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Visiting Nurse Services in Westchester
One Hundred Five
Years: 1901-2006
1893 - Lillian Wald: Visionary
of Visiting Nurses.
The concept of a Visiting Nurse Service was the vision, over 100 years ago, of Lillian Wald, the founder of the Henry Street Settlement in New York City. She realized that some families needed nurses to come to their homes.
Nurses began coming to Westchester County at the turn of this century to care for the German, Irish and Italian immigrant families of railroad workers. According to the Westchester Historical Society, concerned women who were summer residents in Long Island Sound Shore areas, pioneered much-needed social welfare programs in the County. They volunteered for the Henry Street Settlement, the Rye Needlework Guild and later the Junior Leagues. They promoted the importance of home nursing.
1901 - The Beginning of Visiting Nurse Services in Westchester.
The roots of Visiting Nurse Services in Westchester date back to 1901 when Dr. William Hazard Sherman, a prominent physician, interested a group of philanthropic women in starting a nursing service for the care of patients discharged from the wards of the hospitals in Yonkers. The service was known as the Visiting Nurse Department of St. John’s Riverside Hospital. A graduate nurse was employed and soon after, through the interest of the St. John’s Riverside Hospital Board, two student nurses were assigned to the Visiting Nurse Department for several years. In 1921, the name of the department was changed to the Yonkers Visiting Nurse Association.
Then & Now – The Visiting Nurses: “Rugged Individualists”.
What are Visiting Nurses and what makes them special in comparison to other nurses? They are, first of all, highly qualified, independent, “rugged individualists.” Their mission has been skilled nursing for patients, but always in the context of the family and community environment. In the old days grateful patients said they knew how to “make do.”
April 1935 – The Standard-Star: “A Day With A Visiting Nurse”.
A reporter who spent a day with a Visiting Nurse was quoted in an April 1935 issue of the New Rochelle Standard-Star: “…A Visiting Nurse is lastly of all a nurse. She is first a confidant, a soother of children and chronic individuals, an improviser of ideas and gadgets, a news commentator, carpenter, boss in an unorganized home, bookkeeper, lecturer, advertiser–and–finally what the doctor ordered–a nurse…” In her famous little black bag, the nurse carried “…a crisp white apron, scissors and pincers, two regular thermometers and one for contagious cases (which she sells or give to the family or leaves ‘til the next visit)…metal containers for boiling instruments; hypodermic needles; cotton squares, paper sheets, record cards; tincture of green soap; a bottle of alcohol…”
1936 - Westchester Nursing Council.
Westchester County’s need for home health services was met by four official and 16 voluntary agencies until the 1960’s. The only contact these Visiting Nurse Services had with one another was through the Westchester Nursing Council formed in 1936. This was an early attempt to strengthen voluntary agencies.
1959 - New York State Reimbursement for Home Care.
Some member agencies of the Westchester Nursing Council participated
in a study which led in 1959 to passage of legislation amending the
NYS Insurance Law to permit Blue Cross reimbursement for certain home
nursing services following hospitalization.
1960-1961: The Metcalf-McCloskey Act.
Congress passed the Metcalf-McCloskey Act amending the Social Security Act to include a federally assisted medical aid program for the elderly. Standards were established for all agencies rendering services to these patients. Official tax-supported nursing agencies were now permitted to collect fees for their services.
1963 - Certification Standards Upgraded.
University personnel and colleges in New York State notified the State Office of Public Health that new requirements must be met to meet the State Sanitary Code programs. Instead of 30 credits in public health nursing—content beyond the R.N. degree—a qualified public health nurse must complete 45 credits within a program leading to a Bachelor of Science degree.
1966 - Passage of Medicare.
The New York State Office of Public Health also required voluntary nursing agencies to increase the ratio of public health nurses to every R.N. or L.P.N. With the initiation of Medicare in 1966, agencies participating in the program were required to be licensed by the Federal Government and certified by New York State Health Department as HOME HEALTH AGENCIES.
1967 - Voluntary Nursing Agencies Recognize the Need to Consolidate.
In order to meet the new licensing and certification requirements, in March of 1967 representatives of the VNAs of Pelham, Mount Vernon, New Rochelle, Larchmont, Scarsdale, Hartsdale, and White Plains decided to consolidate into one freestanding nursing service. They agreed that the weakening and eventual disappearance of voluntary nursing agencies would be a distinct loss to the community.
1969 - Incorporation of Associated Visiting Nurse Services.
In 1969, these seven VNAs officially merged and became known as Associated Visiting Nurse Services, Inc. Grace Plude became Executive Director of this newly incorporated entity; a Board of Directors was composed of the former boards and citizens from the community-at-large.
1970 – 1976: More Consolidations, Affiliations, and Changes.
In December 1970, Yonkers VNA joined Associated Visiting Nurse Services.
By 1971, voluntary nursing agencies in Port Chester, Harrison, Rye, Mamaroneck and Purchase went out of existence. The Westchester Nursing Council disbanded in June 1971. Health departments in Mount Vernon and Yonkers merged with the Westchester County Department of Health. Five hospital-based Home Health Care programs were established by: Lawrence (Bronxville); New Rochelle, Phelps Memorial (North Tarrytown); St. Joseph’s (Yonkers); and White Plains. By contract arrangement, Associated Visiting Nurse Services provided home nursing, physical therapy and home health aide service to these hospitals.
In December 1972, the White Plains VNA turned over its building at 111 Church Street to Associated Visiting Nurse Services for administrative offices.
In 1973, Community Visiting Nurse Association joined Associated Visiting Nurse Services adding the communities of Briarcliff Manor, Croton-on-Hudson, Irvington, Ossining and the Tarrytowns.
In 1976, the Town of Mamaroneck joined and United Hospital in Port Chester established a Home Health Care program, which was affiliated with the Associated Visiting Nurse Services.
1980-1982: A New Name and New Communities to Serve.
Five more communities were added to the Associated Visiting Nurse Services in the spring of 1980: Ardsley, Dobbs Ferry, East White Plains, Elmsford, Hastings.
At the 13th Annual meeting in 1980, the members voted to change the name from Associated Visiting Nurse Services to Visiting Nurse Services in Westchester (VNSW). Mrs. Plude left the agency in 1980 and Margaret Slater was appointed Executive Director.
In February 1982, the Tarrytown office moved into the Yonkers office space.
1983 - Our Hospice Program was developed.
A task force was formed to develop a hospice service component for VNSW. Comprehensive hospice services for terminally ill patients were initiated in January 1984.
1984 - VNSW purchased its current building.
In 1984, VNSW and Hospice staff moved to its newly purchased building at 360 Mamaroneck Avenue in White Plains.
1987 - New Direction.
Joseph Burns became Executive Director in 1987. Home visits had declined significantly in 1986. Mr. Burns understood that his first priority was to address, correct and increase the number of VNSW home care visits. The Westchester Visiting Nurse Services Group, Inc. (WVNS Group) was established to promote and support community health in Westchester County by assisting VNSW and its related entities to accomplish their mission.
1989 – 1990: 55% Increase in Home Care Visits.
In 1990, there was a 55% increase in visits and the number of staff doubled. The title of Executive Director was changed to President/CEO. The President of the VNSW Board became Chairman.
July 1990 - Westchester Care at Home.
VNSW’s affiliate, Westchester Care at Home became licensed as a Home Care Agency on July 1, 1990, providing skilled nursing and highly qualified home health aides and personal care givers as a proprietary agency under the WVNS Group.
1992 - Hospice Affiliation / VNSW Growth.
The VNSW Hospice, certified by the NYS Department of Health, ceased operation under that name, and on March 1, 1992, was combined with White Plains Hospital Center, Ronald M. Albert Palliative Care unit. Its new name was HOSPICE-VNSW/WPHC. In 1993 it became known as Hospice of Westchester. In 1999 it expanded to include United Hospital as a sponsoring organization.
VNSW home visits grew from 25,000 in 1988 to 80,000 in 1990.
1993 - VNSW Presents: Ask the Visiting Nurse.
Iva Barnes, a retired VNSW Nurse, in 1989 created a popular health and wellness program for Senior Citizens at senior centers, nutrition sites, churches and synagogues, known as ASK THE VISITING NURSE. The project received a copyright in 1993. The first site was in the Pelham Senior Center. The program grew rapidly to over 30 sites in Westchester. Closer collaboration with Westchester County Office of Aging (WCOA) contributed to this growth. VNSW was one of the first agencies to volunteer to “adopt” a senior residence under the WCOA SOS (Senior Outreach to Senior) project. This countywide effort identifies frail, isolated elderly in both privately owned apartments and county/federal housing projects. ASK THE VISITING NURSE brings monthly health screening and an opportunity to have a one-on-one discussion with a registered nurse about health issues, such as medications or nutrition.
1993-2000: RESPITE in Dobbs Ferry.
Westchester Care at Home (WCAH) a licensed proprietary home health care agency affiliated with VNSW opened a Respite in July 1993. This Respite was a joint venture between the Community Hospital at Dobbs Ferry and WCAH. The program offered separate, decorator-enhanced accommodations, within the hospital, to any adult who requires caregivers at home. Private or semi-private rooms were made available for two days to two weeks or longer.
1994-1996: Cutting Edge Technology and Program Development.
In 1994, VNSW began a 3-year project to implement a computerized clinical documentation system to be used by our nurses making home visits with laptop computers. The laptops were linked to the Agency’s newly upgraded in-office computer network.
In 1995, home visits made by VNSW grew to 102,000. Also that year, VNSW became the only home care agency in Westchester to have on staff a clinical specialist (called an “ET” – Enterostomal Therapy Nurse) with advanced certification in the care of wounds, ostomies and continence problems.
In 1996, VNSW’s exclusive ET program expanded to include a nursing “Wound Care Team.” Also that year, the Agency became the first and only home care agency in Westchester to utilize a newly developed technology for in-home blood anti-coagulation monitoring called Coag-u-Chek. Also that year, a specialized Geriatric Case Management Program managed by the VNSW Social Work Department (VNSW CARES) was introduced to the community.
1997-1999: Restructuring, Research and More Program Expansion.
Joseph Burns retired in October 1996 and Carol Weber became President /CEO in 1997. In 1997 and 1998, a major reorganization of internal systems was instituted to ensure the quality of patient service delivery and enhance cost efficiency to successfully manage the turbulent changes being made in Medicare and Managed Care reimbursement.
In 1997, Congress passed the Balanced Budget Act that contained measures to balance the federal budget by the year 2002. Subsequently, over the two-year period between 1997 and 1999, home care expenditures dropped by 45% and approximately one third of Medicare-certified home health agencies across the nation closed their doors.
In 1997, VNSW was selected as the sole participant by Weill Medical College of Cornell University in White Plains to participate in the first ever multi-year research study (funded and sponsored by the National Institute of Mental Health) on the mental health and well being of elderly home health care patients.
In 1999, the Ask the Visiting Nurse Program was expanded to include a Community Flu Shot Program. More than 1,000 immunizations were provided to Westchester residents in its 1st year of operation.
2000 - VNSW Serves 4,000 Patients and Adds More New Services.
Building upon its solid foundation, VNSW ended Y2000 by providing home care services to a record-breaking number of Westchester residents – 4,000! Over 100,000 home visits were made.
Established to meet other identified unmet community needs, VNSW instituted two additional services:
- A Mental Health Home Care Program that provides a support system for high-risk patients with impaired mental health. This program also complements the collaborative research efforts of VNSW and Cornell University.
- The WORTH Program – an expansion of the Ask the Visiting Nurse Program that provides health education and support services to homeless mothers and teenagers at the Coachman Family Center in White Plains.
VNSW expanded its research collaboration with the Weill Medical College of Cornell University by again being the sole participant in a Samuels Foundation funded study of Psychotherapy Intervention for Suicide Risk in Home Care.
VNSW continues its longstanding alliance with Pace University, Cochran School of Nursing at St. John’s Riverside Hospital and the College of New Rochelle by serving as a nursing clinical placement site.
2001 – Centennial Year!
In 2001, VNSW continued to develop partnerships with other community organizations to identify additional unmet needs in Westchester and develop related programs and specialty services.
- The Ask the Visiting Nurse “WORTH” Program expanded its services into a residential group home for teenage boys at Children’s Village in Dobbs Ferry.
- The Ask the Visiting Nurse “Senior” Program was still going strong at 33 senior community centers and at many area health fairs. This program made over 6,000 contacts with seniors in 2001.
- The successful Mental Health Home Care Program was expanded to provide services to the pediatric population.
- The Enterostomal Therapy Home Care Program established in 1996 was upgraded to include state of the art in-home digital wound photography for patients with difficult to heal wounds. The images are forwarded to the physician to enhance RN/MD communication and hasten wound healing.
- The Weill Medical College of Cornell University/VNSW research on “Recognizing Depression in the Elderly Receiving Home Care Services” was presented at the American Association for Geriatric Psychiatry in Miami in March, 2000. Results of this study were published in the September 2001 issue of Home Healthcare Nurse. Several other articles related to this multi-phase collaborative research have been accepted for publication in other national medical journals.
2002 – 2006: More Program Expansion and Continued Growth.
In 2002, VNSW initiated a cutting edge Pain Management/Palliative Care Program (run by clinical nurse specialists) implementing advanced pain/symptom control measures for patients with non-curative illnesses. The program also features a Complementary Care component with massage, music therapy, reflexology, acupuncture, and spiritual care services. The complementary care visits are provided with no charge to patients. The Agency relies on community support for funds to provide these complementary care services.
Also in 2002, with funding received from the POW’R Against Tobacco coalition, VNSW developed and implemented the first of its kind Smoking Cessation Program for homebound patients. The program has since been expanded into the VNSW Ask the Visiting Nurse community sites.
In 2004 – 2005, the Agency introduced three additional specialty programs:
- Specialized Pre/Post-Surgery Joint Replacement Care
- Dysphagia (swallowing disorder) Rehabilitation
- Cardiac Disease Management by Clinical Nurse Specialists
By 2005, The Ask the Visiting Nurse Program was serving 66 senior sites, had added mental health and rehabilitation components, and made over 9,700 contacts with seniors.
Patient Admissions were at an all-time high (5,174) and a record number of home visits were recorded (148,450) in 2005.
In 2006, VNSW had another record-breaking year admitting 5,236 patients to its home care program with 150,250 home visits made – an all-time high for the organization. Specialty Programs were promoted and were well received by the Westchester Community. The Agency’s solid bottom line was maintained. All this is testament to the ability of VNSW’s staff to successfully rise to challenge put before them: Commitment, Creativity, Efficiency and Accountability.
Projection for 2007:
The Agency will remain the Westchester home care agency of choice for the next 100+ years by continuing its focus on:
- Excellence in Patient Care
- Staff Education
- Cutting-Edge Technology
- Community Outreach
- Cost Efficiency
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