VIEWPOINT: The Beautiful Legacy of the Visiting Nurse Association

Three Syracuse women — Laura Bissett Mills, Arria S. Huntington, and Dr. Julia Hanchett — founded the Visiting Nurse Association (VNA) in March 1890. All three were acutely involved in local public-welfare programs, especially those focused on the health of women and children. 

Mills founded the Good Shepherd School of Nursing in 1887 at the Hospital of the Good Shepherd in Syracuse, the first training school for nurses in Central New York, and became the training school’s first superintendent. Huntington was an integral part of local women’s health and welfare in the late 19th and early 20th centuries. Profoundly engaged in the Women’s and Children’s Hospital in Syracuse (later, Syracuse Memorial Hospital), she also founded the Shelter for Unprotected Girls and the Women’s Employment Society. Huntington became absorbed in the Women’s Union, where she fought to better the conditions of working women and to give them the opportunity to make intelligent, moral, physical, and financial improvements in their lives. Dr. Hanchett represented the third generation of Hanchett family physicians. She received her initial medical education at the Training School for Nurses at Bellevue Hospital in New York City and later received her medical degree at the Woman’s Medical College of Pennsylvania, where she graduated in 1883. In 1886, Dr. Hanchett began her private medical practice and became associated with the Hospital of the Good Shepherd, where she assisted with establishing the first maternity ward in Syracuse. Dr. Hanchett also served as Syracuse’s city vaccinator from 1902-1916, during which time she vaccinated more than 30,000 children. She also worked with Huntington at the Shelter for Unprotected Girls.

With aid from Frederic Dan Huntington, the bishop of the Episcopal Diocese of Central New York, founder of the Hospital of the Good Shepherd, and Arria Huntington’s father, these three talented and concerned women recruited some of the newly trained nurses from the Good Shepherd School of Nursing and established the VNA of Syracuse. They opened an office on South Warren Street and installed Huntington as president, Dr. Hanchett as medical advisor, and Mills (now Marlow) as supervisor of nursing services. The women initially launched the association “to care chiefly for maternity cases,” but succeeded and soon expanded its breadth of services. By July 1890, the Syracuse Daily Standard newspaper reported the VNA had made 265 house calls and contributed to the care and comfort of more than 32 ill citizens. The association’s initial expenses amounted to $40 per month (about $1,350 in 2023), mostly paid by concerned citizens. The Third Ward Railway and the People’s Railway, two electric street trolley lines, provided a limited number of free rides so visiting nurses could travel to their patients around Syracuse. Other notable citizens made gifts of money or material to the flourishing medical organization. 

The VNA issued its first annual report in 1895. In the report, Arria Huntington recounted that the organization had been incorporated under the name of The Visiting Nurse Association of Syracuse. She also mentioned the association had hired a paid superintendent due to the increased awareness of the VNA. Infectious diseases, such as diphtheria and scarlet fever, were taking their toll on the most vulnerable citizens at that time. While the VNA’s main mission was to provide maternity services and to teach new mothers how to care for their newborns, visiting nurses also treated the sick, many of them destitute. Services were provided mostly for free or a small fee. The nurses made daily house calls and assisted patients’ recovery to regain their strength so they would once again become healthy and productive. Huntington also stated in the 1895 annual report, “The opportunities for good in the service which our nurses render are incalculable in their results. They are combating not only physical disorder, suffering and death, but helping to preserve the home, to uphold society, to restore the weak and sustain the helpless.”

In 1912, the VNA created one of its most successful programs, known as Baby Camp. Baby Camp opened on Rider Avenue in Syracuse and operated every summer until 1925, when it shifted to a year-round program. From 1912-1931, Baby Camp served both urchins and more affluent children who required extra attention to overcome bronchitis, pneumonia, thrush, jaundice, and rickets. Many parents, often immigrants, praised the care the children received at Baby Camp. Camp nurses provided the children with much needed love, nutrition, and abundant fresh air. The nurses often kept track of the children at their homes after they left the camp. One visiting nurse’s report stated, “Little Joseph, who was with us both summers, is fat and well and can almost walk; his mother is planning already to send him to us again next summer.” In 1931, the VNA thought many of the Baby Camp children would fare better if they were placed in foster homes. That year, the association closed the camp and the responsibility was given to the Children’s Bureau.  

The VNA opened its first well-child clinic in 1918. Two years later, the association obtained its first automobile, greatly expanding the visiting nurses’ range to encompass all of Onondaga County. In 1919, the VNA required each visiting nurse to own a telephone, fountain pen, inexpensive wristwatch, thermometer, scissors, probe, and forceps.

The Spanish Influenza struck Syracuse, as it had all across the United States and Europe, in the fall of 1918. Italian families often suffered, with the disease assaulting entire families. Visiting nurses worked assiduously to stop the disease from spreading and to comfort the patients. Nurses often worked from the early morning until well after midnight, usually making no less than 65 house calls each day. In the beginning of October 1918, nurses made 6,775 visits to 1,496 patients. The epidemic peaked later that month, when visiting nurses made over 2,000 calls in the third week alone. Syracuse’s more affluent citizens loaned the VNA over 100 automobiles to assist with transporting nurses throughout Onondaga County. Unfortunately, 55 visiting nurses died while caring for numerous influenza patients.  

The VNA worked on the Onondaga Nation between 1918 and 1919. At the behest of the New York State Sanitary Supervisor, “the Association agreed to organize and supervise nursing and welfare work on the Indian Reservation, in order to demonstrate to the State the need of such supervision.” The VNA demonstrated to New York State that placing a nurse on the Onondaga Nation was a vital service. The association’s program on the Nation included “nursing care, prenatal instruction, child welfare, and hot lunches on school days.” Nurses also provided baby care instruction to new mothers. For that one year, visiting nurses made over 1,500 calls, assisted with decreasing the tuberculosis epidemic, examined every school child, and sent many of them for dental care at the Free Dispensary’s children’s clinic. New York State then assigned its own nurse on the Nation to perform most of the same functions and then opened a clinic in 1924. The VNA continued to offer school lunches to Onondaga children until 1929. 

Maternity care and home deliveries remained VNA’s concentration for many years. Between 1929 and 1935, visiting nurses assisted with 1,834 home deliveries. In 1938, a visiting nurse attended 50 percent of home deliveries in Syracuse. However, by the mid-1940s, home deliveries dramatically declined to only 41. In 1947, the VNA dropped home-delivery service. Still, the VNA continued to offer maternity care and new parent instruction classes. 

During the World War II years (1941-1945), the National Office of Price Administration and the National Organization of Public Health Nursing approached the Syracuse VNA to demonstrate the dangers of buying fuel and products in the illegal underground economy. The federal program staff thought the Syracuse association could demonstrate the value of public-health nurses on the home front to nurses in other cities.

Two visiting nurses, Second Lieutenant Rita Erard and Second Lieutenant Kathryn McCarthy, paid the ultimate sacrifice for their country during World War II. Life-long friends, these fellow Syracusans were members of the US Army Nurse Corps assigned to the 172nd General Hospital, 803rd Medical Air Evacuation Squadron, in Dinjin, India. On March 4, 1945, Lt. Erard and Lt. McCarthy boarded a C-47 Skytrain airplane bound for Ledo, India, with other passengers. One mile from the Ledo airport, the airplane crashed and completely burned, killing all aboard, including Lt. Erard and Lt. McCarthy. Lt. Erard’s body was never recovered from the burned wreckage. She is memorialized on the Walls of the Missing at the Manila American Cemetery in the Philippines. Lt. McCarthy’s body was recovered and initially interred in Kalaikunda, India, but was later repatriated to the National Memorial of the Pacific in Honolulu, Hawaii, on January 10, 1949. Lieutenant Esther Schisa — a U.S. Army nurse, also from Syracuse, assigned to a hospital ship caring for wounded military personnel during the war — remembered her two close friends in a Syracuse Herald Journal newspaper article in June 1945: “They died bringing relief and comfort to our boys. We in Syracuse should honor their memories with vigor both on the war and home fronts.”

The VNA moved to new headquarters at 704 East Jefferson St. in Syracuse in July 1947. The address was the former home of Abraham Rosenbloom, a local real-estate agent, who appreciated the fine work of the VNA so much that he bequeathed his house and a vacant lot on East Jefferson Street, along with two other properties located at 507-509 Cedar St. and 511 Almond St., to the VNA for its headquarters, as well as future expansion. That year, the VNA made 27,247 calls to 4,696 patients. Almost a third of the visits were to new mothers and their babies. 

As the decade ended in 1949, visiting nurses continued to provide quality service to Onondaga County’s expectant and new mothers, as well as a host of other patients. In 1949, buses conveyed most visiting nurses to their appointments. Each nurse routinely visited seven to eight patients each day and carried a medical supplies bag that weighed about eight pounds. While on their rounds, nurses often ate lunch at a nearby restaurant. The VNA Board of Directors comprised 30 women who met at the Syracuse Museum of Fine Arts on James Street in Syracuse to discuss association business and the public welfare of the community. As the 1950s commenced, the VNA board of directors allowed men to join the board.

 Beginning in 1956, in conjunction with the Council of Social Agencies, the VNA provided a home health aide service. The aides were “unlicensed, non-professional worker[s] prepared to assist the sick, disabled or infirm at home…” That same year, visiting nurses made over 10,000 house calls to patients. 

In the mid-1950s, the VNA played a key role in caring for and comforting cancer patients in their homes. They received a portion of $83,000 to spend on that care. However, the association made a point of not separating cancer care from other care. The board and staff were careful to include cancer patient care as part of its holistic approach to health care and public welfare. At the time, VNA’s approach to cancer care was to emphasize the potential for cancer patients to resume a role in society, “as far away from despair as possible.” The dedicated nurses not only cared for their patients, but also taught family members rudimentary nursing skills, helped patients to be more self-reliant, and guided families through the psychological roller coaster of living with cancer. 

In late 1958, the VNA was among 65 government and voluntary health organizations to approve a constitution and by-laws establishing the Metropolitan Health Council of Onondaga County. Once the new organization was formed, the VNA applied to become an agency member. The purpose of the Metropolitan Health Council was to join varied health organizations around the concept of community health planning. The council worked under the auspices of the Community Chest, which was the forerunner of the United Way of Central New York, and the Council of Social Agencies. The Metropolitan Health Council ended its two-year experiment in community health planning in 1961, when it was criticized for admitting the Planned Parenthood Center to its group and lost funding from the Community Chest and Council of Onondaga County. During its brief tenure, the Metropolitan Health Council “identified community health needs, acted to meet some of them and ha[d] created a desirable liaison, understanding and confidence between lay and professional health workers in the community.”

 The VNA appointed Nora Belle Rothschild as its new executive director in May 1960. Rothschild was the latest director in a long line of dedicated health professionals to hold that position since the association’s inception in 1890. Rothschild had been employed by the VNA since 1946, when she separated from the US Army Nurse Corps after World War II. In 1960, the VNA employed 12 registered nurses with public health training and two practical nurses. The VNA continued to emphasize in-home patient therapy and care. 

Ruth Freeman from the University of Baltimore, guest speaker at the VNA’s 66th annual luncheon meeting at the Corinthian Club on James Street in Syracuse, sized up the character and duties of visiting nurses at the beginning of the 1960s. Touting the positive therapeutic effects of recovering in one’s home instead of the hospital, Freeman stated, “the [visiting] nurse plays a role. … She translates to the family the meaning of the medical diagnosis and the rationale of treatment, she acts as observer for the physical therapist or with help gives and supervises physical therapy procedures; she refers at the right moment to the right resource in the right way, so that all available facilities are used as effectively as possible. … But most of all, she listens to, reassures, cajoles and encourages.” 

In the 1960s, VNA continued to offer in-home health care at adjustable monetary rates, depending on one’s financial circumstances; the destitute continued to receive free health care. The VNA continued to expand the number of patients served via its effective use of home health aides. Another successful VNA program in that decade was training women to become home-aide-homemakers. The home-aide-homemakers were trained by nurses to fill a health-care need in homes where no member of the patient’s family was available to help. Upon successfully completing the three-week course, home-aide-homemakers earned $1.80 per hour to care for those in need.       

The last “walking nurse,” I. Marie Wahlroos of Syracuse, retired in 1970. As a walking nurse, Wahlroos traveled to each of her patients’ homes on foot, rather than by car or public transportation. Born in Finland, she had been employed as a visiting nurse in Syracuse since 1928. Typical of early visiting nurses, Wahlroos accompanied doctors to deliver babies at home. One day in the 1940s, Wahlroos arrived at the delivering mother’s home to find no doctor and had to deliver the baby on her own. “I wasn’t scared. But I was concerned. When the doctor arrived, he said I’d done a good job. I was quite proud of myself,” Walroos stated in the Syracuse Herald Journal newspaper in November 1970. Upon her retirement, Wahlroos said, “VNA goals are still the same, to keep our patients well and comfortable, physically and mentally.”  

In 1977, the VNA was the oldest home health-care organization in the region. By that time, the annual budget was $800,000. More than half of the 15 people on staff were public health nurses with a four-year nursing degree. Each home visit then cost $18.50. 

Home Health Providers, Inc., was created in 1988 as a cooperative endeavor between the VNA and Home Aides of Central New York. The latter was organized in 1966 to assist in the care of aging, ill, and frail individuals at home. At that time, a shortage of nurses and home health aides threatened staff needs for both organizations. This health-care affiliation was originally known as Home Tech of Central New York, but Home Aides later unaffiliated itself. The VNA and Home Health Providers combined their physical locations at 1050 West Genesee St. in Syracuse when the VNA relocated from 704 East Jefferson St. In 1995, the two-way affiliation was called VNA Systems, Inc., and a new agency, Independent Health Care Services, Inc., was added. However, at the end of August 1999, the VNA closed and absorbed the smaller Home Health Providers, Inc., due to cuts in Medicare and Medicaid reimbursements, as well as stricter insurance claims procedures.

The VNA commemorated its centennial anniversary in February 1990 during National Visiting Nurse Association Week. The anniversary slogan was 1890-1990: One Hundred Years of Caring. New York State Senator, Tarky Lombardi, Jr., of Syracuse, presented a New York State Senate Resolution recognizing the VNA’s 100th anniversary. Professional dignitaries spoke at the event, staff presented nursing uniforms from bygone days, and many enjoyed a piece of anniversary cake. The 1990 annual report asserted, “[i]t was a happy night for all who attended.”     

As the 20th century transitioned to the 21st, the VNA remained steady and continued to offer its in-home patient care services. The list of offered services expanded to include physical, occupational, and speech therapy, home safety evaluations, nutrition programs, as well as social and domestic services.

By 2011, VNA Systems, Inc., was the umbrella organization of the VNA of Central New York, CCH Home Care and Palliative Services, Independent Health Care Services, and the VNA Foundation of Central New York. That same year, VNA Systems, Inc., was rebranded as VNA Homecare. In the following year, it launched VNA Homecare Options, a long-term care Medicaid plan targeting chronically ill or disabled patients who required health or long-term care services. By 2015, this plan had expanded into 48 New York State counties. 

Then, in 2013, VNA Homecare and Home Aides of Central New York joined together to offer more affordable and accessible health care to the community.

VNA Homecare celebrated its 125th anniversary in 2015. The milestone commemorated the long medical service the VNA had provided to the community since its founding in 1890. The organization embarked on a capital campaign to raise funds for necessary repairs on the VNA’s building at 1050 West Genesee St. However, VNA’s leadership team soon realized the current facility no longer met the association’s needs; they decided to plan for a new complex at the same address to accommodate future needs. A groundbreaking ceremony was held in 2017 to commence construction of a new 47,000-square-foot complex for VNA Homecare’s headquarters. King & King Architects and Hayner Hoyt Corporation were the primary design and construction firms associated with the building project. The new facility opened in 2018.

Also in 2017, VNA Homecare, VNA Homecare Options, Home Aides of Central New York, and all other affiliated organizations and foundations combined into one new health-care system, known as Nascentia Health. The new system combined programs and services previously managed as separate entities. Under this new umbrella organization, Nascentia Health promotes a unified health-care system guided by mutual goals and vision.

Today, Nascentia Health’s mission is to be the premier home and community-based care system for the regions in which it serves. It holds itself to the highest standard of excellence as a health-care leader and strives to deliver exceptional care. Nascentia Health continues to provide nursing and therapeutic care at home and home health aide care, as well as providing managed Medicare and Medicaid health plans. Along with these services, Nascentia Health also offers low-income seniors a place to live at St. Anthony Gardens in Syracuse.

Marlow, Huntington, and Dr. Hanchett — founders of the original VNA in 1890 — would certainly be proud to know their brainchild not only still exists, but also is growing and expanding throughout New York state. They also would be proud of the fact that women comprise 80 percent of Nascentia Health’s staff. From humble maternity care in the late 19th century to modern health and therapeutic care and health-insurance plans, Nascentia Health not only continues to fulfill the original mission of the VNA, but also looks ahead to provide unparalleled health care well into the future.                    

Thomas Hunter is curator of collections at the Onondaga Historical Association (OHA) (www.cnyhistory.org), located at 321 Montgomery St. in Syracuse.