Will Home Care Come Full Circle?

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"My view, you know, is that the ultimate destination of all nursing is the nursing of the sick in their own homes...I look to the abolition of all hospitals...
But no use to talk about the year 2000."
- Florence Nightingale; June, 1867
The roots of healthcare in the United States are clearly in the care of patients at home. Perhaps the definitive book on home care nursing in this country is No Place Like Home: A History of Nursing and Home Care in the United States authored by Karin Buhler-Wilkerson in 2001. As Ms. Buhler-Wilkerson points out in her book, care for the sick was part of domestic life in early 19th century America. Physicians and nurses delivered care in patients' homes, most often with the help of female family members, neighbors, and perhaps servants. For those who had no one to care for them, the options for care were scarce.
Enter The Ladies Benevolent Society (LBS) of Charleston, South Carolina! The LBS was founded in 1813 during the British blockade of Charleston harbor to address the needs of patients for whom there were few other options. The Society was founded by 125 women who were the wives, sisters, and daughters of Charleston's wealthiest families. The Society was a philanthropic organization only. Members raised needed funds for care of the sick and distributed them, including hiring nurses to care for patients in their homes. A visiting committee conducted the daily work of the Society.
Patient load varied with the seasons and the occurrence of epidemics. In the early years, the Society cared for an average of 290 patients annually. Ms. Buhler-Wilkerson says in her book, "Most important, the LBS supplied the sick poor with nurses, for 'of what avail are medicines or proper nourishment, unless there be some kind hand to administer them in due season?'"
Home care has once again become the "fashion." An increasing number of treatments are provided at home. An article by Shantanu Nundy and Kavita K. Patel entitled "Hospital-at-Home to Support COVID-19 Surge-Time to Bring Down the Walls" that appeared on the JAMA Health Form, JAMA Network on May 2, 2020, makes the point that both COVID-19 patients and patients with other diagnoses should be cared for at home. The authors state that "the concept of a hospital stay in the home has been tested and proven to be effective in a wide variety of settings and clinical conditions..."
The article goes on to say that:
A 2016 Cochrane review evaluating the effectiveness and cost of hospital care at home found no difference in 6-month mortality..., no difference in being transferred or readmitted to a hospital..., and lower costs...
It is clear, contrary to Florence Nightingale's prediction above, that hospitals will always have a role to play in the delivery of healthcare. It is also clear, however, that home care of all types provides an important answer to many dilemmas currently encountered in the healthcare industry and must, therefore, be ascendant! Will healthcare now come full circle to its roots of caring for patients in their homes? 
©2020 Elizabeth E. Hogue, Esq.  All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.


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