National Library of Medicine: History of Medicine: National League for Nursing Archives, 1894-1952.Nursing began to emerge as a profession in the late 19th century, along with professional "home health care." The newly created hospitals needed nurses to care for their patients, and developed schools to train them. As trained nurses became available, wealthier families sometimes hired them as live-in care providers for invalids and the elderly.
"The basis for all nursing was the care that the mother bestowed upon the members of her household in time of illness. Her anxiety for her loved ones, along with her desire to give aid and relief to the suffering, made her gentle and painstaking in the methods she used. At first, the mother was concerned with her own family, but as settlements grew larger, she would offer her services to a neighbor in time of trouble. Apparently there was no need for greater skill than that acquired by experience within the family and the neighborhood. Certain women, however, were handier in caring for the sick than their neighbors; naturally they would be called into service very often. Gradually, women, because of their natural inclination and repeated experience, were set aside by the neighborhood to minister to the sick. These women were called nurses.
"As communities grew, the limits of friendship were less observed and women skilled in giving aid to the suffering were called into homes of strangers and would receive remuneration for their services. This was the beginning of the practical nurse for hire, and for decades she was sufficient for the needs of the people." (Medical History of Michigan, 1930)
Poorer families couldn't afford to hire private nurses, but home care services for the poor also emerged around this time, launched by women like Lillian Wald of New York City, who had been trained as a nurse and was studying to become a doctor. During her medical studies Wald volunteered to visit poor immigrant pregnant women, elderly, and disabled people in their homes. When she saw the need of the poor for medical care, she dropped her medical studies and organized the Henry Street Settlement in 1893, also called the Visiting Nurse Society (VNS) of New York. These early home care agencies were directed to the poor and were supported by philanthropy, often "Societies" of wealthy women interested in public works. (VNSNY)