowth of the Emergency Aid and Home Relief Association during World War I. Representatives from Emergency Aid and Home Relief Association, Women's Club, and the Visiting Nurse Society of Philadelphia comprised a committee established to organize a visiting nurse association for the Downingtown area. Their mission was accomplished in October 1916.
Services rendered by the nurse were many and varied. The main focus of her service was bedside nursing care. In the Depression years, she distributed clothing, food, and fuel which had been donated by the Lions Club and local fire company. Well-baby clinics were held regularly as well. In 1946, another nurse was employed as referrals for service increased.
In early days, funding was obtained through various activities. Association members paid yearly dues, subscriptions were solicited from various clubs in the area, and envelopes were left at every house asking for a penny from each family member. The Metropolitan Life Insurance Company paid for nursing service to its subscribers for twenty-five years.
Due to the trends of the late 1950s and early 1960s health care system, the Directors began merger discussions with the West Chester Visiting Nurse Association in the interest of efficiency and economy. The merger become effective on September 26, 1961. The new organization was named the Visiting Nurse Association of Central Chester County.
Visiting Nurse Association of Central Chester County, 1961-1980
With the consolidation of Downingtown and West Chester, offices were maintained in both areas so health care service in each area could continue. In 1966, the Association was certified for participation under the Medicare Program. During this period, home health care became an important part of the health care system. It was an alternative to institutionalization, a less costly system and psychologically more acceptable to individuals, especially the elderly. The Association expanded its service to include physical therapy, speech therapy, home health aid services, as well as medical supplies and equipment. It also focused on health promotion by providing a maternal-child health home visitation program, child health clinics for pre-school children, and adult health clinics for health maintenance of the elderly.
The late '70s were years of double-digit inflation, and "cost-containment" became a household word. The trend toward greater expectation of home health agencies and less funding for these services also began. These factors prompted the Association to merge with the Neighborhood League of the Upper Main Line. The merger became effective in October 1980.
Home Health Services of Chester County and Vicinity, 1980-1985
With the merger of the Visiting Nurse Association of Central Chester County area and Neighborhood League of Upper Main Line, the organization was named the Home Health Services of Chester County and Vicinity. This formation of a new agency provided home health services in Southern and Central Chester County and in small areas of Delaware and Montgomery Counties.
The Hospice program in coordination with the Chester County Hospital was organized. Emphasis was upon quality of life for the patient and family during the advanced stages of terminal illness. Along with nursing, physical, speech and occupational therapies and home health aide services, music therapy was added for the Hospice Program. Evening home visits were added in 1982 to meet the special needs of home-bound patients. With the increase of Hispanic residents in Chester County, two Spanish-speaking nurses were employed to enable these residents to take advantage of the available services.
The Agency received accreditation from the National League for Nursing in 1982. It was the first organization in Chester County to receive this national recognition and was one of 102 agencies out of 5000 nationwide who were so accredited.
In 1984 the Board of Directors began discussing restructuring the agency to create greater flexibility in meeting home health care needs. Restructuring and approval was accomplished by January 1, 1985. The agency became Home Health Services, Inc. Home Health Services, Inc. 1985-1988
The restructuring and name change did not change nor interfere with any of the home health services provided. The functions and purpose of the organization remained the same. The functions were divided by different corporate structures. Instead of one large organization there were four corporations, a parent and three subsidiaries. The parent corporation was named Home Health Services, Inc. while the subsidiaries were the Visiting Nurse Association of Chester County and Vicinity, the Hospice of Chester County, and the Neighborhood League Health Services.
Home Health Services, Inc. as the parent corporation did not provide any patient care. Its primary function was to provide administrative and management services to the three subsidiaries. It also provided fundraising services for the expansion of the agency.
The Visiting Nurse Association of Chester County and Vicinity was the Medicare/Medicare certified home health agency and provided all Medicare approved home health services, such as skilled nursing; speech, occupational, and physical therapies; enterostomal therapy, mental health counseling; Medicare social services; and personal care service.
The Hospice of Chester of County was another subsidiary. Its primary function was to coordinate all services to client receiving hospice care. In addition, ancillary services to help meet the special needs of the terminally ill and their families were available through funding from the United Way.
Neighborhood League Health Services was the third subsidiary. Services provided included dental/orthodontic clinics, home-bound dental services, day care services and hospital home care. The three auxiliaries, Woman's Exchange, the Junior Service Board and Neighborhood League Shops which were originally auxiliaries of the Neighborhood league in Wayne related directly to the parent corporation, Home Health Services, Inc. Their functions remained unchanged.
In 1988, the economic situation caused financial difficulties. Aggressive action to insure continued financial stability of the organization was initiated. Plans called for space and staff consolidation and down-sizing of administrative staff. In 1989, in recognition of the importance of the Neighborhood League, the Board of the Directors changed the name of the organization to the Neighborhood Health Agencies, Inc., Neighborhood Visiting Nurse Association, Neighborhood Hospice, and the Neighborhood League Health Services. This provided the agency a link between all its operating entities. The Neighborhood Visiting Nurse Association has retained characteristics of a traditional visiting nurse association providing home health care services based on community health needs.
The records for the Neighborhood Visiting Nurse Association document home care services provided to communities in Chester and Delaware counties from 1900 to 1990. The collection also documents changes in social and environmental conditions as well as legislative, technological, and medical science in the period.
In addition the collection documents the process of amalgamation of a number of local VNA organizations. The Neighborhood League merged with the Community Nurse Association of Malvern, Paoli and Berwyn (1919-1965) and changed its name to the Neighborhood League of Upper Main Line in 1965. The Downingtown Visiting Nurse Association (1916-1961) merged with the West Chester Visiting Nurse Association (1914-1961) to become Central Chester County Visiting Nurse Association (1961-1980). This association then merged with the Neighborhood League of Upper Main Line in 1980 and was named Home Health Services of Chester County and Vicinity. The history and administrative files of each organization are included in this collection.
The records also document the reorganization and name change of the Home Health Services of Chester County and Vicinity in 1985 to Home Health Services, Inc., which was renamed in 1988 as the Neighborhood Health Agencies, Inc.
Gift of Mahlon R. Fiscel and Audrey L. Komnik.
- University of Pennsylvania: Barbara Bates Center for the Study of The History of Nursing
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- Finding aid prepared by Center staff, updated by Bethany Myers
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