Home care had never really received much consideration as an alternative to institutionalization. Private duty nurses had provided for wealthier individuals in their homes since the late 1800's, but served only those who could afford the cost of highly individual in-home care. The visiting nurse associations and public health nurses who were available to the poor had been focusing their efforts not on care for the elderly but on health education, disease prevention, and pregnancy. By the 1940's, infant mortality rates had dropped dramatically, hospital care had improved, and patients began to look to medical facilities as the preferred sites for receiving medical care and education. As the cost of salaries and medical technology increased, it was also more cost-effective to ask patients to come to the medical professionals rather than the other way around. Since that was where the jobs were, most nurses began working for hospitals or physicians. By 1952, Metropolitan Life discontinued the visiting nurse program they launched in 1909 and the home care industry floundered with little funding and no clear sense of direction.