As the population of aged and chronically ill rapidly increased after World War II, need for long-term home services also expanded. Public health organizations attempted to respond, but despite rapidly increasing demand, both official and voluntary public health nursing services were squeezed by a nursing shortage, increased costs of care, and declining income. While nursing's historical ambivalence toward caring for the long-term patient had previously restrained innovation, during the 1950s and 1960s public health nurses contributed to development of homemakers/home health aides, meals-on-wheels, friendly visitors, and more. But who deserved to receive services at home? Which service was a priority? Conflict over eligibility for home services erupted between individually-oriented social caseworkers on one side, and, on the other, population-oriented professionals such as public health nurses and settlement house social workers. Advocating for the right of vulnerable populations to receive home services, public health professionals countered social casework efforts to judge the worthiness of the aged and chronically ill for home services solely by their adequate income, sufficient functional status, and moral rectitude. One result of this conflict was the divergent roles, responsibilities, and payment mechanisms for homemakers compared to home health aides. Based on a historical case study of Philadelphia, with additional data reflecting the national experience, this paper will also suggest the contemporary basis for continuing confusion in the organization of supportive home services for vulnerable populations, especially the aged and poor.
Learning Objectives: 1. Identify two advocacy strategies public health nurses used to secure and maintain access to home care services for vulnerable populations. 2. Identify three historical factors that continue to limit home services for the chronically ill and aged
Keywords: Vulnerable Populations, Public Health Nursing
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.