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

Home care is as old as human disease and the human domicile, and it bears repeating that most health care is still provided at home, largely by mothers and other female household members. In this book, Karen Buhler-Wilkerson discusses a variant that emerged in the industrialized world: organized home care provided by paid nurses from outside the home.

In a "Prelude" Buhler-Wilkerson identifies the Ladies Benevolent Society of Charleston as the first organization in the United States to provide home care to the sick poor, beginning in 1814. The Charleston lady visitors provided direct care and other resources to a small number of white and free black indigents—but these antebellum ladies were no more nurses than the household servants who attended their own families in both sickness and health.

The core of the book deals with the period from the 1880s through the 1930s, when home care by paid nurses flourished in several forms. Buhler-Wilkerson describes a graded system dependent on one's level of poverty, one's status as a working person with life insurance, or the extent to which one was able to pay. Nurses could be placed by governmental bodies, voluntary agencies, nonprofit registries, or businesses; and the nurses themselves ranged from the cream of training-school graduates, to the average trained nurse who might barely survive between placements, to women with no qualifications registered with marginal referral services.

This book implicitly asks how this system declined and virtually disappeared by mid-century. Buhler-Wilkerson does not dispute the answers that she and others have already provided. The hospital in America came into its own at the same time as the growth of home care, and the invention of the private or semi-private room made hospital care increasingly attractive to the middle and upper classes. The concentration of new diagnostic and therapeutic technologies in hospitals made them the preferred site for much medical practice, and the growth of the hospital also provided nurses better-paid and more secure jobs in more attractive surroundings. Finally, home care could not demonstrate its economic value to charity agencies, government bureaus, or the insurance industry.

In the seven essays that constitute the core of the book, Buhler-Wilkerson paints richly detailed pictures of the lives of the nurses and examines particular issues in home care. Chapter 1 is an overview of the establishment of visiting nursing in the United States. Chapter 2 reviews conflicts between staff nurses and lady managers. Chapter 3 takes on the life of the visiting nurse, and particularly her relationship with the medical profession. In chapter 4, Buhler-Wilkerson does an exceptional job of incorporating the issue of race into her more general narrative. Chapter 5 deals with Lillian Wald and public health nursing. In chapter 6 Buhler-Wilkerson demonstrates the contradictions inherent in private-duty nursing as simultaneously wage labor, business, and health care. She concludes her main discussion with the rise and fall of the Metropolitan Life Insurance Company's support for home care by nurses.

The remainder of the book is an afterword. In chapter 8 Buhler-Wilkinson describes factors that pointed toward the demise of home care, while in chapter 9 she ruefully describes the reinvention and halting reemergence of home care in recent decades. Here and in an epilogue on the future of home care she makes clear her belief that the failure to institutionalize home care with adequate financial support constitutes a significant missed opportunity.

Nursing history is necessarily an aspect of gender studies, but Buhler-Wilkerson shows how much nursing is bound up with issues of social class, and she also weaves racial issues directly into the fabric of her story. No Place Like Home demonstrates...