My wife is a professional bag-slinger.
This I admit up-front because today’s opus is a eulogy, of sorts, for something called community-based home health care.
That’s an unfamiliar mouthful, which is part of the reason it’s dying. The registered nurses, practical nurses, therapists and home-health aides who toiled for America’s many Visiting Nurse Associations never were much on public relations. They were too busy visiting the homes of the sick, changing dressings, unclogging drainage catheters, teaching family members how to give loved ones a bed bath and snooping into pantries to see if shut-ins have enough to eat. (If they didn’t, the shut-ins were candidates for Meals-on-Wheels.)
Part nurse, part social worker, part domestic troubleshooter, the women (and some men) who bring health care into your home (or perhaps, your parents’ home) are a different breed of cat. Hospital nurses, backed by high-tech gear and on-call physicians, have their own special skills. Community health nurses, armed only with a boxy black leather bag and a doctor’s prescription, are, by necessity, schmoozers and improvisers. (Did you know that, in a pinch, this very newspaper can be used to create a germ-free environment on your dining room table? It has something to do with the acidity of printer’s ink. Ask my wife.)
Anyhow, one of the casualties of the great upheaval in health care has been the community-based home health agency, and particularly the nation’s VNAs. Many of the larger VNAs were founded around the turn-of-the-century, before home health care became a $36 billion-a-year business.
More than 500 of them were organized in cities and towns across the nation. Typically they were set up and endowed by civic leaders alarmed by the spread of communicable diseases such as typhoid, diphtheria and tuberculosis. Along with taxpayer-funded public health nurses, VNA bag-slingers taught generations of new mothers, especially poor and foreign-born mothers, the basics of sanitation and child care.
Now that health-care providers are listed on the New York Stock Exchange, it’s hard to imagine this earlier, gaslight world of not-for-profit, pay-what-you-can nursing services. Here’s a passage from the official history of the Evanston VNA, in the early years, just before World War I:
“Local papers took up the cry. Police furnished an occasional ambulance to transport a diphtheria or typhoid patient to Cook County, there being as yet no local hospitals. The Needlework Guild and the Central Association of Evanston Charities helped with supplies. An occasional patient paid toward the (VNA) service. Though some opposition materialized on the part of a few doctors, the majority of physicians welcomed the appearance of a visiting nurse on the scene . . . funds commenced trickling in–from benefits, concerts, dinner parties. The City Council added to the income. The various churches were hearty supporters from the very start.”
And so it went, through the Great Depression, World War II and into the 60s, with United Way picking up a large portion of the expenses not covered by private health insurance and out-of-pocket payments from grateful patients.
Then, in 1965, Congress created Medicare. The big government insurance program was a godsend for senior citizens, protecting them from the financial ruin that prolonged sickness often brought. But it was also the beginning of medicine-as-Big-Business, and the beginning of the end for community-based home care.
Medicare’s initial coverage of up to 30 home visits per year (now 90 visits at about $100 per visit) triggered an entrepreneurial stampede. The Yellow Pages blossomed with home-care providers of all stripes, including a wave of “not-for-profits” whose owners lacked a medical background but did have good connections with prescribing doctors. Soon for-profit corporations moved into the market, followed by hospitals, with their automated billing systems and captive market of in-patients in need of post-discharge care.
Though they survive here and there, community-based VNAs never had a chance in the new marketplace. The VNA of Chicago, one of the nation’s oldest and best, stopped seeing patients in 1995 and turned its caseload over to the University of Chicago’s hospital chain. A Chicago VNA Foundation still manages the agency’s endowment, making grants to organizations that still target the poor.
The Evanston VNA, where my wife, Janet, worked until we had our kids, was gobbled up last year by the Evanston Hospital Corp. Evanston is a first-class hospital. I doubt it will use its home-care unit to fleece the Medicare program the way Columbia/HCA, the nation’s largest for-profit hospital chain, allegedly has.
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Then again, it bothers my wife, and scores of other VNA alums, that ServiceMaster Co., a big name in outsourced janitorial services and pest control, has been hired to run the thing. And that the “VNA” name is about to be expunged from what will soon be called Evanston Northwestern Healthcare.
The Evanston VNA (in recent years called VNA North) would have been 100 years old this fall. There will be a memorial gathering of bag-slingers (and others with a soft spot for community-based care) at 1 p.m. Sept. 21 in Evanston’s Centennial Park, Sheridan Road at Davis Street.
The ladies plan to renew old friendships and mourn their loss. Our loss, too.