While the professional nurses and nurse training schools had originally emerged to serve the hospitals, there was a growing demand for nurses to care for the sick in their own homes, either as "private duty" nurses, who were paid directly by the family to care for an elderly or infirm family member, or as "visiting nurses" working for an agency. Dozens of nurse training schools opened or expanded their programs to accommodate the need.
In many places, local families would approach the nursing schools looking for help, and the schools would arrange for their students to serve as private duty nurses during their studies. Once the new nurses had graduated, many returned to their home communities. Individual nurses needed a way to find the families that needed help, and families needed a way to contact them. To bring some order to the process of finding and hiring private duty nurses, the Michigan nursing association established a central registry. Nurses who were willing to go out on call would list their names on the registry and work for a set daily fee. Eventually, there was a need for nurses who could work for less than a whole day, and an hourly fee schedule was established, as well. (Medical History of Michigan, 1930)
The "Visiting Nurse" associations around the country were growing. By 1905 there were 455 visiting nurses in the country employed by 171 visiting nurse associations. By 1909 that had tripled to 1,413 nurses employed by 566 associations. The growth was fueled as the organizations started getting financial support from sources other than private charity. State and local boards of health and education began to sponsor public health nursing, which was focused on prevention and education. In 1912, the American Red Cross created a rural visiting nurse association. The response to the Red Cross program "was so tremendous that the Red Cross could not keep up with the chapters' demands for nurses." (Indian River)
In 1909, Lillian Wald convinced Metropolitan Life Insurance Company to finance home care: "Armed with data documenting that nursing care saved lives, Wald urged MetLife to hire visiting nurses to care for policyholders during illness. For a modest fee per policy, Wald believed that MetLife could reduce the number of death benefits paid." (VNSNY)
The program was so successful that in 1911, it was expanded nation-wide. MetLife hired visiting nurses to provide the services, and, by the close of 1916, they had made visiting nurses available to over 90% of their 10.5 million industrial policyholders in 2,000 cities. The insurance funding gave the home nursing agencies a new source of income which allowed them to thrive, and from 1909 to 1924 the number of visiting nurse agencies in the country more than doubled, from 1,413 to 3,183. (VNSNY) (Indian River)