The VNA Today
A leader in visiting care for over 100 years.
Home nursing or private duty nursing in the home was conceived in 1865 in Liverpool, England when a wealthy English gentleman hired a nurse to care for his ill wife in their home. Locally, the Provident Association of St. Louis organized the area’s first nursing committee to care for “the indigent sick” in their home in 1895. Only ten years earlier, the first two public health nursing agencies in America had been started in New York City and Philadelphia.
Provident’s visiting nurses preferred horse and buggy to streetcar services in the late 1800s, finding it to be a more efficient mode of transportation in accessing homebound patients. Stories are told that the visiting nurse often would arrive at a patient’s home with clean linens, sheets, gowns and possibly a wash basin, and would have along a small white dog for guarding the buggy’s contents while she was in the patient’s home.
As the needs for home health care increased and treatment became increasingly sophisticated, Provident Association decided that a separate organization should be created to meet St. Louis’s home nursing needs. Provident Association’s vision and support resulted in Visiting Nurse Association being officially organized as an independent not-for-profit home health care agency on January 6, 1911.
The First Visiting Nurse Association annual report in 1912 summarized that in its initial year of operation: baby welfare work comprised a substantial amount of the organization’s business; a tuberculosis nurse and a social service nurse, both graduates of the St. Louis School of Social Economy, were hired; and arrangements had successfully been made with Metropolitan Life Insurance Company to pay 50 cents a visit for services to industrial policy holders.
In 1912, a Visiting Nurse Association branch in East St. Louis, Illinois was started. The branch operated until 1913, resumed again in 1915, and was closed a final time in 1917. Finances were a burden for the board in 1912. When the organization’s superintendent could not meet payroll, she approached the board president regarding the fiscal situation and was granted a check for $87.33 to cover staff and office expenses.
During World War I, a general nurse shortage led the Visiting Nurse Association board of directors to adopt a policy restricting visits to only those patients within six blocks of a streetcar line. This restriction was lifted in 1923.
In 1918, Visiting Nurse Association arranged affiliations with St. Luke’s, Barnes and Jewish hospitals’ schools of nursing. The affiliation provided the hospitals’ nursing students an opportunity to participate in the organization’s patient care programs. Visiting Nurse Association also became a charter member of St. Louis Community Chest of what has since evolved to the United Way of Greater St. Louis.
The organization began a 20-year relationship with Washington University and St. Louis University’s Medical Schools in 1921, as the schools opened outpatient services. The schools hired Visiting Nurse Association to provide home nursing services.
During the 1920s, the St. Louis Medical Society offered a special committee to act as advisors to Visiting Nurse Association, a forerunner of the Patient Care Services Committee that serves the
organization today. The organization added services for maternity cases and crippled children, the first educational supervisor was hired, and the organization purchased its first automobiles.
Visiting Nurse Association’s caseload of child-related and maternity cases in the 1930s dropped from 70 percent to approximately 50 percent. During this time, medical-surgical cases, chronic illnesses, and disabled adults and children began to rise, creating new home health needs.
Throughout the 1940s, the organization experienced continued growth -- a time when the board of directors made the decision to cease offering services on Sundays and holidays, except in emergencies.
By the 1950s, Visiting Nurse Association was beginning to offer comprehensive care in the home. The organization also hired its first licensed practical nurses and its first male nurse.
Visiting Nurse Association identified a pattern to its referrals with the introduction of skilled nursing services and therapy services for acutely ill patients in the 1960s. This observation led to the organization instituting a coordinator program in 1962 to encourage early referral of patients for home nursing. Full-time instructors and trainers were hired in the mid-60s, establishing Visiting Nurse Association as an educational force in the local health care community -- a position it has continued to maintain.
The introduction of Medicare and Medicaid in 1966 created a variety of new medical and professional opportunities for home health -- the following year, Visiting Nurse Association hired a speech pathologist, social worker, physical therapist, nutritionist and 50 home health aides.
Visiting Nurse Association expanded its geographic service area to include St. Charles County (1966) and Jefferson County (1972). The organization also opened a branch office in Festus in 1975 and a district office in north St. Louis County. The decentralization of the organization was in response to increasing demands for the organization to bring its services closer to its patients.
In 1978, St. Louis Blue Cross began providing home care benefits for its basic plan subscribers. The benefits would provide the same post-hospital services that Medicare provided and opened the possibility for receiving home care to thousands of individuals and their families.
Visiting Nurse Association has been proactive throughout the 80s and 90s in diversifying to meet the St. Louis metropolitan areas’ home health care needs. This progressiveness has resulted in the organization successfully entering new markets and providing an expanded range of services to new patients.
In May 1998, a decision was made by the Board of Directors to discontinue its home health program due to severe cutbacks in funding. Visiting Nurse Association’s Hospice, Case Management, and Community Services programs continued.
Visiting Nurse Association continued to maintain its three programs in the 2000’s. The influenza program gave over 57,000 shots in 2001 (included retail sites) and 46,000 in 2005 when the retail business no longer became viable. Community Services’ travel and preventative vaccination programs continued to grow in 2006. Visiting Nurse Association had become a leader in the travel vaccination programs amongst its peers within the Visiting Nurse Association of Americas.
Case Management Consultants continued to work with self-funded employer groups providing, case management, disease management and predictive modeling services.
In December 2005, Susan Pettit retired after 18 years as CEO. Beverly White, RN, the former Director of Hospice and Case Management Consultants was appointed to the position.
In 2007, a Wellness Program was developed out of demand from employer groups as a means to reduce their medical expenses. This program was managed by the Case Management Consultants division.
A major advertising campaign was implemented in 2008 for the purpose of creating awareness and branding of the VNA name. A new logo was developed at this time.
In 2008, Hospice implemented its first Electronic Medical Record system.
In December 2009, VNA moved to a new location at 11440 Olive Blvd. in Creve Coeur. The new location afforded more space, higher visibility and easy access.
The H1N1 pandemic threat occurred in late 2009 and into early 2010. Visiting Nurse Association was asked to participate as mass immunizers for the city and county health departments. Visiting Nurse Association was commended by the CDC for its efforts in vaccinating children in the St. Louis Public School System. Over 11,000 shots were given to the community.
In August 2010, the organization was restructured, and the legacy name, Visiting Nurse Association of Greater St. Louis, was restored.
January 2011, Visiting Nurse Association celebrated its 100th Anniversary with a gala held at the Starlight Ballroom of the Chase Park Plaza Hotel. Ironically, this was the same location where the 50th Anniversary was celebrated. This was a celebration of the past 100 years while looking forward to the next 100 years.
At the end of 2011, Beverly White, RN retired as CEO. At that time, Board member, Keith Steinhoff, stepped in to serve as the interim CEO until a new CEO could be found. In May 2012, Judy Alexander-Weber was hired and took the reins of leadership of VNA.
In December 2012, VNA closed Case Management Consultants.
April 2013 Visiting Nurse Association Hospice Care and Visiting Nurse Association Community Services were merged into Visiting Nurse Association of Greater St. Louis.
Early in 2013 Judy Alexander-Weber decided to step down from her leadership role due to health reasons, which led the Board of Directors to search for a new leader of VNA. Nesa Joseph, EdD, MHA was selected as President and CEO in August 2013. His strong background in health administration and relationships with physicians in the St. Louis area was the complement to the new strategic direction of the organization.
February 2014 VNA hires, Mary Fox, MD as its Chief Medical Officer.
In March of 2016 VNA held two community Ad-Hoc Committees. The topic was to address VNA’s idea regarding the needs for palliative care in an individual’s home in Greater St. Louis area. Stakeholders in the community that were part of the committee included physicians, nurse practitioners, the health department, senior service providers, IDD providers, nursing home administrators, healthcare educators, etc. The meetings affirmed VNA’s idea that the service of assisting those in their homes that have advanced illnesses was a need in the community that was not being addressed. The reason for the need is because there was no payment structure for providing these services. Hospital systems have palliative care programs in the hospital but none that went to an individual’s home.
In its history VNA has always chosen the path to find the health care need in its community and determine how it can be addressed and how can VNA serve the community in that area.
VNA’s Board of Directors made the decision to go forward in serving this need. As a result, the home-based palliative care program called, Advanced Illness Management Program (AIM), began in July of 2016. Dr. Mary Fox becomes the Clinical Physician for the program and Deborah Jeffery, NP-C was chosen as the Director of AIM to develop the program.
A grant application was submitted to the Missouri Foundation for Health (MFH). The MFH bestowed a large grant to VNA over 3 years in December of 2016 to support this innovative AIM program.
On September 1, 2016 VNA Care At Home, LLC was created to provide private duty services.
On June 20, 2017 VNA moved from its location at, 11440 Olive Blvd. in Creve Coeur, Missouri to 2029 Woodland Parkway in Maryland Heights, Missouri.
In July of 2018, VNA began a new program called Visit-A-Bit. This program was developed to address senior loneliness in our community. It pairs a senior citizen with a volunteer. The volunteer visits or telephones the senior each week. VNA developed a website: www.visitabit.org to assist the volunteers and provide resources for seniors.
In January 2020, COVID-19 appears in China. The World Health Organization declares the novel coronavirus outbreak a global pandemic. VNA implements procedures to continue to care for its Hospice and AIM patients as well as to continue Visit-A-Bit and Vaccination and Wellness Services.
In March of 2020, VNA introduced a telemedicine component, available for Hospice and AIM patients. Telemedicine allowed virtual visits with patients, which became critically necessary with the COVID-19 Pandemic. Access to nursing homes became extremely limited and access to patients’ homes, was challenging at times. Telemedicine offered a way to virtually visit patients and make assessments.
In July of 2020 VNA bade farewell to Dr. Saira Asadullah as Medical Director for VNA Hospice Care. Dr. Asadullah had been the Medical Director for 10 years. Dr. Zinnat Meghjee was recruited to replace Dr. Asadullah as the new Hospice Medical Director.
At the October 2020 Board meeting, Dr. Nesa Joseph began his President’s Report with information on Mrs. John Haskell, who was President of VNA from 1918-1953. He stated he had been searching for her first name for the past seven years. He stated he was able to find the following information on Mrs. Haskell.
• The dynamic leader of VNA for several decades...from
the end of World War I to the end of the Korean War!
• One of the seven community leaders instrumental in
starting the St. Louis Community Chest in 1923 which
later became the United Way of Greater St. Louis.
• Relentlessly followed her conviction, “Nursing Service - in
the home for ALL”.
• Mrs. John A. Haskell is the former Ruth Hanna (1879-
1953), who lived at 12 Washington Terrace in St. Louis at
the time of her death.
• She had a heart attack while visiting her son, Norman A.
Haskell in Cambridge, MA. He was on the faculty of MIT and was a research geophysicist for the Air Force.
• Mrs. Ruth Hanna Haskell had gone on a "motor trip" from St. Louis with her daughter Lucy (Mrs. Lucy Clifford), who was on Martha's Vineyard when the heart attack occurred.
• Ruth Haskell previously served as secretary and a director of the Social Planning Council. She was President of the VNA at the time of her death.
• John Abraham Haskell (1878-1951) came from a prominent Alton (IL) family. He and Ruth are buried in
In October 2020, the VNA Board of Directors approved to update of the Mission, Vision and Guiding Values of VNA.
In November 2020, VNA became a COVID approved vaccinator. In December, 2020, VNA received its first doses of the new COVID vaccine and began vaccinating healthcare workers in our community. VNA received both Moderna and Pfizer COVID vaccines. While Moderna could be stored at normal freezer temperatures, Pfizer had to be maintained at -86 to -60 in ultra-low coolers. The vaccine also had to be administered with a few hours once a vial was opened and/or mixed. VNA adapted quickly to what was needed to provide these vaccinations. VNA followed the Phases of Vaccine Distribution issued by the State of Missouri, working mainly with corporations and small healthcare organizations to vaccinate their staff.
Since starting the process of providing Covid-19 vaccinations from December 2020 to May 2021, VNA had given over 15,000 vaccinations and continued the process. At times it was challenging because VNA did not receive the requested vaccines each week due to limited vaccine supply. VNA’s nursing and support staff stepped up to assist in the process and nurses and physicians in our community volunteered to help VNA in the mass vaccination effort.