Returning home: historical influences on home healthcare in Canada

In this article, the historical context of home healthcare in early 20th century Canada is examined with an emphasis on key events and groups that shaped nursing in the home as the primary form of healthcare. Ways in which home healthcare evolved are also addressed, including the movement from an emphasis on the home as the point of care for both preventative and curative services, to the separation of healthcare functions into public health, treatment of illness and injury, and pregnancy care-each with its own practitioners and regulators as hospital-based systems became the desirable norm. We conclude that the nature and status of home-based nursing evolved in response to public expectations of what comprised "best care" and who was responsible for providing (and funding) it. At a certain level, the home offered independent-minded nurses a level of autonomy and inscrutability unparalleled in hospital-based settings. As hospitals took preeminence as preferred sites for healthcare, the same geographic, cultural, and economic barriers that complicated access to hospitals also provided nurses unique opportunities in the home as relatively autonomous caregivers.