Janna L. Dieckmann - Caring for the Chronically Ill: Philadelphia, 1945-1965

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GARLAND STUDIES ON
THE ELDERLY IN AMERICA

edited by
STUART BRUCHEY
ALLAN NEVINS PROFESSOR EMERITUS
COLUMBIA UNIVERSITY

Caring for the Chronically Ill

Philadelphia, 19451965

Janna L. Dieckmann

Copyright 1999 Janna L. Dieckman
All rights reserved

Library of Congress Cataloging-in-Publication Data

Dieckman, Janna L., 1949
Caring for the chronically ill: Philadelphia, 19451965 /
Janna L. Dieckman.
p. cm. (Garland studies on the elderly in America)
Includes bibliographical references and index.
ISBN 0-8153-3251-3 (alk. paper)
1. Chronically illCarePennsylvaniaPhiladelphia
History 20th century. 2. Long-term health careDevelopment
PennsylvaniaPhiladelphiaHistory 20th century. 3. Aged
Long-term carePennsylvaniaPhiladelphiaHistory 20th
century. I. Title. II. Series.
RA973.5.D54 1998
362.160974811dc21

98-37265

To people living with chronic illness,
their families, friends, and caregivers

Contents

1. i
2. xv

Guide

As the following study will suggest, adequate funding is a critical necessity in any venture. I would like to thank the organizations that supported this research. The Program for the Assessment and Revitalization of the Social Sciences, University of Pennsylvania provided a dissertation fellowship which was very helpful early in the research process. Research support grants were offered by the "Agnes Olson, R.N., Scholar" Fund of the American Nurses' Foundation; the Lillian Sholtis Brunner Summer Fellowship for Historical Research, Center for the Study of the History of Nursing; and the Frank Morgan Jones/Foulkeways Research Fund, both of the University of Pennsylvania. I was especially grateful to receive a National Research Service Award, Dissertation Fellowship, from the National Institute for Nursing Research, National Institutes of Health. In addition, I would like to thank those whose generous financial contributions made these grants possible.

I am very grateful to many archivists and archival assistants for their thoughtful consultations and generous contributions to the research, and to other researchers for their interest, encouragement, and good advice. The archivists and staff of the Urban Archives, Temple University, and the Center for the Study of the History of Nursing, University of Pennsylvania, have been particularly helpful.

I wish to thank faculty and graduate students of the Center for the Study of the History of Nursing at the School of Nursing, University of Pennsylvania, for their commitment to the field and work of nursing history, as I am grateful for their contributions to my scholarly inquiries. I want to particularly thank Karen Buhler-Wilkerson, Neville Strumpf, and Rosemary Stevens for their thoughtful and pertinent feedback and excellent suggestions for development of the scholarly concepts.

I am grateful to my colleagues at the La Salle University School of Nursing for their continuing support of my research. My thanks to family and friends who have supported the writing of this book. I am also indebted to my parents for their foresight in planning my birth on "National Shut-In Day," an ironic start for my research interest in patterns of care for the chronically ill.

• AAHA Association of Administrators, Home for the Aging
• AC Advisory Committee
• BC Bulletin Collection, TUUA
• BI Balch Institute, Philadelphia, PA
• CHCP Coordinated Home Care Plan
• CHCS Committee on Home Care and Services, HWC
• CSA Council of Social Agencies, HWC
• DA Division on Aged, HWC, TUUA
• DHEW United States Department of Health, Education, and Welfare
• DPW Department of Public Welfare, Commonwealth of Pennsylvania
• f. Folder, File
• FD Family Division, HWC
• HD Health Division, HWC
• HC&S Health Care and Services, HWC
• HWC Health and Welfare Council, TUUA
• JAoP Jewish Archives of Philadelphia, at BI
• Ms. Miscellaneous
• MMC-ZA Zimmerman Archives, Montefiore Medical Center Bronx, NY
• MHCP Home Care Program of Montefiore Hospital, Bronx, NY
• MOW Meals-on-Wheels
• NA National Archives, Washington, DC
• NCOA Archives of the National Council on Aging, Washington, DC
• PCA Philadelphia City Archives, Philadelphia, PA
• PCPA Philadelphia County Board of Assistance
• PGH Philadelphia General Hospital
• PHCP Philadelphia Home Care Plan
• PHS Public Health Service
• PSA Pennsylvania State Archives, Harrisburg, PA
• RG Record Group
• RVH Riverview Home for the Aged
• s. series
• Sub-C Subcommittee
• TUVA Urban Archives, Paley Library, Temple University, Philadelphia, PA
• VNA Visiting Nurse Association
• VNS Visiting Nurse Society, Visiting Nurse Service
• VNS Arch. Visiting Nurse Society of Philadelphia, MC 5, Center for the Study of the History of Nursing, School of Nursing, University of Pennsylvania, Philadelphia, PA
• ULP Urban League of Philadelphia, Urban Archives, Paley Library, Temple University, Philadelphia, PA

Caring for the Chronically Ill

Chapter One
Changing Patterns of Long-Term Care

When human populations and their needs change, organizations responsible for their care inevitably react. With the rapidly and significantly increased demand for chronic care at mid-twentieth century, solutions deemed satisfactory in the past were entirely inadequate. Thus, community leaders and politicians began promoting several approaches to long-term care services in the two decades between 1945 and 1965, but without an adequate source of financing to establish an effective system. In contrast to acute care services and despite the need, chronic care remained unavailable and of poor quality. No doubt, persistent societal ambivalence about care of the chronic sick was a reaction to their heavy use of available, but limited, financial and caregiving resources, and in the United States, contributed to policy decisions that essentially rationed long-term care. These decisions have played out repeatedly in the design and implementation of long-term care in institutions and at home.

Each component of the long-term care system possesses its own history, pattern of financial support, and specific placement in the continuum from medical to social welfare. This inquiry, while related to individual circumstances and experiences of chronicity and prolonged illness, is fundamentally about the larger system of long-term care system. Development of patterns of care and formation of a chronic care delivery system are examined and emphasized. An important part of the inquiry relates to how organized health and social services, politicians, and professionals reacted to the increased need for chronic care. A case study approach to development of long-term care will be used to examine the approaches and strategies of the planners and managers who created these systems.

Until the middle of the twentieth century, most long-term care was provided and paid for at the local level, frequently by county government. Charitable groups shared some responsibility for chronic illness and aged care, but provided little medical treatment. Despite the dominance of local solutions, state-local conflicts over care, strategies for management, and quality improvement often arose, especially after 1950. Philadelphia offers a diversity of examples of this complex process, including innovations used throughout the country.

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