WNY Nurses Blazed a Caregiving Trail

Released: 7/8/2010
Nurse Vicki Miller of the Visiting Nursing Association tends to Helen Zylka of Cheektowaga. Bill Wippert/Buffalo News

Published in The Buffalo News, July 06, 2010
http://www.buffalonews.com/2010/07/02/1102040/wny-nurses-blazed-a-caregiving.html

By Charity Vogel / News Staff Reporter

Mae Gambino may not realize it, but the wound on her leg is being helped by history.

Gambino, 88, leaned back in a chair in her sunny Amherst apartment one morning last month and extended her shin — which she gashed in a household mishap — toward nurse Tanya Woods.

Woods' capable hands quickly changed Gambino's dressing, applied a solution to her wound, and massaged lotion onto her foot.

Less visible, but no less true, was the fact that another woman — one who lived in Buffalo more than a century ago — was also involved in Gambino's recovery.

Elizabeth Coe Marshall, a Sunday school teacher, founded Buffalo's original visiting nurses association 125 years ago this year.

The group was the first of its kind in Western New York — and in the nation.

Since 1885, the Buffalo visiting nurses organization has never been out of operation.

Today, the organization — now called the Visiting Nursing Association, and one of many in-home health care outfits operating in Western New York — is bigger and more far-reaching than ever.

Consider this: While Marshall's first nurses made 2,000 visits in one year, the current Visiting Nursing Association, an arm of Kaleida Health, makes 1,000 home visits across the region each day.

At this milestone, some say, the association might be entering something of a second golden age.

With baby boomers aging, senior citizens living longer and more active lives, and the whole picture of American health care changing, some think that the at-home, one-on-one techniques of the VNA might be entering a renaissance, making the visiting nursing corps not just the past of health care but its future.

"If one of our big goals is to change people's behavior, we are more likely to change an individual's behavior if we take the lessons to them, in their environment," said Dr. Anthony J. Billittier IV, Erie County's commissioner of health and an emergency room doctor. He is not affiliated with the Visiting Nursing Association. "The VNA is a good partner in helping make up that system [of care]."

The 125-year-old brainchild of a Buffalo schoolmarm becoming part of the cutting-edge face of 21st century health care?

Even Elizabeth Coe Marshall might have raised her eyebrows at that.

Lois Schwartz, 86, needed treatment on a recent morning for a cut she suffered when a gust of wind blew a taxicab door, hitting her.

Woods, the nurse assigned to Schwartz's case, walked through the door of the Amherst woman's apartment after a brisk knock and a bright "Hello!" The two women chatted about Woods' recent honeymoon and Schwartz's family members, whose faces fill picture frames on the walls and shelves inside her assisted-living home.

"Are you watching your salt intake?" Woods asked Schwartz in a cheerful tone, as she measured the skin abrasion with a small ruler.

Schwartz nodded vigorously. "How long before my foot goes down?" she queried.

"We'll get that wound healed in no time," said Woods.

"I'm sick of looking at it," Schwartz admitted.

On a typical day, a visiting nurse will make perhaps five or six visits with patients like Schwartz and Gambino, association executives said.

Each modern association nurse — most are still women, and the average age is early 50s — carries a black shoulder bag stuffed with high-tech tools of the trade, from patient monitoring devices and electronic scales to digital cameras and notebook-style computers. Some nurses travel with IV equipment, to give intravenous therapy in home settings.

"It's a well-stocked bag, for any patient they might have," said Lisa C. Greisler, director of clinical services for the Visiting Nursing Association, which is headquartered on Wehrle Drive in Williamsville.

It's a far cry from the black leather bags — think Mary Poppins-esque, deep and capacious — that visiting nurses used to carry. Those even had glass bottles inside, with alcohol, tinctures of bergamot, and the like.

In the early days, a visiting nurse would pair a bag like that with a pair of tidy gloves.

'Foot soldiers'

Elizabeth Coe Marshall was the daughter of a Buffalo attorney, Orsamus Marshall, who rubbed shoulders with influential Buffalonians of his day: Grover Cleveland, Millard Fillmore and the like. When Marshall fell and broke her leg, in her early 30s, she was able to pay for private-duty nurses, who tended to her recovery in her home.

Recuperating quickly, Marshall decided that the residents of Buffalo — many of whom were poor, including people of immigrant populations — deserved the same care.

She hired Mary Taylor, a new nursing school graduate, to be the first full-time nurse of the District Nursing Association of Buffalo — the group that grew into today's Visiting Nursing Association.

Nurses of the new association made 2,000 visits in their first year, according to a study of the group by Audrey B. Davis, a curator at the Smithsonian Institution, who published an article on the Buffalo VNA's roots in 1990.

In those early years, medical care for many people — especially that practiced in the home — was primitive. Germ theory and sanitizing techniques were considered cutting-edge medicine.

Buffalo's early visiting nurses found themselves not only tending to the sick and injured, but helping teach residents how to keep their homes and bodies clean, their milk sanitary and babies germ-free.

"The visiting nurse became the foot soldier in the battle to restrain poverty and disease and its attendant social decay," wrote Davis, in her article.

But the idea caught on. By 1890, there were 21 visiting nurses associations in the United States.

By 1921, there were more than 4,000.

Nationally, at the Smithsonian and elsewhere, Buffalo is recognized — and praised — as the early innovator in this nationwide movement.

The personal touch

At the Visiting Nursing Association, Woods said that, once she tried one-on-one nursing in patients' homes, she knew she would want to make a career of it. Spending time with patients and getting to know them is the best part of her job, she said.

Leaders of the association call it a "community-driven" idea of nursing — both in its beginnings, and in its current practices. "Our goal is to have the same nurse treating the patient," said Greisler, "so that there's continuity."

The average length of care for a Visiting Nursing Association patient is 45 days, association executives said.

The association employs 380 nurses, 130 therapists of various kinds and 150 home health aides, according to Judy Baumgartner, vice president and chief operating officer.

The total staff numbers 930 people, and "we're growing," said Baumgartner.

Part of the reason for that, association executives said, is the forward-thinking approach in health care is to try to keep people in their homes as much as possible during their treatment.

"It's a less-costly setting for health care, but also a more effective setting," said Baumgartner.

"This is where health care is going," added Greisler. "It doesn't replace an acute-care setting. But it's a setting where people will heal — it's the setting where we want them to be. People will heal fastest in their homes."