Visiting Nurse and Hospice Care 1908-2008

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Visiting Nurse & Hospice Care

1908â&#x20AC;&#x201C;2008

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From VˆA to Vˆ˙C 1908-2008 NA

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One ˙undred Years of Compassionate Community Care The one hundred-year longe ity o the isiting Nurse Association in Santa Barbara is a testament to the organization s ability to anticipate needs and societal health care trends, to respond with inno ation in both its programs and technologies, and to deli er health care compassionately and competently hile other institutions ha e come

and gone, the Santa Barbara community has supported and unded the NA to keep it strong or an entire century Indeed, the organization s ery name change in to isiting Nurse ospice Care N C , as it enters its second century, is demonstrati e o this ser ice and support

Erin Graffy de García 1

NOTICIAS

The Founding of the Santa Barbara VˆA On Thursday, May 6, 1909, the first semiannual meeting of the Visiting Nurse Association was to be held at as Acacias, the home of Mrs. Samuel P. Calef. Although the members usually met twice a month on Thursdays at the Arlington Hotel at half past two, this was a special occasion and the women looked forward to riding out to Montecito to see Calef’s large ostentatious house, which even boasted electric lights.

The women reviewed the work they had started on November 8, 1908, when they founded the Visiting Nurse Association of Santa Barbara. For the good of the community and out of compassion for those less fortunate, they had sought to inaugurate a visiting nurse program. It would provide health care not only for the poor, but also those away from home, or for those who “may not be able or wish to go to the hospital.”1 The ladies also sought instruction for families who were not informed on the necessary methods of nursing, cooking, and hygiene.

This was not a small matter. As the twentieth century dawned, bringing hope for a better standard of living, based on increased knowledge, technology, and better techniques, American society– and Santa Barbara in particular - began to rethink old practices and institute new programs of health, education, and social reform. In this era preceding the availability of antibiotics, the spread of disease and germs was a serious public health concern. This meant that providing health care to the indigent was not only a compassionate endeavor, but an activity of value to the health of the whole community.

Secretary Mrs. George Agassiz reviewed statistics and accomplishments of the previous six months for the interested

group. An article from The Independent dated October 29, 1908, had announced the launching of the visiting nurse program, and the phone number to reach the nurse, Miss A. L. Frisbie, a graduate nurse who already had course work and experience in public nursing. The program was immediately well received; in the first month of operation (November 3–December 12), Miss Frisbie went on 140 patient visits.

The community rallied to support the program. Among the interesting donated items were two loads of wood, one dozen pillowcases, a bicycle, six women’s nightgowns, two suits of clothing, and fifty feet of garden hose.

Although the area served was just Santa Barbara and not Montecito, it is significant to note that members from Montecito were the first to fund the new Visiting Nurse Association. Indeed, the organization gathered the sustaining membership support of some two hundred women who could appreciate the “community health insurance” benefits of the program.

From November 1908 to May 1909, their donations totaled $875—about $35,000 in today’s economy. The women underwrote the program for one year, so that the fees collected could go toward establishing a permanent association.2 The founders were affluent, well-educated, and well-connected. Treasurer Mrs. Frederick (Clara) Gould was the wife and the daughter of physicians. President Miss Marian Watts was a world traveler. Mrs. George (Anna) Edwards was married to the town’s most prominent banker and was a scion of the Sexton family of the Goleta Valley.

Some of the founders were members of prominent families from the East Coast

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who took their winters in Santa Barbara.

Secretary Mrs. Bowman H. (Elizabeth) McCalla was wife of a famous admiral; they wintered in Mission Canyon. Bostonian Mrs. George Agassiz wintered at Las Tejas. Her husband was the grandson of the renowned zoologist, Louis Agassiz.

Other members who were leaders in the community included Miss Charlotte Bowditch, Miss Fannie Bigelow, Mrs. Stewart Edward White, Miss Josefina de La Guerra, Mrs. William Deer, Mrs. Edward A. Gilbert, and Mrs. Huron (May) Rock. A medical advisory board of physicians served the organization.3 Ë&#x2020;ursing Duties The ladiesâ&#x20AC;&#x2122; many accomplishments in such a short time spurred them on to officially incorporate on October 12, 1910. Some of the expectations for their nurses had been spelled out in their early meetings:

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The isiting nurses are under the orders o a licensed doctor o medicine All types o cases are taken care o surgical, acute medical, orthopedic broken bones , chronic medical, children s cases o communicable diseases, maternity and prenatal work isits could last as long as one hour i all-day nursing was re uired, the patients were re erred to the Nursing Registry ach nurse should gi e hours work daily and shall go to the Neighborhood ouse once a day to see what calls ha e come in A great deal o maternity work is done in Santa Barbara instructing young mothers how to bathe their babies in the easiest, sa est manner and to ormulas properly Nurse was to get list o sick children rom school teachers isiting nurse could then care or child and train mother 4 Within a few years, the VNA was to become the premier health service organi-

The ittle Red ouse at ast aley Street was purchased by the isiting Nurse Association in It would ser e as the Association s head uarters or se enty-three years

NOTICIAS

Pro iding transportation or the nurses was a challenge in the early years, buggies and streetcars pro ing less than ideal solutions The challenge was success ully met with the introduction o automobiles or nurses use

zation in Santa Barbara. The VNA started Santa Barbara’s first clinics for dental care, heart support, tuberculosis treatment, infant welfare, women’s health, immunization, pre-school care, posture, and physiotherapy—all held at its dispensary.

The VNA also initiated school nursing and county nursing programs. An Open Air School and summer health camp were additional programs begun for children, as well as parochial school screening and handling the licensing for boarding homes for children.

These were just some of the initiatives that would become the hallmarks of the VNA’s ability to provide innovative and compassionate care to the community.

Initially, the VNA had an office located in the Neighborhood House, a non-profit community agency primarily serving youth activities, on the northeast corner of De la Guerra and Santa Barbara streets.

In 1910, the VNA purchased a fairly new redwood house with white trim at 133

East Haley Street. In 1915, a nurses’ annex was added at a cost of $1395 to provide employee housing. The “little red house” was to remain its home for more than seventy years.

The First Nurses Staffing was difficult in the beginning. The first nurse, Miss A. L. Frisbie, was fired before the end of a year, for reasons unstated. Since she complained that the streetcar was not good enough for transportation, and she collected only $8.75 in fees after the initial 134 visits, she may have proven just too difficult an employee.

Her full-time position was then filled by a Mrs. Thompson, at $75 per month.

Thompson convinced the board to also hire her friend, a Miss Oliver, who would work part-time for $45 a month, if she could live with Thompson, gratis, and share a horse and buggy. The two worked

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on a trial basis for six months and then one month after that Thompson resigned. It was recorded, ”Domestic troubles seemed to render her unfit for nursing work in a public capacity.” She also had “undesirable traits of character.”5 Next Miss Mary Cole served the organization competently and efficiently, and as the organization grew she assumed the position of Superintendent of Nurses.

After ten years of loyal service, she became Director of the Bureau of Public Health Nursing in the American Red Cross Pacific Division, covering the states of California, Nevada, and Arizona. It was an incredible move, considering she had come from a city of less than 20,000. As Miss Cole had managed the nursing for the extraordinary and foresighted programs implemented by Santa Barbara’s VNA, her qualifications put her ahead of the nurses from big cities across the country.

The personal visit by the nurse lay at the core of the Association’s service and at the core of its purpose, to educate and treat. Transportation for the nurse was not easy in the days without cars. The trolley was considered inadequate for the needs of the nurse and there was discussion of buying a bicycle for her to use in 1910. In 1912, VNA nurses were given passes for the streetcars. When a horse was rented for the nurses, Mrs. George Edwards donated a phaeton (a light four-wheeled open carriage) and Mrs. Howland Russell gave a harness.

In 1913, Major Durfee “kindly lent the association a horse for which we pay only the board.”6 Over the next several years, cars were donated to the organization for the use of the nurses. Twenty years later, during the Depression, the women were not only driving themselves, but often found they also had to drive patients to other appointments. The problem became

so serious, the local Red Cross met to take up a proposal for a Red Cross motor corps to transport sick and needy persons to the free dispensaries, which were then handled by the VNA.7 The awareness of and access to health care information that Americans take for granted today, in even the most humble of homes, simply did not exist among the majority of well-to-do citizens one hundred years ago.

The primary difference was the absence of mass communications; there were no computers, radio, or television. Telephones were primarily used for conveying short messages and exchanging information, rather than for longer, informal social conversation. Literacy was not as widespread as today. People had to be educated on the basics of health and that had to occur one-on-one in order to bring this information to people in their homes and neighborhoods.

For instance, germ theory was still not household knowledge, and people needed to be educated about the importance of washing one’s hands. There were no refrigerators; food spoiled and people who did not know better ate it. This was the era before penicillin, and infections had to be handled more seriously. Even a middle ear infection, mastoiditis, could mean death. In 1908, the average American home was less than ont thousand square feet, and about half had no hot water, flushing toilets, bathtubs, or telephones.8 Santa Barbara’s Visiting Nurses were thus the “mass media of health care” in the community. They started first with the children, to teach them good hygiene and health habits that were not common knowledge. They educated the mothers on how to keep their babies healthy – fresh air, clean surroundings and utensils, wholesome foods. They showed families how

NOTICIAS

to safeguard their health, to immunize their children, and to be proactive and to screen for potential problems. These things were not known universally and so were “broadcast” to the community by the Visiting Nurses.

Importance of the VˆA to the Medical Community The VNA started the first, non-hospital health care services in Santa Barbara, pre-dating city and county health departments and school nursing programs. The VNA was established the same year as the city’s second hospital, St. Francis, and before any health clinics.

Early ˙ealth Services and Institutions in Santa Barbara EXISTING INSTITUTIONS BEFORE VNA 1870s County General Hospital 1891 Cottage Hospital 1902 Quisisana Sanitorium 1908 St. Francis Hospital VNA PROGRAMS ESTABLISHED 1908 Visiting Nurse Association begun 1911 VNA Dispensary 1914 VNA School Nursing Program 1914 VNA Infant Welfare Station 1915 VNA Open Air School 1916 VNA Dental Clinic for students 1917 VNA Well Baby Clinic 1917 VNA Medical inspection for children at parochial schools and St. Vincent’s 1919 VNA County Nursing Program

CLINICS ESTABLISHED 1917 Potter Metabolic Clinic 1921 Santa Barbara Clinic 1924 Children’s Clinic 1928 Sansum Clinic Audrey Davis, Curator of Medical Science at the Smithsonian Institution, determined in her 1985 research on the Santa Barbara VNA that it was one of the oldest in the western U.S. and the third oldest in California.9 Demonstrating Community ˆeeds A significant function of the VNA was to demonstrate the need for certain work in the community. It would launch a program to address a public health problem, and then, when the time was appropriate, turn it over to another agency or appropriate government entity that could embrace and sustain the needed services. Some of these entities included the public schools, county health department, and Cottage Hospital.

1911 General Dispensary: Cottage Hospital took over in 1916.

1914 VNA Infant Welfare Station.

1914 School nursing: Became full department in schools 1924.

1915 Open Air School for pre-TB children: Taken over by Board of Education 1925.

1916 School Dental Clinic for children: Board of Education took over in 1928.

1917 Infant Welfare Station: In cooperation with city physician.

1917 Medical inspection for children at parochial schools, St. Vincent’s.

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1919 County nursing: Taken over by County Health in 1925.

1919 Summer Health Camp: Taken over

by Recreation Center 1930.

1920 Tuberculosis Clinic: Turned over to City Health in 1929.

1923 Cardiac Clinic: Taken over by Cottage Hospital in 1926.

1924 Posture Clinic: Taken over by city schools 1928.

1926 Well Baby Clinic started at East Side Social Center for Spanish speakers.

1926 Licensing of boarding homes for children: Taken over by County Welfare in 1933.

VNA services to the needy were primarily supported through individual philanthropy and, after 1923, the Community Chest. All other agencies

employing public heath nursing were tax-supported.

The VNA board decided that one of the first orders of business was to establish a dispensary. This was an office that dispensed medical supplies and medical aid for non- emergencies. Essentially, the VNA Dispensary was, in a very real sense, the community’s first “medi-center” or “urgent care” center—seventy-five years ahead of its time.

Mary Cole, Superintendent of Nurses, stressed the importance of creating the dispensary, which she felt was necessary to address “an illness which does not immediately threaten life, but only diminishes comfort or weakening efficiency so that the economic future of the parents of their little children is at stake.

“There are the cases in which a self-respecting but poor family does not readily

Inade uate housing was the lot or many o the NA s clients element in the Association s outreach

ducation in proper hygiene was a key

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seek medical aid from the private physician; for such cases a properly conducted dispensary could perform a great service in preventing suffering and keeping wage earners at work.”10 The Neighborhood House was willing to provide two rooms for free to the VNA, but still it was estimated that the overall expense could run as high as $245 a year.

Ultimately the idea of placing a dispensary at Neighborhood House was turned down since it did not want tuberculosis patients on the premises.

After the VNA acquired the house on Haley Street in 1910, the dispensary was opened there in 1911. In 1916, it was taken over by Cottage Hospital, and later became the outpatient clinic for General Hospital, which was the county-run facility serving medically indigent patients.

Caring During Crisis Responding to Disasters: pidemics, arth uake, Depression, and ars

by the raging waters. The VNA Annual Report indicated that the VNA nurses worked to find shelter for eleven flood victim families.

World War I The major impact of World War I on the community, besides the men reporting for duty, was the number of nurses leaving for the war to serve either through the military or through the Red Cross. In 1916, Miss Christine England, who had given five years “of most devoted service,”11 took leave from the VNA to lend her skills to the war effort when an emergency call went out for nurses to serve. There were five nurses with the VNA in 1917, of which two left to serve in the war. On the plus side, the capable Florence Johnson joined the nursing staff that year. She later became the supervising nurse and enjoyed a long career with the VNA, serving until 1942.

The Spanish Flu Epidemic

The skills of the VNA nurses and their ability to rise to the occasion in times of calamity would stand in good stead during the disasters that affected the Santa Barbara area during the course of the twentieth century. The first natural disaster was the flood of 1914, in which two lives were lost and a number of families were displaced

This virus attacked everyone similarly.

It started like any flu with sore throat, chills and fever, but ended with a deadly twist. The virus ravaged and filled its victim’s lungs with fluid so that victims literally suffocated or drowned. Complete respiratory failure could happen within hours.

What baffled health professionals was that, unlike other types of flu, which could be life-threatening only to the elderly or young children, this epidemic attacked healthy, strong adults. Men and women died, leaving their children behind. And it happened quickly. For instance, in the fall of 1918, Italian immigrant Marcellina Borgatello caught the flu while still nursing her

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infant son, Mario. She went to St. Francis Hospital and was able to recover. Several weeks later, her husband, Secundo, came home one day with a headache and cough.

By dinnertime he was also running a fever and had a sore throat. Secundo Borgatello died two days later, a week before Christmas, leaving behind five children under the age of eight.

Around October of 1918, the epidemic hit with full force in Santa Barbara. It was recommended that patients be taken to Cottage or St. Francis hospitals, but these were overcrowded. The workload of the VNA doubled as nurse visits were expanded to include Montecito, Goleta, and Carpinteria. The VNA conducted two thousand more visits than during the same period in 1917.12 The shortage of nurses due to the war increased the strain. Most patients were cared for in their own surroundings, and nursing visits were now necessarily made in half the usual time. After assessing the patient, the VNA nurses provided the families with careful instructions,

allowing the nurses to attend more serious cases. In Santa Barbara, it was not unusual to find three or four people sick in one bed.13 In general, visits for instruction in the care of communicable diseases were made after other patients were cared for, so there would not be a risk of infection. Patients in greater need received care first. The Sisters of Notre Dame, a teaching order which ran the parochial school at Our Lady of Sorrows Church, came out to help the VNA with the housekeeping problems that needed to be met in the homes where every adult in the family was stricken with the influenza.

The toll that the epidemic took may be seen in the statistics gathered by the VNA. In 1918, there were 5,947 visits, and the budget ran approximately $7,300. The 1919 statistics showed the nursing effort almost doubled: 10,844 visits were made with a budget of $14,105.

The VNA annual report in 1919 noted the effect the influenza epidemic had on the community. The City Health Officer cited

The NA entry in the Independence Day parade, American entry into sta ng di culties or the agency as nurses le t to ser e in the military

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a reverse in what had been a steady rise in the city’s birth rate: 1916–17 380 babies born 1917–18 410 babies born 1918–19 340 babies born In one year, the birth rate in Santa Barbara declined seventeen percent. Nearly every expectant mother who had been stricken with influenza lost her baby. Influenza also played a role in the nineteen babies that were stillborn or premature in 1919.14 The VNA also worked in the Red Cross canteen to cook and serve nourishing food during the epidemic because so many families had adults afflicted who were unable to tend to their family’s needs. One important outcome of the Spanish influenza epidemic was an increased respect for the visiting nurse and recognition that her value was not restricted to just the indigent.

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Earthquake Santa Barbara’s Great Earthquake was a nineteen-second tremor that hit at 6:45 in the morning of June 29, 1925. The 6.3 magnitude quake (a Richter scale estimate) caused $10,000,000 in damage, mostly through the downtown business corridor.

In private residences, damage was more often limited to broken dishes and glassware falling out of cupboards, and books and objects tossed off shelves. The houses surprisingly did not suffer much damage; the loss of chimneys seemed to be the most frequently cited complaint. Despite the size of the earthquake, there were only eleven deaths, and only twenty-nine hospital visits blamed on the quake, probably because of the early hour when most people were still in bed.

The many aftershocks kept people fearful of returning inside their homes, so a

The NA made house calls to clients li ing in temporary shelters throughout Santa Barbara in the a termath o the massi e earth uake o June

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good deal of the population was sleeping in their backyards. Electricity was out, sewer lines compromised and in some places there was no water. The Red Cross erected several tent city stations throughout the town including De La Guerra Plaza, the public library, and a number of parks, where people could go for food or to receive medical attention. The phone lines were down, so the VNA could not wait for calls to come in, but provided assistance where needed. The nurses also made themselves useful by taking charge of the food at Vera Cruz Park, the site of Red Cross Canteen #3, and fed four hundred people over five days.

Depression It was the goal of VNA to bring within the reach of every family the services of trained nurses regardless of ability to pay.

The Depression saw a marked increase in

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the number of critical cases of many elderly who had been forced for the first time to accept this aid.

After an exhausting September in 1932, the VNA reported to the community that it served the busiest month in their 24-year history: 1,244 visits had been conducted against 1,019 visits in September 1931. 582 nursing visits for a sick child had been made versus 423 in September 1930.15 There were 207 chronic case visits compared to 131 the previous year. This 60percent increase was attributed to the Depression; previously people paid their own way, but now they were calling on the VNA for charitable medical care. In response to some of these needs, the VNA planted and maintained a garden to feed those in need.

Vacation time for the VNA nurses necessarily had to be cut from one month a year to two weeks. The local Community Chest reported that nursesâ&#x20AC;&#x2122; salaries were cut

The NA sponsored a community garden to help eed those in need during the depths o the Depression in the early s

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five percent; nursing supervisorsâ&#x20AC;&#x2122; pay was cut ten percent. The nurses were also transporting needy patients to the clinics.

One of the local newspapers ran an article on the statistics presented by the nurses on their outreach and service.

Within a short time, the nurses had visited one thousand homes, in which half of the families were actually too poor to pay. The paper praised the efforts of the nurses:

daily visits was forty-one and eighty-four percent of these were non-paying cases.

The head nurse, Florence Johnson, said that much time was spent on home calls â&#x20AC;&#x153;for individuals who called for advice and aid in their family problems such as where to find work, how to secure food and clothes, how to obtain free medical care.â&#x20AC;?17

The report said that more than hal these people were chronic indigent patients hat more noble record than that er persons sad and hopelessly ill were gi en encouragement and medical attention by a corps o women who recognize neither weariness nor long hours That is news which orti es aith in humanity 16

Unlike the First World War, the Second World War affected nearly every home and involved far more people at all levels of community. The demand for nurses by the armed services caused the VNA to utilize more part-time nurses whenever and wherever needed.

One response by the VNA was the War Emergency Committee. Considered to be their most important project of 1943, it was organized by suggestion of the National Nursing Council on War Defense and func-

The number of chronic cases also increased. By 1934, the average number of

World War II

Beginning in , the NA partnered with Santa Barbara schools in a ariety o pre enti e health care programs or children ere a NA nurse pays a isit to a local classroom

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tioned through the Office of Civilian Defense for community services needed as a result of war, earthquakes, fires, or epidemics. Since the Santa Barbara VNA had plenty of proven experience in handling these crises, it was in a good position to strategically create such a response committee.

The VNA recruited twenty-four volunteers, inactive graduate nurses, who signed on for home nursing in case of disaster. Carrie Belle Spiller of the VNA along with Catherine Crea from the State Department of Public Health Nursing gave a “refresher course,” to get the volunteers up to speed on the latest techniques.

Nurses made newspapers into waste bags and into bed pads; they also sewed aprons. Other necessary equipment for nurses was assembled and put together in kits. Statistics reported for 1945: 7110 calls for 1030 patients 5027 chronically ill 57 acute 832 non-communicable diseases 84 maternity 40 well baby clinic sessions and 896 visits.18

Children’s Care 1915–1945

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The VˆA and School Programs During the early years of the VNA, there was a particular emphasis on children’s health care, and it initiated school health and lunch programs, beginning with school nursing. The strategy behind having a school nurse was not to care for a sick child, but to prevent one from becoming sick.

School nursing was started by the VNA with assistance from the St. Cecilia Society (whose purpose was and is to fund health care for those who cannot afford it), Neighborhood House, Cottage Hospital, and the Woman’s Club.

In 1914, there were some 1,600 Santa Barbara children attending the elementary and kindergarten schools, which at that time included Jefferson, Franklin, Lincoln, Mission Canyon, Washington, McKinley, and Garfield schools. This number would double within just a decade as Mexican and European immigrants—Italian, Yugoslavian, Czech, and Polish—came to Santa Barbara.

Children who were reported absent from schools could be paid a visit by the nurses. The nurses could assist parents who had neither the finances nor knowledge to provide appropriate care for their children.

In addition, tending to the children in their homes provided the nurses the opportunity to help address the health issues of the parents or other children.

For instance, some homes of the poorer families lacked the materials or facilities necessary to provide the cleanliness appropriate for school. Through the recommendations of the VNA nurses, a bathtub and heater were installed in Lincoln School in 1914. Meanwhile, in the Franklin School neighborhood, the visiting nurse alerted the City Health Officer to unsanitary condi-

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tions there, which could be ameliorated.

Through the arrangements with the Visiting Nurse Association, the school nurses who worked in the Hygienic Department were paid a monthly salary of $75.

Open Air School The real scourge in the United States was tuberculosis, which is almost just a footnote in many medical manuscripts today. At the beginning of the twentieth century, in fact, TB was the leading cause of death in the U.S. The primary medical concern of the day was to treat and to prevent it.

In 1915, the Santa Barbara VNA started the first Open Air School in California for “sub-normal and pre-tuberculosis students.” It was designed to benefit “delicate children physically unfit to keep the pace set by the graded school,” i.e.,

under-nourished, anemic, asthmatic, and TB-disposed children.19 The VNA Open Air School was supported by the Anti-Tuberculosis Society of Santa Barbara and through the sale of Christmas Seals. The school operated during the academic year and focused on hygiene, nutrition, and mid-day rest within the curriculum.

The small school of twenty-one students allowed each child to receive more mental stimulus and attention. The intent was to provide fresh air and sunshine, and to keep the children out of badly ventilated or overheated classrooms, and to increase physical activity to provide greater flexibility and strength building.

Another key curriculum component was a substantial noon-day dinner meal of healthy, wholesomely cooked foods, and a rest after lunch to restore the body. There was an emphasis on personal hygiene.

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The children made gains of six pounds to twenty-eight pounds; the average weight gain was fourteen pounds over the course of a school year.

Open Air School started on the grounds of the Neighborhood House. In 1919, it moved to a building that was formerly the Municipal Cannery, next to Associated Charities in the Arrellanes Adobe at 800 Santa Barbara Street. In 1925, the VNA’s Open Air School was taken over by the Santa Barbara Board of Education.

Dental Clinic In 1916, the VNA put its money where its mouth was, so to speak, and opened a school dental clinic. This clinic, the first dental clinic in Santa Barbara, was started by the VNA because it recognized that oral hygiene was important for overall health.

In the school programs, the VNA nurses emphasized brushing, but interestingly, tooth brushing was not a mainstream practice in the U.S. until after World War II. Mrs. George Owen Knapp gave $500 for the salary of a dentist; an anonymous donor gave $113.60 for equipment. Within the first year and a half, the Dental Clinic saw 558 patients for 2302 treatments. In the second year of operation, the salary of the dentist was paid by Montecito philanthropists George Owen Knapp and C. K. G. Billings. This agreement between the Visiting Nurses and the schools continued until June 1919, when the schools were asked to take over the Dental Clinic.20 Dr. C. M. Moore, who had

Children demonstrate what they ha e learned at the NA Dental Clinic, ca

1

done dental work for the schools, urged the schools to establish a Dental Hygienist position (and later set up the Cornelia Moore Fund as a private endowment to provide matching funds for staffing).

The Visiting Nurses loaned a dental chair and dental equipment to Lincoln School, and by 1929 the district had two dental hygienists.

This in-house health clinic program began with dental hygiene, and then blossomed into a full-fledged department by 1924 and included the hiring of Dr. Edward J. Lamb, who was hired as School Physician on a part-time basis.

Children’s ˙ealth Camp When former VNA board president Mrs. Theodore (Lucia) Porter was school nurse, she heard that two local siblings were going to be sent to San Francisco for the summer to a special school for health.

She decided Santa Barbara should have one of its own and asked the VNA for $200 to launch a camp in 1919.

The first Children’s Health Camp started out with ten children. The purpose of the camp was to build up undernourished children with healthful exercise, good food, and sleep in the open air. It was a summer continuation of the Open Air School. It

1

was felt that the camp could be a benefit to families where both parents worked, and would aid in preventing delinquency in Santa Barbara by keeping the children supervised in positive activities.

Initially the program worked with children eight to twelve years of age. Within five years the program had grown to include youngsters down to five years of age. The program enrolled approximately eighty children, with an average daily attendance of about half of that.

Because many of the parents worked, or were unable to transport the students, the children needed a way to get to camp each morning and back at the end of the day. Mrs. Edgar Stow enlisted the help of automobile owners to volunteer for six weeks to drive the children in their own automobiles. During the first year, the camp was headquartered in one of the

NOTICIAS

rental cottages owned by James L. Barker along East Boulevard (today’s Cabrillo Boulevard). Margaret Arnett, supervising nurse at the VNA, was in charge of the program.

The following year, Frederick Leadbetter donated the use of his property, which was at the end of a ravine starting at the Mesa and ending down at the beach, west of Castle Rock. A grove of pine trees formed a small forest right down to the sand. The steep walls flanking the ravine provided shelter from winds. It was a perfect summer campsite for the youngsters.

Five tents donated by the Red Cross made up the kitchen and dining room and sheltered activity rooms for the Children’s Health Camp. For naptime, the children slept on little cots purchased by the VNA, with blankets supplied by the Red Cross.21 One outgrowth of the Children’s Health Camp was the development of Sunshine Cottage. The VNA Annual Report stated that “Our great need for a preventorium was brought to the attention of the Junior League.

They immediately became interested and are busy raising funds to make such a place possible.”22 This led directly to the creation of Sunshine Cottage, a resident facility for ailing children established in 1927 by the Junior League of Santa Barbara.

The summertime Children s ealth Camp was held on property owned by Frederick eadbetter at the eastern end o Santa Barbara s Mesa neighborhood

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NOTICIAS

1 8

In 7 the NA opened the second clinic was opened in

ell Baby Clinic to address the problem o in ant mortality and illness A

could be evaluated and treated if a mother received her care early and regularly. Their slogan was â&#x20AC;&#x153;keep well babies well,â&#x20AC;? and that involved intervention and education.

The Well Baby Clinic was set up in 1917, and was considered a bulwark against communicable diseases. Milre Cox, a public health nurse, conducted the Well Baby Clinic, which saw eight to twentyeight babies a week.

A significant step was to immunize children, which began around the First World War. At six months, a baby received the immunization series, with all immunization material supplied by City Health. During the 1920s and 1930s, as new vaccinations were created, children could be immunized against diphtheria, pertussis (whooping cough), tetanus, yellow fever, smallpox, and were tested for tuberculosis.

In 1926 a second Well Baby Clinic, this one for the Spanish-speaking population, was set up at the East Side Social Center in conjunction with the Catholic Welfare Bureau. Marcelina Hualde assisted in translations. Before the second Well Baby Clinic opened, the Catholic Welfare Bureau office was used to work with new mothers, particularly those from the poor immigrant families. Due to limited space, the tops of the sewing machines in the sewing room were used as tables for examining the babies. In the second Well Baby Clinic, equipment was supplied by the East Side Social Center. Recent immigrants often were reluctant to have their babies in a hospital. Cultural constraints were sometimes a factor as were financial concerns.

Language interference also played a role.

Carrie Belle Spiller, who joined the VNA staff in 1928, worked compassion-

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ately with these families. She would often improvise bedding for the poorer families.

For one premature infant, Nurse Spiller showed the Italian immigrant family how to improvise an incubator of sorts by padding a fruit crate with cotton batting and pillows, and tucking in a hot water bottle.

The baby was so tiny, that she had to be fed with an eye dropper.25 Due in part to the educational outreach of the VNA, more babies were being born in Santa Barbara hospitals during the 1930s.

The number of babies born in Cottage and St. Francis hospitals rather than at home increased from 45% to 92% between 1930 and 1940. The VNA reported that this was an important factor in reducing maternal and infant mortality rates, as emergency services were available in the case of any birth trauma or complication.26 The City Health Department began to service the Well Baby Clinic in 1934.

1

It was under the auspices of the Catholic Welfare Bureau, and with the cooperation of Dr. C. L. Roome, the City Health officer. (Interestingly, the program was headed by Regina Moorehead, sister of the famous actress Natalie Moorehead.)

In 1940, the Well Baby Clinic at Catholic Welfare Bureau recorded 222 babies had been seen in 950 visits.

The diet that the VNA nurses recommended for the “modern baby” was adjusted according to age, and was considered flavorful and nutritious. It variously consisted of carrots, spinach, meat broth soups, string beans, and cabbage.

The mainstay of the diet was milk – but the recommendation differed according to evaluation of the baby’s needs. Sometimes the diet ordered that the milk should have no cream in it, or other times “half cream,” and other instances it was recommended that it even be diluted.

The Physiotherapy Clinic, also known as the Posture Clinic, treated a ariety o orthopedic disorders ere some children recei e attention in

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NOTICIAS

11

rehabilitation center for polio victims. It was rejected by the national organization because President Franklin D. Roosevelt preferred Georgia.

After 1954, when the vaccine Jonas Salk had developed was administered, the VNA nurses led the charge locally for families to get their children immunized.

By 1964, the number of cases reported in the U.S. was down to just 121.

Cancer was another concern. In 1948, the VNA started home care for cancer patients, with funding from the American Cancer Society.

Community Growth Material changes in the city of Santa Barbara affected the operations of the VNA. The growth of the population starting after World War II saw new housing developments in San Roque, Samarkand, the Mesa, and Goleta, and the addition of the freeway.

The bottom line was that it took longer to get around the city. More travel time between visits was needed and the nurses could no longer handle as many cases.

The service area was split into five geographic districts during the 1950s with one full-time nurse assigned to each.32 Homemaker services were added in 1963. The first VNA Homemakers made three thousand calls on some two hundred families and spent seven thousand hours shopping, cleaning, washing, ironing, sewing and cooking.

When a mother was sick or maybe caring for a newborn, or fragile seniors were not up to the task, these services were necessary to keep the home environment in order.

Care of the Elderly 1965–Present

Coming into the 1970s, as the population aged, the VNA began to focus on developing services which would meet the needs of the elderly. ˙ome ˙ealth Aides An important new component of the VNA staff, Home Health Aides (HHAs), was implemented in 1965. In three years, there were already six HHAs, along with six registered nurses. This was to be the first in several farsighted programs created by the VNA to improve the quality of life for the elderly in Santa Barbara.

The Home Health Aides were the equivalent of hospital aides who had passed qualifying tests by the Department of Health. These HHAs helped with services that the patients could not perform for themselves including bathing, dressing, grooming, checking vital signs, and helping the patient with exercises. HHAs also could help with brief light housekeeping tasks directly related to the patient such as changing a bed or fixing a quick meal. Aide services were provided under the supervision of a skilled nurse or physical therapist and with orders from a physician.

In addition to addressing the patient’s physical needs, the VNA also astutely

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recognized the tremendous boost that recovering or elderly shut-ins could receive from the interaction with these compassionate caregivers. The Home Health Aides often made it possible for elderly, convalescent, or disabled people to live in their own homes instead of in a nursing home.

The cost of a HHA was less than a registered nurse, and the need for their services was growing. To keep up with the demand, a certified HHA program was established by the VNA in conjunction with Santa Barbara City College Adult Education. In 1970, City College assumed the program and graduated thirty-four women and two men.

113

Geriatric Nursing Other, smaller steps with large impacts were undertaken by the VNA in the early 1980s in anticipation of, and response to, the increased need to care for the aged at home. VNA nurse Carmen Vandenheuvel trained as a geriatric nurse, and in 2006 a full-time Geriatric Care Management Program was added.

In 2003, Visiting Care & Companions (VCC) a sister program of the VNA, was launched in order to offer professional, non-medical care to people in their homes.

The services were designed to support people to remain independent at home by helping them recover from an illness

lder care became increasingly important in NA operations towards the end o the Archi es

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NOTICIAS

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The worst was yet to come. The decision to reject payment for terminal cases did not simply apply to current patients.

Because there had not been a clear definition of reimbursable care, Blue Cross applied it retroactively. The VNA now had to scramble to pay this debt.

The budget was cut to the bone for 1970. The $109,000 budget included $86,000 for salaries. Patient payments (full and partial) totaled $40,000. Reimbursement from Medicare was only $13,400 while Medi-Cal was $16,800. (Medi-Cal is the Medicaid program in California.) The VNA board panicked.

Just six months into 1970, the VNA had dipped into its reserves to the tune of $23,000 in order to care for 154 community patients refused assistance by Medicare. The reserve of $100,000 had been carefully nurtured for sixty years

and was earmarked for extreme emergencies.

VNA Executive Director Patricia Lach noted that at this rate the reserve fund would be exhausted by midsummer, ”Unless financial assistance is coming from somewhere, the VNA will have to give up.”36 The stress on the staff and the board was enormous.

Tompkins warned readers of the News-Press, “The VNA celebrates its 60th anniversary at El Encanto. But the party may well turn into a wake. Barring a fiscal miracle, the Visiting Nurse Association will be forced out of existence within months.” 7 The situation was not lost on the community. The News-Press devoted numerous editorials and many column inches of stories to bring attention to the VNA’s problem and highlight its plight. Thank-

This in ormation booth, set up or the Santa Barbara ome Show in ariety o ser ices the NA o ered to the Santa Barbara community

, shows at a glance the wide

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fully the Community Chest, precursor to United Way, provided $10,000 and the Santa Barbara Foundation rushed to the aid of the VNA with a grant for emergency funds.

Detaching from Medicare In 1971, because the federal Department of Health, Education, and Welfare had not clearly defined the rules and had placed an enormous burden on the communities, the VNA of Santa Barbara was forced to withdraw from Medicare. Unfortunately, Medicare policies actually forced the closure of many VNAs around the country. The VNA in Santa Barbara became de-certified from Medicare and put an end to a bad situation.

At this time, a total of 6,500 visits representing 2,225 hours were rendered to local residents needing the services of nursing, physical therapy, occupational therapy, speech therapy, and home health aides. Half of the nearly three hundred patients that the VNA had been serving were not eligible for Medicare benefits, but the VNA kept its commitment to its community.38 Santa Barbara was unique in that, despite its small size, the community rallied to support their VNA, aided by support from the Santa Barbara NewsPress Feature stories and editorials alerted and informed the community as to the importance of the VNA and what its loss would mean. Residents understood and reacted to ensure the Santa Barbara VNA would not fold.

Right at this juncture, “an angel” entered in the picture, as board president Leone Rathbone put it. Pauline Meyer became VNA Executive Director. Organized and energetic, she met problems

11

head on, researching and learning all she could to address the needs of the organization. She inspired the board to work more now as a business team than as a social group. Previously the board had held Christmas teas and luncheons and did all the baking to raise money for the budget or gifts for the poor.

The Return of Medicare Meyer and the board undertook a fullscale evaluation of the VNA’s responsibility to the community and made the uneasy decision to go back to Medicare to meet the needs of eligible patients. It was hoped that time had straightened out Medicare’s eligibility requirements and reimbursement definitions. Many on the board were very distrustful of Medicare. They worked diligently for a full year, however, and took classes to become re-licensed.

In 1974, nearly ten years after Medicare was started, the VNA extended its services to Medicare and Medi-Cal once again.

1976 Community Stats & Staff 12,235 House Calls Service fees $176, 423 Expenses $193, 870 Arthritis 863 visits Cancer 133 Cardiovascular 2475 Strokes 799 Diabetes 836 TB 56 Alcoholism 54 Broken bones 752 Neurosensory 175939

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NOTICIAS

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the Health Care Financing Administration Demonstration Project. While the VNA had been served by a medical advisory board since its initial years, they now brought on their first Medical Director, Dr. Henry Holderman to provide his expertise and guidance for the project.

David Woodsfellow, the Hospice of Santa Barbara education director, explained that there was â&#x20AC;&#x153;a considerable body of evidence to show that savings in hospital costs through hospice home care are considerable and that the illnesses that often follow grief can be prevented

The nurse isit has always been at the core o the Association s ser ice to a young mother, late s

ere a nurse pays a isit

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at, again, a considerable savings. The two-year project is to nail down how much.”41 Actually, the project only needed eight months to demonstrate the overwhelming need for hospice coverage. Because of the work of the Santa Barbara VNA along with the other selected VNAs in other states, Medicare began covering hospice care to the dying in 1983.

During the period 1984–1990, both the Visiting Nurse Association and Hospice of Santa Barbara ran separate Medicare-certified hospice programs. In 1990, they decided to join forces again, to establish Hospice Services of Santa Barbara (HSSB) as a division of VNA. HSSB was staffed, licensed, and funded

by VNA, with HSB and their Hospice Auxiliary carrying out the fundraising and community education arm of the program. Hospice funds raised were used to subsidize hospice care for the financially needy.

Although the partnership accomplished much that was positive, it also caused much confusion for the community in distinguishing between the services, the names, previous separate histories, and reimbursement policies.

After ten years, in 2001, the two organizations decided to end their Hospice Services of Santa Barbara collaboration. Hospice of Santa Barbara, Inc. returned to its roots as a stand-alone all-volunteer hospice providing counseling, education, and support services for those facing the end of life or grieving the death of a loved one. The services are free of charge; they do not provide nursing or medical assistance, and they do not deal with third-party insurers.

The VNA changed its name to Visiting Nurse and Hospice Care (VNHC)

1 1

to better represent its mission and range of services. The VNHC is state-licensed and Medicare-certified to provide a full range of services through a professional team approach. Payment is generally covered by Medicare or other health insurance, but for those who are uninsured or suffering financially, the VNA’s century-old tradition applies: no one is ever turned away for lack of ability to pay.

Vˆ˙C ˙ospice Care Program: • A team approach with specially trained professionals who help care for the patient in all the ways desired: physically, mentally, emotionally, and spiritually with a medical director, physician, nurse, and social worker as well as a chaplain, home health aide, and volunteers as needed.

• 24-hour, seven-day-a-week on-call availability of a hospice registered nurse.

• Medications to provide comfort and symptom management related to the terminal illness.

• Medical equipment and supplies.

• Home Health Aide assistance with bathing and personal care.

• Instruction to aid loved ones in caring for the patient.

• Support and practical assistance from trained hospice volunteers.

• Emotional and spiritual support for patients and their loved ones.

• Counseling and bereavement support for surviving loved ones.

• Services even to people residing in skilled nursing and assisted living facilities.

• Serenity House, a residential hospice house.

67<1+1);

ospice Residential Facility: Leigh Block ouse & Serenity ouse Although the majority of hospice patients are cared for at home, some terminally ill patients have no family caregivers while others require more care than can be provided at home, but do not want to be in a hospital. The need for around-theclock care in a peaceful, residential setting was identified as an important need in the 1990s by the VNA and HSB (operating jointly as Hospice Services). Together, they founded Leigh Block House in 1994.

This was a small six-bed, in-patient hospice facility located in a leased cottage on the grounds of the Valle Verde Retirement Community.

In 2001, when the Hospice Services collaboration ended, the name of Leigh Block House was changed to Serenity House and was operated and funded solely by the VNA. In that same year, the VNA changed its own name to Visiting Nurse & Hospice Care.

With the closures in the early 2000s of St. Francis Medical Center and the Transitional Care Unit at Cottage Hospital, the demand for Serenity House beds grew significantly; the waiting list often had up to ten or twelve patients a day. With an increase in both Santa Barbara’s aging population and the community’s desire for hospice care, it was clear to the VNHC that more beds were needed.

In 2006, the VNHC purchased property at 930 Miramonte Drive to build a new eighteen-bed facility. The former site of the Community Environmental Council provided the perfect ambience with its natural setting of gardens and trees.

This new Serenity House is scheduled for completion in 2009.

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Caring Through Transition 1975–1995

Pauline Meyer‘s administration coincided with the era of dramatic changes in the health care industry. The next two decades posed fiscal and organizational challenges to every health care provider in the nation. Some organizations could not adapt to the changes and closed.

For the Santa Barbara VNA, it meant programs needed to change: • to accommodate new government regulations, • to address the new “bottom line,“ and • to adjust to the introduction of technology.

At the same time, the VNA continued its tradition of implementing innovative

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programs, such as hospice care, and initiating new health services to meet the needs of the community.

Inside the four walls of the Haley Street building, there was an enormous sense of pride in the VNA’s mission and tremendous camaraderie among co-workers. Board president Margaret Bolduan remembered, “It was an honor to be invited to be on the board, which was very prestigious.“42 All of these strong components allowed the VNA to grow and adapt though these decades.

The Transition Begins According to many, the period of the 1970s, and into the 1980s, were the Golden Days of the VNA. It was then a “mom and pop“operation—except there were no pops! The entire organization was made up of women until the early 1980s. The VNA had a very dedicated staff and no problem with recruiting; in fact, the executive director Pauline Meyer never had to advertise to fill a position.

The field staff started every morning by having coffee together in the kitchen.

Pauline and her crew talked about patients, but also about what was going on in their own lives. They were like a family. If an employee‘s car was in the shop and Pauline was not using hers, she would loan her car to use for the day.

Then at the end of the day, all the nurses and therapists came back to the office to check in and discuss their day‘s work. It was not required but something the field staff looked forward to. Because the Executive Director was a nurse herself, she set the tone in the office, which was one of both interest and support in the staff’s work and challenges. Their informal “debriefings” at the end of the day provided

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an opportunity for advice, empathy, and a sense of balance.

In the days before government regulations, there was a lot of flexibility and informality in providing services. Most of the patients were homebound, but some patients were treated in creative places. One woman came down from her Santa Ynez ranch and had her chauffeur call the VNA to arrange a meeting place to receive her B-12 injection, which she took while still sitting in her car, before she continued on her way to the Biltmore Hotel. Sometimes she had the nurse give her the injection while in the beauty shop.

One man regularly got his B-12 injection in his favorite bar.

There was much leeway in what the field staff did for their patients. It was not uncommon for them to bring in the mail and take out the garbage. The HHAs especially would sometimes cook for the patients, shop for them, do dishes, and sometimes even do the laundry. The VNA provided care from the heart.

It was during the 1970s that the staff began to increase dramatically as Medicare required home health agencies to have other disciplines on staff.

In 1978, Enid Pritikin became the first social worker, as well as one of the most dedicated employees—she was still with the organization thirty years later.

Sheilagh Means was the first physical therapist. There was now a total of sixteen employees—a director, an assistant director, an administrative assistant, a bookkeeper, and a clerk/typist. There were five nurses, five home health aides and one half-time social worker. A physical therapist (PT), occupational therapist (OT), and speech therapist (ST) were all under contract, and four volunteers helped around the office.

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Paperwork It is hard to imagine that only thirty years ago, there were no computers, no Post-it Notes, and no photocopy machine. For statistics and billing, instead of computers, punch cards were used. The case manager would fill out the card, the bookkeeper would punch the appropriate holes, and then a spindle was used to pull out the cards with intact holes. The cards that had an extra hole punched in them fell out and would be counted.

Paperwork was minimal in those days compared to what would be required by the late 1980s and into the millennium. The initial assessment sheet was one page long.

The page was practically blank so nurses could write what they, not government agencies, felt was important. Each nurse kept the charts of her patients in her desk and took them out with her on home visits.

Other specialists wrote on half sheets that were taped onto the main chart.

Doctor‘s Orders Physicians developed the treatment plan for each patient, which was typed up on a sheet or two of paper. When Medicare entered the picture, they set additional parameters, including that every two months a patient had to be re-certified. The entire order then had to be retyped, even if the instructions stayed basically the same. In the era before computers this was a timeconsuming task. Next, the form had to be mailed back to the doctor for a signature and then returned to the VNA. Copying was done on a mimeograph or ditto machine. A master copy was mounted on a drum with ink. Copies that were produced were laid all over the office on flat surfaces to dry, with an accompanying distinctive odor filling the room,

along with the swish-crank sound of the machine as it churned out more copies.

During those years, the service area of the agency extended to Carpinteria, but visits were only made there three times a week. There was no weekend and no evening coverage. The entire agency shut down for the four days of Fiesta in August.

Telecommunication The VNA office had one telephone line with push buttons to direct calls.

From time to time, a call might come in, requesting an urgent nursing visit. Since cell phones and pagers were not commonplace until the end of the century, a nurse would have to be tracked down at one of her patients’ homes. Staff would make a calculated guess as to where a nurse would be, according to her patient visit schedule, then call the patient‘s house and ask to have the nurse call the office.

People routinely called the VNA for a variety of medical-related situations, as the VNA had a reputation of being accessible and knowledgeable. Not infrequently, an anxious caller (not a VNA patient) would tell the VNA they had no way to get to a doctor‘s appointment that afternoon. Although it was not part of their function to accommodate such requests, the VNA responded nonetheless by tapping into their network of community services. They might connect with Catholic Charities and request that one of the Sisters of Bethany pick up the patient and drive her to the doctor.

Innovation The VNA continually demonstrated its prescience in recognizing innovative services and technologies that would be of value to the community.

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During the 1980s, the United States was experiencing dramatic changes in health care. First there was the introduction of managed health care and then, coinciding with that, was the increasing shift away from hospital inpatient care. Once again, the VNA was in the forefront and brought home health services to the community, which would alleviate the expense, disruption, and discomfort of patients having to be treated in the hospital rather than at home. Ë&#x2122;ome Respiratory Care A joint program inaugurated by the Visiting Nurses with the American Lung Association allowed patients with chronic obstructive lung conditions to live more comfortably and independently. Patients

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with asthma or emphysema could reduce the number and length of hospitalizations for severe episodes. Three nurses were specifically trained for a home respiratory program in which they worked with patients on breathing, hygiene, physical conditioning, and energy conservation. Ë&#x2122;ome Phototherapy Program The VNA initiated a Home Phototherapy for jaundiced babies as a safe and effective means of treating uncomplicated neonatal jaundice. Prior to this, babies had to remain in the hospital until the jaundice was resolved. The VNA could treat the baby The N C stri es to allow clients to remain in their homes in com ort and sa ety

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with special ultraviolet lamps in the homes for a prescribed period of time to help reduce elevated bilirubin levels, which might otherwise cause brain damage in the infant. ˙ome Drug Infusion Therapy Prior to 1980, drug infusion therapy was a hospital procedure that could involve prolonged hospital stays. As an inpatient procedure this was not only very expensive, but it also prevented the individual from resuming a normal lifestyle and work activities. The VNA began a program for home drug infusion therapy, to provide patients with pain management, parental nutrition (for people who could not eat), chemotherapy, antibiotics, and other necessary drugs that had to be administered intravenously. In the comfort of home, the VNA could bring their professional services, specialized equipment and supplies to ensure safe and effective administration of the therapy.43 VˆA ˙omecare ˆursing The VNA nurse was a unique breed.

Technically, she had to have hospital nursing skills yet be comfortable working independently in the field without the immediate support of peers. The visiting nurse had to handle pumps, draw blood in the homes, or start an IV without being able to call down the hall for help or backup like in a hospital setting. She had to be highly skilled, yet genuinely like people enough to be comfortable in their homes.

She also had to maintain enough discipline to be able to set good boundaries and know when to wrap things up and move on to the next patient.

What set the VNA apart from other

nursing venues was that the clinical staff was using their skills in private homes.

The staff felt deeply that it was a privilege to be allowed to be there and to share their patient’s lives in an intimate way.

The patients confirmed that sense of trust in subtle ways—such as wanting to share family photo albums or offering a cup of tea. Patients knew the nurses were committed to caring for them as individual people.

Seeing the patient in his or her environment also gave the nurses an important perspective in understanding the whole patient and identifying other factors, which would contribute to or interfere with recovery. In that sense the VNA nurse also became a kind of patient advocate and would relate back to the physician pertinent information about issues in the patient‘s environment.

Changes By 1980, the usual Monday-throughFriday, 8 am to 4:30 pm work week was no longer feasible. Innovations brought about by the VNA such as IV Home Therapy, Hospice Care, as well as the new trend of sending patients home earlier from the hospital meant the VNA would now need to be available aroundthe-clock.

During the 1980s and into the 1990s, the number of home health agencies exploded. For the first time in eighty years, the VNA, a non-profit organization, found itself in the middle of an extremely competitive environment as for-profit home health agencies sprung up to do business with the government via Medicare.

To continue to provide services for the community, the VNA would need to be proactive. A liaison nurse was assigned to

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New head uarters at ast Canon Perdido Street allows or the centralization o sta and ser ices N C Archi es

the local medical facilities to be immediately available to receive referrals and assist with transitions to home.

Other changes occurred. Up until the 1980s, board members had been exclusively women, although there was a menâ&#x20AC;&#x2122;s advisory board, and male physicians had served on a medical advisory board. Now businessmen were asked to join the board and to address the fiscal and competitive nature of the industry.

They found their fiduciary responsibility meant taking a hard-line and belt-tightening approach. People had to share desks.

Office space was reduced. Some of the office staff and middle managers had to be let go. This was very hard to accept in this tightly knit organization.

In addition, there was a shortage of

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nurses, and the VNA had to hire per diem or traveling nurses. While they were well qualified, they were only temporary members of the VNA family.

While the agency had always cared for people, regardless of their ability to pay, changes occurred in that arena as well. In the past, patients had been simply asked to pay what they could afford. During the years of transition, however, when things were financially tight, a stricter sliding scale was applied.

These were years when the staff had the unpleasant task of requesting the patients provide detailed financial information and proof of their resources to justify what they would be paying.

These changes affected staff more than just operationally; there was a dip in morale, too. It was a difficult period in the agencyâ&#x20AC;&#x2122;s history. Yet the VNA weathered these internal disruptions, dedication intact, and entered into the twenty-first century intact.

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Tapping Into Technology Some of the exciting changes adopted by the VNA were the technological innovations that were being applied to its health care services. The technology that the VNA rolled out in clinical information systems provided greater efficiency and patient safety, as well as compliance with Medicare regulations.

Electronic Charting Small hand-held computers were introduced at the end of the century, with funding by the Santa Barbara Foundation.

The field staff, who were used to pen-andpaper charting, now had the challenge of using computers, which were awkward at first. However, these computers, which allowed the nurses to do electronic charting for patient records, reduced the need for paperwork and the concurrent illegibility.

This meant fewer errors from scribbled, handwritten notes. Most importantly, the electronic charting made it simpler to make sure the Medicare-mandated information was collected, such as OASIS data (Outcome and Assessment Information Set) which became required for all their patients.

Charts were downloaded at the end of every day to the main VNA computer.

Telemedicine Through grants provided by the Mosher and Hutton Foundations in 2006, the VNA-implemented telemedicine units that could be utilized by a number of its patients. Telemedicine technology utilizes home monitoring devices to automatically transmit information to a website accessed by the physician and the VNA. In this manner, essential vital signs could

be monitored such as blood pressure, blood pulse, glucose and oxygen levels, or weight. This is especially used for patients with hypertension, diabetes, pulmonary disease, and congestive heart failure. Parameters are set so telemedicine units alert the nurses and physicians before a serious problem develops that might necessitate hospitalization.

The Computerized ˙ealth Care Office Office operations were streamlined as billing, mailings, record keeping, collating, and budgeting is now all done on computer.

Every single agency employee now has a computer on his or her desk, and the entire field staff utilizes laptops. ˙ouse, ˙ome, & ˙eadquarters It was during this era (1975-1990) that the VNA was clearly outgrowing their landmark red house on the corner of Haley and Santa Barbara streets. In 1975, the building was remodeled and incorporated an annex, but it was soon stretched beyond capacity. It was difficult to leave the little building filled with history, which had been the physical and spiritual heart and home of the VNA for seventy-three years.

In 1983, the VNA found a roomier building at 401 North Milpas Street, and leased it to save money to eventually buy a building.

In 1990, the VNA bought and moved to 614 Santa Barbara Street, just a block up from the Haley Street red house.

The ink was hardly dry on the deed, when the opportunity for a more ideal facility opened just four more blocks up the street and around the corner on East Canon Perdido Street. The board wisely

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pursued this option in anticipation of future growth.

Embarking on their first formal capital campaign, board members, led by Judy Brown and fundraising consultant Debbie Arnesen, raised an astonishing $2.5 million from the community to purchase and renovate this new administrative headquarters at 222 East Canon Perdido. The large downtown building enabled all the VNA services and staff to be housed in one central, downtown location and continues today as the landmark home for Visiting Nurse & Hospice Care.

Ë&#x2122;ow the Community Cares At its inception, the Visiting Nurse Association was subsidized by board members to make community nursing a reality. Over the decades, however, support also came through special fundraising events, donations of materials and assets by community organizations and individuals, underwriting by other community agencies, and reimbursement through government and insurance programs.

For decades the NA helped distribute presents and gi t baskets to the needy at Christmas

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Special Events During the first year of operation, all expenses were met by the generous board members and their friends. At the May 6, 1909 first semi-annual meeting at as Acacias, the Montecito home of Anna Calef, a report was given by treasurer Clara Gould.

The donations, collected since their initial meeting in November of 1908, totaled $875 (about $35,000 by 2007 standards) to fund their grass roots community health initiative.

The ladies of the VNA board also began to hold membership teas (annual dues were two dollars) and other special events to raise funds and garner interest from other women in the community to support the VNA. A Charity Ball was initiated in the winter of 1910. The first year it netted several hundred dollars. A huge Christmas Dance was held the following year on December 29, 1911, at the Arlington Hotel. Steering committee members consisted of Miss Sadie Palache, Miss Fannie Bigelow, Miss Josefina de la Guerra, sisters-in-law Anna Edwards and Ruth Edwards, Lucy Porter,

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Betty White, Mrs. John Driver, and Mrs. George Trenwith, wife of the prominent retailer. The charity ball brought in $462, which would almost cover a half-year salary for a nurse at that time.

One of the founding board members, Mrs. White, was the wife of America’s most celebrated writer. Stewart Edward White wrote much on worldwide travel, adventure and history and brought to life the first definitive and widely acclaimed account of the northern Serengeti. A conservationist, naturalist, and hunter, he had a great friend in like-minded Theodore Roosevelt. As an African explorer, who was one of the first to map Tanzania, White had collected and mounted a number of the animals he had successfully hunted.

So the feature of the October 1912 tea was the rare opportunity to view these many and unusual hunting trophies from his African collection.

The house was set among an entrancing and lushly landscaped garden of bamboo and tropical plants, terraced lawns, winding paths, streams, and nooks. The home included a museum purposely added to house the author’s exotic specimen collection, which included an owl, a lion, and a nearly full-scale giraffe.

The event was an enormous success —over five hundred people turned out, nearly five percent of the community’s population—to visit the home at the corner of Santa Barbara and Los Olivos streets.

The town folk paid twenty-five cents per adult and ten cents per child to see the fabled treasures of the celebrated author.

Mrs. Isabel Strong, the stepdaughter of Robert Louis Stevenson, assisted the Whites with this Garden Tea, which netted $350 for the VNA.

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An Early “Pageant of The Masters” The most publicized benefit in the summer of 1914 was the ”living pictures” program presented by the “girls of the sub-debutante circle, who, touched by the sufferings and sorrows of those less fortunate than themselves decided to give the benefit, the proceeds to be devoted to the VNA.”44 Decades before the Laguna Beach Pageant of the Masters, Santa Barbara presented this artistic event created by sisters Ruth and Rosamond Codman and Olivia Long. Spectacular costumes and styling brought portraits of the masters to life.

Margaret Trimble (niece of Louis Jones) posed as Sargeant’s “La Carmenita,” Genevieve Tallant portrayed “Little Infanta of Spain” by Velázquez. Ruth Hoyt gave the audience Gainsborough’s “A Morning Walk,” while Louise Redding was fashionable as “Aurora.”

A Girls Auxiliary was created in 1915. Miss Mary Gallaher of Montecito was chairman, and others who served with her were from notable families of the community: Mrs. John Barrymore (wife of the actor), Isadora Dreyfus (daughter of prominent realtor Louis Dreyfus), Miss Miriam Vail, Dorothy Edwards, Norma Burley, and Camilla Waterman. The Girls Auxiliary board met once a month to make dressings and roll bandages.

Most curious, a society of Montecito children, with the mysterious name of The Oboedire Tacite Cupimus Club sent $225, proceeds from a garden party. A very loose translation of the club’s name from the Latin suggests a mother with a sense of humor may have entitled the club, “We Desire to Listen Quietly.”

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An Annual Christmas Tea continued as a tradition well into the 1980s. On the first Friday in December, the board had Christmas teas to honor the staff.

These teas either took place at the office or sometimes at the home of one of the board members. Donors were also invited as well as prominent community members. Silver tea service was used, and the board did all the baking.

Up through the 1970’s, nothing was done in the way of formal fundraising.

The prestige of the organization regularly brought in gifts, annual funding from United Way, and occasionally a special grant from the Santa Barbara Foundation. Board members personally wrote thank-you notes for all donations.

The Santa Barbara News-Press Christmas Fund was or years the primary nancial support o the NA s oan Closet which allowed people to borrow a ariety o medical e uipment on a temporary basis N C Archi es

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Sporting Events Sporting-related events have also been used for fundraising and fun. As early as 1919, the Annual Horse Show in the spring raised $250 for the VNA. It was held down at the waterfront on West Beach at the Belvedere, the former Potter Hotel.

In 1987, an “Ascot Races” theme brought out guys in grey top hats and gals in Gibson Girl attire at the Santa Barbara Polo Club to watch the “sport of kings.”

In 2005 the Santa Barbara Yacht Club sponsored a regatta to benefit the VNHC (Visiting Nurse & Hospice Care). Staff commodores served as chairman and committee members of the first Charity Regatta, which netted $50,000. Within two years, the regatta proceeds had increased sixty percent, to provide $80,000 in funding support for the hospice programs at Serenity House.

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In-Kind Donations During the earliest months of operation, the eight founding members of the VNA not only provided the funds to get the program started, they also bought or procured practical items and equipment.

One matron volunteered to bring sheets and pillowcases; another said she would get nightgowns and water bags. Other supplies gathered included old muslin, a rubber ring, and alcohol.

During the VNA’s first decade of operation, citizens and civic groups donated many in-kind services and goods to benefit the nurses. Major Durfee donated the use of a horse in 1912, while the Morrison Stable agreed to keep any horses at a nominal fee.

Mrs. Clinton B. Hale donated a carriage.

Later three Ford automobiles were donated. The first Ford was purchased in 1915 by Montecito donors, with the provision that the nurses would establish a branch in Montecito. The VNA then founded a branch at the Montecito Home Club. The Mariposa Knitting Club donated the VNA’s second Ford, and Captain Pryce Mitchell provided space in his garage for the VNA cars.

A contribution was collected from the Sunday school class of Mrs. George Weld, whose husband was pastor at AllSaints-By-the-Sea Episcopal Church in Montecito. Dr. Anna McCaughey and Miss Margaret Baylor gave gifts of dolls, toys, fruits, and candy for a Christmas tree for needy children.

The Santa Barbara Garden Club donated plants, seeds, garden tools, and other items to establish gardens for needy families. For at least thirty years, the Club also made the Christmas baskets that the nurses distributed to families in need – a forerunner of the Council of Christmas

Cheer/Christmas Unity. The St. Cecilia Society provided linens for the nurses’ rooms, and continually came forward with cash contributions for specific needs. The Needlework Guild fashioned clothing and household linens.

Selling Red Cross Seals at Christmas to affix on holiday cards was an annual fundraiser. This Red Cross Seal Fund covered the tuition cost for needy pre-TB children attending the Open Air School—ten cents a day.

For special needs, philanthropists generously provided the underwriting. During the Depression, Mrs. Max Fleischmann and others offered to meet the expense of an extra nurse needed through those difficult times.

Even a half-century later, local organizations did their part to contribute in meaningful ways to help the VNA in its efforts. In the 1960s, the Marguerite and Vallecito chapters of the Order of the Eastern Star made dressings for the cancer patients served by the VNA. Santa Barbara News-Press Christmas Fund

In 1948, Thomas M. Storke, the publisher and editor of the Santa Barbara News-Press, broke his leg. In order to get around, he needed a wheelchair and was dumbfounded to learn what it cost to rent one. He wondered how the average person, or families with limited means, could ever afford such a necessary expense. Storke determined to do something about it.

He started a charitable fund the proceeds of which would go to buy and stock a Loan Closet for the VNA. This would include crutches, braces, wheelchairs, walkers, hospital beds, commode chairs, exercisers, stretchers, bed trays, and other hospital equipment needed for limited times.

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The News-Press Christmas Fund solicited contributions from the public during the holiday season, and acknowledged them daily on its front page. Residents made donations to honor friends or community leaders who had passed on.

Even the smallest of checks was gratefully received, and often gratefully submitted, as they arrived with handwritten notes praising the services provided by the VNA in caring for their relatives. At the conclusion of the drive, Storke would load up a News-Press delivery van with the equipment and have them delivered to all the in-need patients on the VNA Loan Closet list.

Originally the Loan Closet was located in the carriage shed of the Haley Street headquarters. The carriage house had been the space for the horse and buggy, which was used to make home visits by the first visiting nurses so many years before.

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The Loan Closet was truly an informal asset created for the convenience of the community. People freely borrowed and also passed on equipment they no longer needed. In this informal arrangement, patients might forget to return items, or mistakenly believe they already owned the item. So, board members made calls once a month for borrowed items and sometimes resorted to hiring help to go throughout the town picking up equipment to ensure its return.

The News-Press Christmas Fund was an enormous success and popular tradition, which continued to support the Loan Closet for more than half a century, until the newspaper was sold in 2000. By that time the Loan Closet, staffed for over twenty-five years by Barbie Free, had become a community institution serving over two thousand local residents annually, and it continues to be underwritten by community gifts and grants.

ne-on-one care remains a key element o the N C ser ice to the community

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Agency Funding As early as 1912, contracts were negotiated with insurance companies. Metropolitan Life Insurance Company was the first to provide care coverage to their policyholders on a fee basis. After World War II, the Veterans Administration contracted with the VNA, and in the 1970s the VNA became a licensed Medicare provider.

In 1923, after two years of board debate, the VNA decided to become a recipient member of the Community Chest, the forerunner of the United Way. The Community Chest paid for those unable to pay or who could only make partial payments. The Community Chest helped pay for the Children’s Health Camp during the 1920s. In the 1970s, United Way (formerly known as the Community Chest) provided significant funding to help the VNA stay open during the Medicare crisis.

The Community Chest/United Way was the greatest single source of regular financial assistance to the VNA throughout the century.

During the 1930s and 1940s, the American Cancer Society paid for the care of the VNA’s cancer patients in their homes. During the 1960s, the Santa Barbara County Health Association gave the VNA grants to underwrite a month-long rehabilitation training session.

The Santa Barbara Foundation has been a significant player throughout the century.

Over the years, they have provided funding for infrastructure—new roof, building expansions, and other capital needs. They made possible the new technology, such as the hand-held computers for clinicians and they provided a start-up gift of $225,000 for the New Serenity House.

The Santa Barbara Foundation also provided an emergency grant during the

height of the Medicare crisis. Then, in 1976, still feeling the aftershocks from their previous financial disaster with Medicare, the VNA board was provided a financial reprieve. The survival of their agency was assured by a generous $25,000 gift from the Santa Barbara Foundation. Its president, Harold W. Beard, personally investigated their plight and reported back to the Foundation board which concurred the VNA was a very worthwhile agency, and “too necessary to Santa Barbara to allow it to founder for lack of funds.”45 Auxiliary An Auxiliary was started by Kay Loustalot, Anne Friedell, Leona Rathbone, Margaret Bolduan, and Johnnie Owens in 1985. They had a coffee at Eloise Weller’s house, with each woman inviting former board members and friends to participate.

Since the VNA was starting to get more business oriented, the idea was that the Auxiliary would do fundraising and help in the office. They also wanted to relieve the board members of duties like baking brownies.

The Auxiliary focused on volunteer services and fundraising through practical activities. To raise money they sponsored garden tours and sold poinsettias, and hosted benefit theatre performances at Santa Barbara City College. An invaluable but necessarily chore was writing thank-you notes to acknowledge donations. The Auxiliary was also useful in filing, putting charts and nurses’ bags together, and helping with parties. They also prepared the 20,000 yearly ”Friends of VNA” newsletters for mailing by folding, labeling, and—the bane of every non-profit mass mailing of the time—sorting by zip code. Within just two years, the Auxiliary

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had expanded to thirty members and five associates, and was contributing over one thousand hours of service annually.

As the end of the century approached, the Auxiliary became less active. As the VNA became more automated, less help was needed in the office. Professional mail house companies could handle the mailings more efficiently. With the hiring of a fulltime professional development officer in 1994, the Auxiliary had decreased fundraising duties. By the end of the decade, the Auxiliaryâ&#x20AC;&#x2122;s only fundraising function was selling poinsettias at Christmas.

At the annual meeting in 2001, Jim Rivera, VNA President and CEO, did a special recognition of the Auxiliary members to acknowledge their rich history of contributions to the VNA. Later that year, the remaining members decided to cease their operations as a group organization.

After closing their books, they used their last dollars to purchase a medical supply cabinet for Serenity House. Several longtime Auxiliary members continued to perform volunteer administrative tasks, such as preparing patient admission packets.

er the years the N C has partnered with any number o public and pri ate agencies For e ample, by the s the ell Baby Clinic in ol ed both City ealth and the Catholic el are Bureau

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The New Foundation Community philanthropy had been the sustaining force of the VNA throughout its history, enabling it to meet the needs of the poor and to weather the ups and downs of Medicare and insurance reimbursements.

In early 1994, the board of directors decided to form the Santa Barbara Visiting Nurse Association Foundation as a separate supporting organization to provide greater stewardship with professional fundraising. Debbie Arnesen was the first director of development, Petra Retamoza served as development assistant, with agency president Jim Rivera doubling as the foundationâ&#x20AC;&#x2122;s executive director. They developed the organization into a professional fundraising operation, computerizing the donor database previously kept on index cards, creating a Chairmanâ&#x20AC;&#x2122;s Council to recognize high level donors, and initiating the Samaritan Society, a planned giving program.

At the millennium, a number of institutional firsts and a series of financial

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achievements provided stability and a sense of security to ensure the future of the nearly century-old institution.

In 2001, the first full-time executive director for the Foundation was hired, and fundraising was increased significantly over the ensuing years. A signature new event was launched in 2002—a Mother’s Day Luncheon to honor and remember mothers. It began modestly but quickly became so popular that it was raising over $200,000 per year by 2006. The luncheon honored as Mother of the Year many of Santa Barbara’s leading citizens, including Leslie Ridley-Tree, Anne Douglas, Anne Smith Towbes, and Irma Jurkowitz.

With the volunteer leadership of board member Jane Habermann, a campaign to raise $500,000 to subsidize care for Serenity House patients was started in 2002.

This was followed in 2006-2007 by a capital campaign to fund the New Serenity House, co-chaired by Jane and Dr. Roger Dunham. Over $7 million was raised for design and construction of the new hospice residential facility, supplemented by endowment reserves to total $12 million for the project.

Campaign gifts included the organization’s first $1 million gift, which was received from Cliff and Juliette Sponsel.

This was followed shortly thereafter by an extraordinary and unexpected $32 million bequest from H. Guy Di Stefano to establish a long-term operating endowment for this ninety-nine-year-old non-profit, thus helping to secure its next one hundred years of service to Santa Barbara.

Entering the Second Century of Caring As VNHC celebrates their one-hundredth year, it provides care to over five

thousand community members through a variety of programs: Over 1,500 ome Care patients now have access to telemedicine, infusion services, rehabilitation therapies, wound care, and other services which allow patients to recover at home. ospice Care will provide more than 750 patients with expert pain management, along with psychological, and spiritual support to complete their life’s journey with dignity and peace. The new Serenity ouse, to be completed in 2009, will triple the capacity of care for those unable to receive hospice services at home. isiting Care and Companions assists over four hundred clients in remaining independent at home while eriatric Care Management will provide one thousand hours of service oversight to the elderly.

Personal bath care and caregiver respite for low-income frail seniors is underwritten by the VNHC Foundation.

Over two thousand residents use the popular oan Closet as the community resource offering free use of crutches, wheelchairs and other medical/assistive equipment. The VNHC continues to educate the community about care-giving, elder care, health and wellness issues.

From a small rented room with one nurse and a horse and buggy, Visiting Nurse & Hospice Care has grown to a healthcare provider with a professional staff of 150, revenues of $12 million annually, and over $50 million in assets.

Continuing a century-long tradition of never turning anyone away for lack of ability to pay, the VNHC provides over $1 million in charitable services each year to the sick, the frail elderly, and the terminally ill, through community contributions.

The one-hundred-year-old organization is not only Medicare-certified, but nation-

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ally accredited at the highest level possible for home care agencies. More than eighty percent of its revenue now comes from Medicare, and its staff is highly skilled in successful patient documentation and insurance billing.

Visiting Nurse & Hospice Care enters its second century as a financially strong and strategically managed non-profit agency, committed to meeting the future health challenges of its community by serving with innovation and compassionate care.

For one hundred years the Visiting Nurses have been at the forefront of innovative health services bringing compassionate care to the Santa Barbara community.

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Walker Tompkins aptly summed up the work of the VNA at their sixtieth anniversary. While technology has changed and staffing now includes both men and women, his underlying sentiments remain true nearly forty years later: Nurses ha e gone into mansions and ho els, alike to administer shots, change bandages, gi e alcohol rubs, make beds, order groceries, write letters the whole gamut o humanitarianism Three generations o the elderly and needy in Santa Barbara, oleta, Summerland, and Montecito ha e bene ted rom the care o these dedicated women 46 And so the tradition continuesâ&#x20AC;Ś.

ne hundred years o caring and compassion

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ˆotes

1 The Independent (Santa Barbara), 29 October 1908.

2 Minutes, VNA, 8 December 1908.

3 Annual Report, VNA, 1913–14.

4 Minutes, VNA, 8 December 1908.

5 Ibid.

6 Annual Report, VNA, 1912–1913.

7 Santa Barbara News-Press, 14 December 1933.

8 This description of the American home was compiled from the following: Claude S. Fischer, “Gender and the Residential Telephone, 1890-1940,” Sociological Forum 3 (1988): 211–233; Adam D. Thierer, “Unnatural Monopoly: Critical Moments In the Development of the Bell System Monopoly,” The Cato Journal 14 (1994); “Lisa’s Nostalgia Café, At Home 1910s and 1920s,” at www.angelfire.com/retro2/lisa/ 10s.html, accessed 15 January 2008.

9 Virginia Cochrane, “Expert Finds Santa Barbara VNA May Be ‘Best Kept Secret,’” Press Release, VNA, 26 March 1986.

10 Annual Report, VNA, 1915–1916.

11 Annual Report, VNA, 1916–1917.

12 Annual Report, VNA, 1918.

13 Annual Report, VNA, 1914–1915.

14 Annual Report, VNA, 1919.

15 “Visiting Nurses Busiest in Santa Barbara,” (handwritten date 1932), Scrapbook 1935– 1951 in VNA Collection, Gledhill Library, Santa Barbara Historical Museum.

16 Scrapbook 1935–1951 in VNA Collection, Gledhill Library, Santa Barbara Historical Museum.

17 Ibid.

18 Ibid.

19 Ibid.

20 Annual Report, VNA, 1916–1917.

21 Annual Report, VNA, 1919, 1922, 1925.

22 Annual Report, VNA, 1925.

23 President William Howard Taft address to the American Association for the Study and Prevention of Infant Mortality, 9 November 1910. In Lina Gutherz Straus, Disease in Milk: The Remedy Pasteurization, (New York: E. P. Dutton and Company, 1917), 29.

24 “Santa Barbara Infantile Death Rates,” Santa Barbara News-Press, (handwritten date 1941), Scrapbook 1935-1951 in VNA Collection, Gledhill Library, Santa Barbara Historical Museum.

25 Santa Barbara News-Press, 3 June 1973.

26 “Five Year Low,” Santa Barbara News-

NOTICIAS

Press, (handwritten date 1940), Scrapbook 1935–1951 in VNA Collection, Gledhill Library, Santa Barbara Historical Museum.

27 Santa Barbara News-Press (handwritten date 1939), Scrapbook 1935–1951 in VNA Collection.

28 Santa Barbara News-Press (handwritten date 1940), Scrapbook 1935–1951 in VNA Collection.

29 “Visiting Nurse Bedside Care Service Ending,” Santa Barbara News-Press, (handwritten date 1954), Scrapbook 1951–1959 in VNA Collection, Gledhill Library, Santa Barbara Historical Museum.

30 Santa Barbara News-Press, 8 March 1955.

31 Santa Barbara News-Press, n.d., Scrapbook 1935–1951 in VNA Collection.

32 Santa Barbara News-Press, 7 September 1956.

33 Santa Barbara News-Press, 22 October 1969.

34 Santa Barbara News-Press, 22 February 1970.

35 Santa Barbara News-Press, 22 October 1969.

36 Santa Barbara News-Press, 22 February 1970.

37 Ibid.

Walker Tompkins, “Visiting Nurses Are Happy About Their New Status,”Santa Barbara News-Press, (handwritten date February 1971), Scrapbook “VNA” in VNA Collection, Gledhill Library, Santa Barbara Historical Museum.

39 Santa Barbara News-Press, 26 March 1976.

40 Santa Barbara News-Press, 18 November 1982.

41 Santa Barbara News-Press, 19 December 1979.

42 Margaret Bolduan. Interviewed by Enid Pritikin, 29 November 2000. Pritikin conducted a number of “centennial interviews” with older VNA staff and board members in 2000 and 2001 to record some of their memories.

43 Enid Pritikin, Sally Hall, Katina Etsell, interview with author, 21 December 2007.

44 Santa Barbara News-Press, 26 February 1978.

45 “Visiting Nurses Are Assured of Survival by $25,000 Gift,” Santa Barbara NewsPress, n.d., Scrapbook “VNA” in VNA Collection, Gledhill Library, Santa Barbara Historical Museum.

46 Santa Barbara News-Press , 22 February 1970.

Santa Barbara Historical Museum Board of Trustees wishes to acknowledge the generous support of the following major contributors for making these 75th anniversary events possible:

Diamond Jubilee Gala Stefani Taliaferro, Chairman

Remember the Magic Holiday Party 2007

Tiffany & Co.

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