Lillian Wald invented public health nursing in 1893, making this year the field's centennial. One of nursing's visionaries, Wald secured reforms in health, industry, education, recreation, and housing. This historical inquiry examines three of Wald's critical experiments, each of which illuminates the past of public health nursing and its contemporary dilemmas: invention of public health nursing itself, establishment of a nationwide system of insurance payments for home-based care, and creation of a national public health nursing service.

Symptom distress, mental health status, enforced social dependency and health perceptions were measured in two groups of cancer patients, one receiving home care services (n = 49) and the other receiving no such services (n = 11). Data were obtained at hospital discharge and 3 months later. Patients receiving home care demonstrated statistically significant improvement on mental health and social dependency; patients not receiving home care did not improve on any variable. After controlling for baseline scores, the home care group had significantly higher mental health status at the second interview than the no home care group.

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Public health nursing began in the United States as a small undertaking in which a few wealthy women hired one or two nurses to visit the sick poor in their homes. By 1910, the work of these nurses had expanded to include a variety of preventive programs. While most preventive programs originated with voluntary organizations, such as the visiting nurse societies, they were eventually taken over either by boards of education or health departments. As a consequence of the new division that resulted,

The problems of caring for patients with disabling illnesses who neither get well nor die are not new. Such patients have always required assistance at home from family, benevolent volunteers, or paid caregivers. Despite two centuries of experimentation, however, no agreement exists concerning the balance between the public and private resources to be allocated through state funding, private insurance, and family contributions for the daily and routine care at home for chronically ill persons of all ages. This article examines these issues and the unavoidable tensions between fiscal reality and legitimate need. It also uses historical and policy analyses to explain why home care has never become the cornerstone for caring for the chronically ill.