No Place Like Home: A History of Nursing and Home Care in the United States (review)

No Place Like Home clearly illustrates the profound resilience of professional nursing. Using the history of home care as the context, the author highlights the struggles and victories of professional nursing from post-Civil War times to the present, showing how nurses have adapted to changing circumstances and to shifting priorities and political agendas, all the while trying to insure that even the poorest of people are cared for. As a historical researcher, Buhler-Wilkerson is superb. She has included the initiation of professional nursing in the United States and its direct links to professional nursing in Great Britain; the evolution of private-duty nursing and the visiting nurses associations; and the ever-present and constant tension between hospital care and home care that persists to this day.

Within this framework, Buhler-Wilkerson cogently argues that the professional nurse has been a consistent link to health, health care, and the health care system for the poor and the needy. When large populations of immigrants crowded into the burgeoning industrial northern cities in the mid- to late-1800s, the interaction of poverty, filth, and disease created the need for health and illness care. Perceptions of the risk and transmission of disease were disturbing to the social order and precipitated the growth of charitable organizations, many of which sent nurses into the homes of the sick poor. It was not long until government public health systems evolved, with programs directed at the community rather than the individual.

There are multiple examples of the relationships between professional nurses and physicians. While it is clear that the early subordination of nursing was closely tied to the status of women of the time, the question arises as to why little is different today, despite gains in education and the numbers of professional nurses with graduate degrees. Good nurses have always recognized and worked with good physicians, and good physicians with good nurses. Yet, one is taken by the fact that the post-Civil War professional nurses who visited sick immigrants in the poorest sections of cities made these visits alone, without a physician present. Today, professional nurses continue to provide care to patients without physicians present, but they do so under the direction of a physician.

While this book is a carefully documented history, it reads like a novel.The author moves fluently through the historical accounts of the earliest days of home nursing captured through nurses' records and notes; to the stops and starts in professional nursing associated with the funding of health, health care, and the growth of hospital care; to federal intervention via Medicare. I was continuously struck by the realization that the noteworthy contributions of dedicated nurses and physicians related throughout the book were overshadowed by the politics and business of health care. This fact is crystallized within the final pages of the book, which combine summary, reflection, and prediction. In these final pages, the author relates the initial, but unmet, promise of Medicare funding for home care and also the escalating costs associated with caring for people in the home. In the final analysis, the author makes clear that health care providers have shown that they are willing to change patterns of care and that, in fact, they have consistently done so. The problem she identifies is a lack of public recognition of the need for home care, and the public will to fund it. She is adamant in her statements that it is the public who must decide whether care of people at home is a civic duty or family responsibility; and that if the public does not recognize the value of home care, home care funding will remain negligible.

The final sentence of the book is one to commit to memory: "Who pays, for whom, for what...