Our History

The History of Visiting Nurse Association and Visiting Nurse Plus

1888 At the suggestion of a local physician, the King’s Daughters Circle was formed by Miss Eleanor Igleheart.  Its purpose was to provide cheer and good will to patients in the City Hospital located at Second and Division Streets.

1902 By now, the work of the King’s Daughters Circle had expanded to a point where the need for a nurse to visit the sick poor in their home was realized.  Miss Lydia Metz, of the Deaconess Hospital in Evansville, was employed at a salary of $50.00 per month.  It is significant to note that Miss Metz was the first visiting nurse in the state of Indiana to provide this service and one of the first in the country.

Expenses for the year totaled $754.00 and the majority of the revenue was raised through a tea reception held at the home of James L. Orr.  The minimal charge of 50 cents per cup was considered so exorbitant that the cup and saucer were given along with its contents.  Later during this period, the King’s Daughters Circle would become the Visiting Nurse Circle.

1913 As the years passed and the women who founded the King’s Daughters Circle grew older, married, and had children of their own, they soon realized the impor­tance of pediatric care in Evansville: pediatrics as a specialized form of care was then in its infancy.  The women also recognized the need for special attention required by children of the poor, and being no longer satisfied with doing just auxiliary work, they separated from the Visiting Nurse Circle and formed the Babies Milk Fund Association (BMFA).  Funds needed by the BMFA were raised through a well-attended chari­ty ball held at the magnificent St. George Hotel in Evansville.  During the formative years of this new association, much of its success was due to the en­thusiasm and support of Mayor Benjamin Bosse.  It was through his efforts that BMFA received city funding.

1915 During 1915, the Board of the BMFA was expanded, and the number of clinics increased to four (4); the primary purpose of BMFA was to assure that milk was available and provided to needy families in Evansville.

1923 At the request of the Board of Directors, the National Association for Public Health Nursing accepted an invitation to survey the public health nursing needs in Evansville.  Based on the outcome of this survey, the Visiting Nurse Circle that was organized in 1902 was reorganized and become known as the Visiting Nurse Association.

1924 A joint Executive Board was formed between the Visit­ing Nurse Association (VNA) and the Babies Milk Fund Association (BMFA).  The first step in this coopera­tive venture was the agreement to function as one organization under a superintendent (executive direc­tor).  Miss Hulda B. Cron, a public health nurse living in Ohio, was employed to manage the newly merged associations.

1926 It was during this year that the joint Executive Board dissolved.  The Babies Milk Fund Association and the Visiting Nurse Association, through a formal merger, incorporated as the Evansville Public Health Nursing Association (EPHNA).  A Junior Auxiliary was formed and with a membership of 47 women they assisted the EPHNA with clinic and clerical functions.  Later this same year, the Junior Auxiliary evaluated its purpose and reorganized to become the Junior Service League, the forerunner of Junior League of Evansville.

1927 EPHNA no longer desiring to be a recipient of Communi­ty Chest funds, conducted its own independent fund raising campaigns.  It was during this year that a building located at 120 S. E. First Street in Evans­ville was purchased for the organization by Mr. and Mrs. E. Mead Johnson, Sr.

1934 Independent fund raising proved to be difficult, to say the least, and EPHNA re‑established its relation ship with the Community Chest fund.

1953 Miss Cron retired as Executive Director of EPHNA following 28 years of dedicated service.

1964 Mayor McDonald requested that EPHNA seriously consider moving from the office location at 120 S. E. First Street into the City‑County Building at the proposed Civic Center Complex to be completed some time in 1968 or 1969.

1965 The EPHNA Board of Directors, after much deliberation, decided to remain at their present location.  In May, a proposal to withhold city funding from EPHNA made headline news.  The Board reconsidered its earlier vote and reversed the decision to remain at 120 S. E. First Street.  It was agreed that EPHNA would move as requested into the proposed new building complex.

1966 Medicare funding for health care became available; however, to qualify as a Medicare provider the EPHNA was required to add home health aide service program.  1966 was also the first year that men were invited to serve on the Board of Directors.

1969 As the proposed move to the Civic Center Complex became more of a reality, the Board of Directors once again reversed their decision and elected to stay at 120 S. E. First Street.  Because of this, the City Council voted to transfer the money allocated for EPHNA to the City Health Department.

1971 Again, due to the decision not to move into the Civic Center Complex, the city and county withdrew financial support for the Child Health Conference and Parochial School Programs.  It was a difficult year caused by struggling with deficit accounts that necessitated withdrawing approximately $30,000 from the Agency’s investment account to continue the provision of skilled nursing care in the home, and other therapeu­tic services to the sick and disabled in Vanderburgh County.

1972 After another re‑organization, the EPHNA became the Visiting Nurse Association of Southwestern Indiana, Inc. This was also the first year that home health care services were provided in Warrick County.

1973 VNA/SWI expands its services into Gibson County on September 10th with the opening of a separate office in Princeton.

1974 After a long and difficult search for an Executive Director, Miss (Col. Ret.) Ida B. Ayer, was hired as Executive Director.  The Professional Advisory and Utilization Review Committees as required by Medicare were formed.  Major improvements were made to the building and new carpeting and drapes were added.

1976 Services were offered in Posey County for the first time.

1977 VNA/SWI enters into a contract with the state of Indiana to provide Title XX‑funded homemaking service to residents of Vanderburgh, Gibson, and Posey coun­ties (making this the first year a non‑medical service is provided by the Agency).  Miss Ayer resigned as Executive Director, and Patricia Galbraith, RN, was hired in December to succeed her.

1978 Major improvements on the building were completed early in 1978.

VNA/SWI signs a contract with Deaconess Hospital to provide under Agency direction and supervision physi­cal therapy, occupational therapy, speech pathology, and medical social service.

In May, the Board of Directors held an open house and invited the community to come and see all of the improvements.  New furniture for the reception area and drapery for the second floor were given to the Agency by the Association membership.

As the demand increased for home care services, VNA/SWI grew to meet this need and became the third largest home health agency (by visit volume) in Indiana.

1979 VNA/SWI moves from a manual system of billing and data gathering to an automated shared system based in California.  Remodeling continued and improvements were made to the kitchen and staff dining area.  In December, a second satellite office was opened, in Tell City, in order to serve the residents of Perry County.

1980 VNA/SWI provides 70,727 total program visits, making it the largest single provider of home care services in Indiana.  Because of continued growth, office space was leased in downtown Evansville for the Home Health Aide Program, and Perry County staff moved to their leased office in the Professional Building in Tell City.

Based on the changing needs of the Agency, an in‑house mini computer terminal and printer were purchased, enabling the Agency to enter its own data; thereby, reducing the billing turn‑around time.

The Agency develops its own medical social work de­partment.

The Board of Directors appointed a special Long Range Planning Committee to develop the first Strategic Plan.  The Articles of Incorporation were revised in accord­ance with the planning needs of the Agency.

1981 The Planning Committee in developing the Strategic Plan identified not only expansion and diversification of services, but also a need to research and evaluate the creation of a second corporation.  In August, the Board of Directors, after much deliberation and many long days of soul searching, voted to sell the historic building at 120 S. E. First Street to Research Systems Corporation of Evansville, for $130,000.  The Board also approved the purchase of land at the corner of Sixth and Mulberry Streets to construct a new facility, using proceeds from the sale of the building and funding obtained through the City of Evansville Economic Development Bonds.

1982 The Agency was relocated to 600 S. E. Sixth Street after an arduous process of selling, buying, and planning a new building.

HealthSkills, Inc., a separate not‑for‑profit corporation, was created to offer services to the private‑pay sector. The corporation’s first service, companion caregiving, was started by hiring one customer service representative, Karen (Flynn) Bennett (who served as the agency’s first Executive Director) and 40 caregivers.

Spencer County became the sixth county in Southwestern Indiana to receive VNA services.

1983 HealthSkills, Inc. begins offering companion services to the private pay sector in Vanderburgh County.  Response by the community is extremely favorable.

VNA nurses extend outreach services to residents of senior citizen high‑rise buildings by presenting weekly lectures on topics of interest.

Plans are developed for the implementation of an enteral and parenteral nutrition program.

A newly created department begins development of on‑staff rehabilitative services.

Consultation services are provided to other Indiana home health agencies.

1984 VNA’s homemaking program, funded by Social Service Block Grant monies, is shifted to the HealthSkills corporation. The SSBG program receives state and federal funding. The referrals, administration and case management are through the Southwestern Indiana Regional Council on Aging (SWIRCA).

Nursing coverage is extended to 24 hours per day.  Enterostomal therapy further expands service provision; on‑staff occupational therapists and a speech pathologist are hired.

Narcissa L. Niemeier, BSN, succeeds Patricia Galbraith as the Executive Director.

VNA seeks and obtains licensure in the state of Illinois and begin providing service in 10 south eastern counties.  Non‑traditional utilization of services is evidenced by VNA providing follow‑up care for Birthing Center patients and assisting outlying hospitals with physical therapy staffing.

1985 Competition in home care surfaced in VNA’s area “en force”Ceight (8) competi­tors “popped up” in a l2‑month period.  VNA began an increasingly aggressive marketing campaign aimed at retaining and attracting patients.  A Preferred Patient Program ensured the pre‑enrollment of patients into the VNA system.

HealthSkills’ increased in both size and scope, with a private‑pay nursing service added to the roster.  A move of some administration offices to 601 S. E. Sev­enth Street enabled HealthSkills to move into the upper level of the building. They began offering private pay professional nursing services. Services may include, but are not limited to: health screenings, sorting medications and other routine techniques not covered by Medicare or most types of insurance.

To ensure market penetration, VNA sought and received Certificate‑of‑Need in the Commonwealth of Kentucky.  Kentucky licensure rapidly followed in July.

Strengthening of a non‑Medicare patient base was partially achieved by nursing follow‑up of apnea-monitored children; the marketing of other targeted segments continued.

1986 Visiting Nurse Association proudly received accreditation from the National League for Nursing.  The NLN accreditation is effective for a five-year period and is recognition of excellence in home health care.  The NLN is the only true accrediting body for free‑standing agencies providing home care nursing in the United States.

VNA’s Tell City, Indiana and Eldorado, Illinois staffs moved into larger facilities, thereby acquiring much needed additional workspace as well as increased visibility in those communities.

HealthSkills took measures to structurally reorganize.  Karen Flynn was named Executive Director after having been affiliated with HealthSkills since its inception in 1982. Private pay aide, physical and occupational therapies, speech-language pathology and medical social work were started. Services performed are those not covered by Medicare or most insurance.

The diversification of VNA’s services continued with the provision of CPR classes, counseling with private firms and assisting their review of health care alternatives, providing needed services to a number of nursing homes in our area, and providing follow‑up visits to patients requiring specialized nursing care following hospital discharge through our Extended Services Program.

1987 VNA restructured internally during 1987, creating three distinct areas of Agency administration:  programs, human resources, and finance.  This restructuring resulted in clearer communications, more productive intra‑agency business, and enhanced positioning in the home care market.

Special Board and staff committees were appointed to plan a year-long celebration of VNA’s Centennial in 1988.

During 1987, VNA received greater allocations from all of the United Ways funding the Agency.  The increased United Way monies enhanced ability to serve the needy.

The service area expanded as a long‑awaited Certificate of Need was granted to visit patients in Hancock County, Kentucky.

With relocation of VNA’s Princeton, Indiana office, the goal of providing all four locations with pleasant surroundings and consumer accessibility was met.

Another highlight of the year occurred when St. Mary’s Medical Center formally chose VNA to assist in the after‑care of its discharged patients, and to be an integral part of their home care programs.

1988 The Visiting Nurse Association’s Centennial was celebrated all year long.  The phrase “celebrating 100 years” modified the usual VNA logo to call attention to this important anniversary.  Mayor Frank McDonald proclaimed February 24th as “VNA Day” in Evansville, and he assisted in dedicating a time capsule for the occasion.  Other Centennial events included an employee appreciation luncheon hosted September 28th by the VNA Board of Directors, having Val Halamanda­ris, President of the National Association for Home Care, as guest speaker for the annual meeting.  The annual meeting was held in the historic Rose Room of the old McCurdy Hotel.   Reenactments of historical Flower Missions were held at each VNA office site.

Acknowledging that smoking is one of the biggest, yet most controllable health hazards, the VNA adopted a policy that prohibits smoking in all VNA facilities.

In response to a growing need for pediatric care, VNA added a pediatric nurse associate to the intermittent staff. A full time speech‑language pathologist was added to the Rehab StaffCa first in VNA’s long history.  Due to growth in the Extended Services program, policies and procedures were restructured in 1988.  The staff grew with LPNs, clerical support and two coordinators added to a core group of RNs.

Warrick Hospital, as part of the Daughters of Charity System, chose VNA as their home care provider.  This relationship was identified in an addendum to the Agency’s agreement with St. Mary’s Medical Center.  VNA provides Warrick Hospital with a VNA liaison nurse that assists patients plan for and utilize home care services within 24 hours of hospital discharge.

All VNA and HealthSkills employees participated in the Williams & Williams marketing survey conducted in the fall.  The study provided objective information regarding VNA and HSI market positions.  Consumers and other health professionals also provided feedback on Agency services.

1989 Growth continued in VNA’s Extended Services program.  This department served an increased patient load in 1989, and supplied RN staffing for an exciting drug research project at Bristol Myers.

The Corporate Care program, an expansion of Extended Services’ patient Services Coordination, was introduced in the latter half of the year.  Corporate Care serves businesses by assisting employers to control health care costs while helping employees effectively utilize the health care system.

VNA Executive Director, Cissy Niemeier Kraft, was awarded the Norah J. McFarland Award for her outstanding accomplishments in home care.  She was the third recipient of this honor bestowed by the Indiana Association of Home Health Agencies (IAHHA) at their annual meeting.

VNA’s staff in Princeton moved “next door” to a more spacious office suite in the Kidd Building.  A new nursing supervisor joined VNA’s Illinois staff and the Tell City office celebrated ten years of service to Perry County residents.

A mandatory licensure law for home health agencies in Indiana was made effective July 1st. The act states that home health services are defined as nursing, rehabilitative therapy services, home health aide services and other therapeutic services performed in the temporary or permanent residence of the patient.  Anyone who provides home health services for compensation must be licensed by the State Board of Health.

The VNA received a positive review by the Joint Commission on Accreditation of Health Care Organizations.  Surveyed as a result of VNA’s cooperative agreement with St. Mary’s Medical Center, comments from JCAHO surveyors included, “…VNA has done a marvelous job of implementing quality assurance.”

During National Home Care Week activities, Karla Bayless, RN, received the VNA Caregiver Award for 1989.  Bayless was acknowledged locally and by IAHHA as a caring, compassionate, professional caregiver.

1990 Hand‑in‑hand with a nursing shortage, VNA’s volume of business increased over 25% in 1990.  More than ever before, 1990′s challenge became providing the same quality of care while coping with a myriad of human resource issues.

The development of the Educational Resources Department enhanced many components of the operations of the nursing department.  The department encompasses not only quality assurance, but focuses on staff development through educational offerings, inservices, standardized orientation and specialty nursing support.

Standardized competency testing for state board of health certification for home health aides was mandated.  While individualized training for home health aides had been in existence at VNA for many years, the training program was reorganized to meet new federal guidelines.

For the majority of the year, VNA assisted Bristol Myers Squibb in staffing a clinical research project.  A group of RN employees assisted the medical staff with research for ddi, a break through drug for AIDS treatment.

VNA’s sister corporation, HealthSkills, Inc. changed its name to Visiting Nurse Plus, Inc. to better reflect the services their organization provides, plus to capitalize on all marketing potential afforded by standard names. VNP opened a branch office in Princeton to better serve the residents of Gibson County.

Also, VNP offered a new service in the Evansville area called KidCare. The program took care of sick children while parents went to work.  Caregivers went through special training to become Kid Caregivers.  This service was eliminated in 1993 due to low volume.

During the Agency’s VNA Week celebration in February, four area families received VNA’s first Lydia Metz Awards.  The Lydia Metz Award honored a non‑professional caregiver, such as a spouse or other relative, who provided excellent care for the patient at home.

Physical therapist Mary Ledbetter was honored as VNA’s Caregiver of the Year during National Home Care Week in November.

1991 The Visiting Nurse Association earned accreditation from the Joint Commission on Accreditation of Healthcare Organizations in 1991.  The accreditation, granted for three (3) years, was awarded following an extensive audit of both records and services.  The Joint Commission on Accreditation recognizes that VNA has met the Commission’s national standards for quality.

The Agency experienced extensive growth in 1991, nearly 30% overall.  Great expansion took place in the Extended Services Department with an 87% increase in services.  The intermittent home health aide program increased 40%.

VNA began development of a Hospice program for the terminally ill.  A natural extension of VNA’s existing programs, VNA Hospice serves the special needs of terminally ill patients.

Growth in the Agency’s branch offices dictated the need for larger quarters.  Tell City made their move to 314 E. Highway 66 in October and both Princeton and Eldorado secured new locations by year’s end.

During National Home Care Week, Lou Brinkmeyer, Home Health Aide, received the VNA Caregiver Award for 1991.

VNP began providing government funded Medicaid Waiver homemaking services. The administration of these funds is through SWIRCA.

1992 Corporate offices in Evansville were expanded to fill the two vacated floors of the One Mulberry Place Building.  All of the space was quickly filled.

Medical Social Services extended its program to the Princeton, Indiana office.

In August 1992, Dr. Patrick Flamion joined VNA’s Hospice program as medical director.  That same month, the Hospice program passed the Medicare survey and achieved Medicare certification.

VNA staff members prepared an exhibit on home health care entitled “Home Health: the Science of Caring” which was held at the Evansville Museum of Arts and Science from October 26, 1992 to January 5, 1993.  Included in the exhibit was a timeline of the Agency’s history, costumes and artifacts from early home health care days, as well as three home care vignettes and a hands‑on rehabilitation display for children.

Corporate Care initiated a flu vaccination program in the fall.  This pilot project offered flu shots, for a minimal fee, in area grocery stores.  The program was well received by the community, providing many Hoo­siers with the vaccine.  Plans were made to expand the program in 1993.

VNP met requirements to become an Indiana licensed home care agency. We began providing Community and Home Options to Institutional Care for the Elderly and Disabled (CHOICE)             homemaking services. The referrals, administration and case management are through SWIRCA.

1993 VNA celebrates its 105th Anniversary this year.  Special programs and events center around the theme:  “The heart of home care for generations.”

The Intake and Referral department expands its serv­ices to the Illinois office.  In addition, two nurses in the Illinois office are certified to begin in‑home chemotherapy.

Corporate Care carries out knee assessments as part of a state‑wide research project on osteoarthritis.  Run by the Reigenstrief Institute of IU Medical Center, the program calls for VNA’s throughout the state to provide baseline and follow‑up knee assessments during a patient’s course of treatment.  The program will follow patients for two (2) years.

VNA secures a building site in the Walnut Centre Complex, moving forward with plans to reunite the Evansville Visiting and support staffs under one roof.  Architect Edmund L. Hafer is hired to design the building.  VNA directorial staff holds numerous meet­ings and inservices to incorporate as many cost/time saving factors as possible.  Staff participation in the project is excellent.

A part‑time resource coordinator is added to the staff in the Eldorado office.

Medical Social Services extends its program to the Tell City and Eldorado offices, completing its goal for a social worker in every location.

Corporate Care flu vaccination program is expanded to include the Indiana, Illinois, and Henderson, Ken­tucky, service areas.  The American Lung Association lends its support to the project.  Scheduled for seven (7) weeks, the program has already administered over 2,300 shots in the first two and one-half weeks.

The VNP Princeton office expanded its service area to provide companion services in Wabash County in Illinois. Staffing Solutions services began in the Evansville office. A skilled team of RNs, LPNs, QMAs, CNAs and other types of professionals supplement the staffs of nursing homes, hospitals, surgery centers, physicians’ offices and industries.

1994 On July 1st, the Agency broke ground to build a 67,000 square foot building on property in Walnut Centre.  The structure was planned to house the central office staff who were located in three (3) separate facilities on Mulberry Street.

The Tell City branch office experienced growth in providing extended services and Hospice services.  With 56 staff members, plans to lease a new building were developed and underway by year-end.

The expansion of social services, mental health nursing, and Hospice contributed to significant growth and increased effectiveness in the Eldorado, Illinois office.  Maternal and pediatric patients became a larger portion of the population served in Illinois during 1994.

The Infusion Therapy program served its first patient in March.  Three (3) new positions were created for this department, which served nearly 100 patients in its first year.

VNA’s Mental Health program expanded its services in Illinois and made plans to enhance services in Gibson County.  The program entered its third year of providing psychiatric home care to homebound patients.

VNA Hospice brought Hospice services to Perry and Spencer counties in March.  VNA’s Hospice in Illinois received licensure and was awarded Medicare certification at the end of the year.

The Agency underwent a survey by the Joint Commission on Accreditation of Healthcare Organizations and was awarded the maximum three-year accreditation.

VNP Staffing Solutions obtained the ability to teach Certified Nursing Assistants training. VNP also became registered as a nursing pool by state of Kentucky.

1995 VNA Hospice expanded its services to the Princeton office in April.

In June, VNA headquarters moved to a new location at 610 E. Walnut Street in downtown Evansville.  An open house was held in July for employees and their families.  In September, an open house was held with invitations issued to local dignitaries, Agency employees and special guests.

In June, the Tell City branch office moved to a new location on Highway 37.  The office held an open house health fair which was attended by more than 200 people.

In an effort to meet the changing needs of the home health care market, the Agency hired a managed care coordinator.

The Agency was re-accredited by the Joint Commission on Accreditation of Healthcare Organizations for an additional three (3) years.

VNA’s community flu immunization program held 53 public sites and a number of corporate sites providing protection from influenza to thousands of tri-state residents.

VNP obtained a nurse agency license in Illinois to provide Staffing Solutions services. The “Welcome Home” service also began. This service was designed for nursing home residents returning home from illness.  Companion caregivers provide four hours of service to help them settle and adjust to being home again.

1996 “Critical pathways” and “Outcomes” became buzz words for the Agency as the Care Steps program was initiated.  Care Steps provide specific steps for the caregiver to follow as he/she proceeds in assisting the patient gain independence.  The development of Care Steps became necessary as payer sources began revising requirements for reimbursement.  The program allows for more precise measurement of results or outcomes from patient treatment.

VNA’s entire supervisory group was restructured this year. Changes included redistribution and expansion of work among the existing directors.  Supervision of program areas were consolidated and streamlined.  Cissy Kraft continued her 12th year as the Agency’s executive director.

Larger Agency facilities allowed VNA to better serve the community by offering our building as a meeting place for health-related groups.  The Agency also provided community education opportunities on-site, hosting national speakers with topics on stress and humor and Hospice.

Community Health Services, formerly called Corporate Care, continued to provide low-cost immunizations at public sites throughout VNA’s service area.  Internally, they offered health risk appraisals at no cost to employees and began a “lunch and learn” series of wellness education.

The VNP Princeton office began the CheckMate service whereby companions make short visits, usually thirty minutes, to “check in” on a client.

VNP began offering Attendant Care, Respite Attendant Care and Respite Home Care Aide services through CHOICE and Medicaid Waiver and Title III.  VNA transferred all its Attendant Care and Respite Home Care Aide services to VNP.  The referrals, administration and case management of these services are through SWIRCA.

This year in the Tell City VNP office, one office employee was hired to oversee the scheduling needs of Government Funded Services and to look for marketing opportunities.

1997 Performance Improvement became a priority focus in 1997.  Many of the Agency’s activities were reviewed and evaluated with the ultimate goal of providing better patient care, better communication, better documentation, and better customer service.  Fine-tuning the Agency’s Care Steps program was one example of PI in action.

VNA introduced Wound Care teams to provide the latest scientific wound care practices available.  Teams led by a Certified Enterstomal Therapy Nurse (CETN) include specially trained home care aides and physical therapists to provide not only state of the art care, but also cost-effective outcomes that benefit both patient and physician.

The Agency’s two infusion nurses earned accreditation from the Intravenous Nurses Credentialing Commission and began building specialized IV teams.  An insurance nurse liaison role was created to streamline the Agency’s communication with managed-care providers.

The Agency joined the information highway by creating a website located on the Internet at www.vnahc.org.  Internal communications were enhanced by VNA Vision, a monthly video newsletter.

VNA publications underwent a facelift and were renamed and refocused to better serve their individual readerships.  VNA Views is published for VNA employees, board members and volunteers; Outreach, with the largest circulation, is mailed to community residents; Advantage provides information directed to physicians and other prospective referral sources; and Perspective is targeted for managed-care organizations.

1998 Change and challenge were the two (2) watch-words of 1998.  The home care industry as a whole was faced with dramatic changes in the structure of home health care reimbursement as a result of the implementation of the Balance Budget Act of 1997.  VNA instituted fiscal measures to respond to the reduction of Medicare home health funding.  In addition to overall “belt-tightening” measures, VNA removed Speech Therapy and Occupational Therapy from the array of available services provided by the Agency.

Proactively, VNA initiated exploration into the realm of fundraising with the founding of the Virtual Development office.  This work group began to focus energy on fundraising and fund development.  Agency-wide education was undertaken to increase staff knowledge in the arena of fundraising.  Initial fundraising efforts were kicked off by an Agency-wide raffle.

The annual flu immunization program continued to grow and expanded to include the availability of pneumonia immunizations.  The 1998 immunization campaign reached out to include counties in the states of Indiana, Illinois, and Kentucky.  The total number of immunizations administered to tri-state residents by VNA’s immunization campaign reached a record total of 10,636.

Consolidation of VNA networks on a regional dimension occurred as Visiting Nurse Affiliates of Indiana and VNA First joined forces to become a single regional entity.  This resulted in cost efficiencies as well as operational streamlining.  The combined organization retained the name VNA First and member agencies reach into five (5) separate states.

VNP celebrates its 15th Anniversary by hosting a “Crystal” celebration breakfast for employees and Board members. Employees were honored for their years of service to VNP.

VNP began designing special services for customers. The first special service was MedMinders. VNP RNs help customers track and sort medications, usually on a weekly basis. Nurses can also perform blood pressure checks and other health screenings as needed.

1999 Legislation and the effects of Medicare’s Interim Payment System remained center stage during 1999.  Home health agencies across the nation worked together to increase public awareness of the effects of the Balanced Budget Act of 1997.  As agencies received final notification of their reimbursement status, faced with difficult choices, many were forced to close their doors.  VNA continued to practice stringent fiscal management in response to the Interim Payment System.

As the year drew to a close, VNA realized a positive position both in revenue and business volume in the final quarter of 1999.  In response to this positive outlook, the Board of Directors approved partial restoration of a portion of employee benefits reduced as result of Medicare’s Interim Payment System.

Hospice led the way in 1999 as Hospice patients grew from 140 the previous year to 281.  Hospice continued to expand its collaborative role with long-term care as contracts were solidified with area nursing home facilities.

Alternative sources of revenue were secured to enable VNA to embark on two (2) innovative community outreach programs.  Grants totaling $55,703 were obtained from The Retirement Research Foundation and the Evansville Affiliate of the Komen Foundation.  These funds were used to provide stress management programming for Alzheimer patients’ family caregivers and Breast Cancer education training and outreach in collaboration with the Tri-State Parish Nurse Organization.

VNA continued to focus efforts in the area of fundraising and development.  In February, VNA hosted its inaugural fundraising event, “Wingin’ It!”, an off Broadway musical starring Pamela Campbell.  Proceeds from the event totaled $14,890 and were designated for VNA’s Hospice Program.  VNA hosted a second fundraising event in May.  For this event, a motorcycle run, VNA was the benefactor of $3,500 from the bike tour sponsored by the Evansville Blue Knights and Evansville Custom Cycle and Van Supply.

Data collection and patient acuity levels entered into the national home heath care scene as the Health Care Financing Association introduced the OASIS data collection tool.  This tool was mandated for all Medicare and other skilled care patients.  VNA implemented a computerized data entry system to comply with this requirement.  The information derived from the Oasis served to provide the financial underpinning of the Prospective Payment System set for implementation in the year 2000.  This system sets Medicare’s home health care reimbursement based on the acuity level of each individual patient served by the Agency.

VNP began a second special service: Alzheimer’s respite care. This cooperative effort initially began as a pilot program with the Mental Health Association. Some VNP caregivers elected to receive additional Alzheimer’s education and training to better assist customers.

2000 If one word were to describe the year 2000, rollercoaster might be the most apropos choice. The year began with the ongoing effects of the Balanced Budget Act of 1997 continuing to wreak havoc throughout the home care industry on the national arena.

Locally, VNA continued to struggle under the dual burdens of the Interim Payment System and the repayment of our Medicare debt.  Perhaps the lowest point of the year fell in June when additional layoffs were instituted as a further attempt to buy time until the initiation of the Prospective Payment System.  This step was taken with much deliberation only after recognizing the potential risk that the Agency might have to close its doors unless a solution could be found.

Throughout the year, a cross section of the Agency worked intensely on a Prospective Payment System Task Force to prepare the Agency to successfully transition to the Prospective Payment System due to be rolled out October 1, 2000.  Every aspect of care delivery was scrutinized from referral to discharge and final billing.

New standards of performance were identified and implemented in many areas of the Agency. One of the most significant changes the Agency experienced was a complete overhaul of the Medicare Billing System required of our billing vendor, Delta.  On October 1, 2000, VNA successfully transitioned to the Medicare Prospective Payment System as the many months of preparation came to fruition.

As hoped for, the fiscal status of the Agency began to show improvement under the Prospective Payment System and resulted in a positive year-end balance of $113,765.55. VNA was officially in the process of recovery.

The Agency’s commitment to fund development continued to grow with the designation of the role of Director of Development.  Fundraising efforts were highlighted by the Annual Motorcycle Run hosted in May by Evansville Custom Cycle and Van Supply and the Blue Knights of Evansville and Voices For Hospice that was held in October.  Fundraising goals for 2000 were exceeded with funds raised totaling $149,601.95. Additional bequests of $30,096.46 brought the overall total for 2000 to $179,698.41.

Positive strides continued to be achieved by VNA’s Hospice Program as program census continued to grow in 2000.  An average of 1,457 routine days of care per month were provided our Hospice patients.  VNA’s ability to provide care in the alternative setting of long-term care was strengthened through reinforcement and expansion of our contract network.

VNA continued to share its Evansville offices with two tenants, Vectren and Visiting Nurse Plus.  Although staff had to adjust to several moves as we shifted to meet the space needs of our tenants, VNA benefited from significant rental income that helped to support movement toward fiscal recovery.

In an ongoing effort to bring the benefits of VNA’s progress toward recovery to the staff, two benefits were reinstated in 2000.  First, the wage freeze that had been in place for two years was lifted and merit increases were reinstated.  Secondly, the Agency’s contribution to the retirement fund was increased from 0.5% to 1.5%.  A commitment was made by the board to continue to evaluate the ability to restore benefits as the Agency’s fiscal position improved.

VNA continued its outreach efforts through Komen Grant funding for breast cancer education to both the general public and health care practitioners in rural Southeastern Illinois.  A grant from the Board of the Evansville Christian Home for Unwed Mothers was received to support in-home care of underprivileged infants and their mothers.

A decision was reached by VNP management staff to focus efforts on crafting “Exceptional Customer Service (Experiences).” A new strategic plan was formulated.

2001 The year 2001 was perhaps the crucial turning point in VNA’s recovery from the impact of The Balanced Budget Act of 1997.  VNA continued to gain expertise under Medicare’s new Prospective Payment System resulting in a significant gain in financial viability by the end of the year.

The Agency was able to bring welcome relief to the staff through further reinstatement of wages and benefits.  Staff members working under a reduced work schedule as a result of The Balanced Budget Act of 1997 were brought back to their previous work schedule.  Both mileage and retirement benefits saw further restoration.

The Agency once again began to move toward reasserting our involvement in the home care industry on a local, regional and national level.  Two key memberships, Visiting Nurse Associations of America and Indiana Association for Home and Hospice Care, were reinstated.  VNA’s service array was expended to once again include both occupational therapy and speech-language pathology.

Fund development continued to gain momentum in 2001.  The annual goal set at $148,062 was exceeded with donations topping the mark at $157,994.  Likewise, grant income provided the Agency with additional revenues of $73,093.  The funding from both of these sources allowed the Agency to provide innovative patient focused offerings outside of the more “traditional” Medicare model.

The return of both growth and profitability to the home health care component of the Agency was a watershed event for fiscal year 2001.  During this year, the mental health specialty area continued to grow in recognition and stature in the community and experienced an expansion in staff.  The wound care team continued to provide a strong specialty presence in the marketplace.

The Hospice program continued to experience an annual growth of over 20% for the third straight year.  In response to trends within the Hospice marketplace, VNA began preliminary investigation of the ability to offer the resources of a Hospice Center to the tri-state community.

Two new regulatory challenges moved to the forefront in 2001.  The Health Information Portability and Accountability Act guidelines were set forth and a multi-departmental task force was implemented to prepare VNA for the mandated guidelines scheduled for implementation in 2003.

The Centers for Medicare and Medicaid Services moved toward the use of Outcome Based Quality Improvement with the insurance of Agency Specific Adverse Events and Patient Outcome Reports.  VNA implemented a cross-sectional work group to analyze the information provided through these reports and determine the impact of this data on future Quality Improvement initiatives within the Agency.

2002 The year 2002 was one of both stabilization and growth for VNA.  Patient census in Home Health held steady and occupational and speech therapy services were restored to the Agency’s service array.  The Hospice program continued to grow and welcomed a full-time volunteer coordinator and dietitian to further strengthen the team.

Recognizing the increased utilization of therapy and social work services, the department was removed from the umbrella of the Hospice program, and a separate stand-alone department was created.  This transition builds the foundation for further growth of the therapy and social work component of the Agency.

As the Agency’s workforce continued to grow, a dedicated Human Resource Supervisor position was created to foster long-term retention and enhance the Agency’s ability to create a progressive workplace that is responsive to the needs of both our current and future staff.

In a major commitment toward the future of Hospice, the Board of Directors approved the decision to build a Hospice Center to provide inpatient care for Hospice patients who cannot be cared for in their homes.  A decision was made to renovate 6,000 square feet of the Evansville office to create the Hospice Center which will house seven (7) private patient suites.

VNP began a new service called Health Watch Personal Response System. Through the use of a personal transmitter pendant and a “Help” console, Health Watch is convenient to use, simple to operate and offers customers safety and reassurance 24 hours a day.

To better serve customers, VNP began offering a new level of care called personal care assistants, or PCAs.  This caregiver fills a niche between companions and home care aides.

2003 Continued growth was the watch phrase for 2003.  The spring season kicked off VNA’s first ever Capital Campaign dedicated to raising funds to build an inpatient Hospice Center. Under the leadership of Campaign Chairman, Andy Goebel, a goal was set to raise 1.5 million dollars.  This dream was realized when The John and Betty Charlier Hospice Center opened its doors to patients December 10, 2003.

This marked a significant commitment to VNA’s mission and placed VNA in the role of providing around-the-clock on-site medical care for the first time in its long history.  To help support this inpatient unit, a part-time Medical Director was added to VNA’s employee roster.  The first patient was admitted December 12, 2003.

Growth was occurring in VNA’s technology resources as well with the Agency moving forward into a Windows-based computer environment.  A decision was made to bring      on-board technological support and the role of Systems Administrator was created.

Community Wellness continued to grow with the provision of over 14,000 flu immunizations.  As the country responded to the military call, VNA supported our troops by providing immunizations to the men and women in the Army Reserves as they prepared for active duty in Iraq.

The growth VNA experienced in 2003 was evident in the services provided to patients, the outreach to our communities, and in the expansion of staff.  By the close of 2003,   VNA   had grown to include a total of 250 staff members.

The VNP Geriatric Care Consulting Service began offering consulting services for seniors. The consultant’s role encompasses the following four steps: assessment; creation of a care plan; arrangement of services; and ongoing care management.

2004 The year of 2004 was highlighted with several significant steps into the future.  VNA’s Hospice Center was renamed The John and Betty Charlier Hospice Center in honor of the Charliers’ completion of the building fund and substantial contribution toward the one million dollar goal for an Endowment Fund to support ongoing operational costs of the Center.

As the year progressed, VNA joined the technology boom and worked with GrayLoon Marketing Group to redesign the agency’s website.  With the completion of the revision, viewers are now able to make on-line referrals and complete an on-line application among other enhancements.

Internal restructuring to meet the changing face of health care resulted in the creation of the Restorative Services Department.  This transition combined the Therapy, Medical Social Services, Home Care Aide and Extended Care components of the agency into a multidisciplinary structure.

The flu immunization outreach program of 2004 was the shortest on record for the agency. One-half of the nation’s flu serum was tainted during manufacture causing the Center for Disease Control to initially restrict the available serum to only those individuals who fell in a high-risk category.  VNA responded to the community by pooling resources and provided 14,000 immunizations in just eight (8) days.

In December, the VNA Board of Directors and management staff participated in a two-day Strategic Planning session lead by nationally known home health care strategist, Stephen Tweed.  Working together, a renewed strategic plan was developed to provide future guidance and direction for the agency’s future.

VNP’s strategic plan was revised and updated to reflect the continued focus on Exceptional Customer Experiences with an emphasis on Exceptional Employee Experiences in recruitment and retention.

In April—following the retirement of Karen Bennett—Gloria Horton was appointed as the VNP Executive Director by the Visiting Nurse Plus Board of Directors.

Effective December 1, VNP established an on-site office at Solarbron–The Pointe, an independent living community located on the west side of Evansville, to more effectively serve the needs of its aging residents.

2005 With the blueprint of an ambitious and forward-thinking strategic plan setting the stage for future advances, 2005 actually began by celebrating the past with the dedication in January of Legacy Hall–a decade-by-decade display of the Agency’s evolution since 1888.  This project was prominently featured on the front page of the July 4^th edition of the Evansville Courier and Press.  Additional recognition was given to the Agency as a recipient of the 2005 Family Friendly Award for Work Environment and Scheduling, sponsored in part by the Evansville Area Human Resource Association.

Profound technological advance was the focus for most of the staff throughout the year as financial and clinical documentation systems were converted, bringing the Agency fully into the electronic age.  Point-of-care documentation on laptop computers forever changed not only documentation procedures, but also internal communication and culture.  Computer and telephone upgrades brought internal data and voice communication to new levels of speed and efficiency.  Geographic separation of the offices was further erased by linking all locations with one phone system, thus enabling all employees to call desk-to-desk regardless of physical location.  In support of these significant changes, VNA’s Information Technology staff was expanded.

After only two (2) years of operation, The John and Betty Charlier Hospice Center achieved notable successes in patients served, community recognition, and growing donations.  VNA’s hospice and home care programs both exceeded growth expectations for the year.  Mental health and wound care specialty teams also gained momentum and further distinguished the Agency from competitors in the market.  Community-based immunization clinics again offered flu and pneumonia vaccines, as well as a new program offering meningitis vaccines to incoming college freshman.

Hurricane Katrina devastated the Gulf coast in late summer.  The financial success of the Agency enabled a $5,000 contribution to be made to help home health and hospice organizations recover from the effects of this storm.  Much closer to home, in November an F3 rated tornado tore a large path of destruction through Vanderburgh and Warrick counties in Indiana, creating more challenges for visiting personnel attempting to meet the patient needs in these areas.

2006 After two years of positive growth, Agency admissions, patients served, and hospice care             days leveled off to result in the Agency’s third busiest year of the decade. The competitive landscape continued to change with an increase in both home health (32 total) and hospice providers (11 total) in our service area.

Technology improvements continued in 2006.  Carewatch, a new system of care documentation completed by using the telephone, was implemented in November.  This system afforded the Agency’s home care aides the opportunity to lessen their paperwork responsibilities while providing timely patient communication and care reminders.

An initiative began in 2006 to evaluate and compare new technology under the umbrella term of “telehealth” monitoring.  The goal of utilizing such equipment is to evaluate health indicators between nursing visits; thereby decreasing costly re-hospitalizations and improve patient outcomes.

The Agency’s fund development initiative continued its growth with donations for the Hospice Center and Hospice Endowment Fund leading the effort.  For the first time in the Agency’s history as a United Way agency, donor contributions of $430,000 exceeded funding from the United Way.

In November, the Agency and community came together for a bittersweet retirement celebration for Executive Director Cissy Kraft, who had served as leader, friend, and home health advocate for 22 years.  Cissy had served as a nurse liaison, nursing   supervisor, and assistant director prior to her appointment to the Executive Director’s post in 1984.  In recognition of her leadership, VNA employees raised money to name the 2000 panel in Legacy Hall in her honor.

Steve Starke was named to succeed Cissy in the position of Executive Director. Steve started with VNA in 1980 as the Agency’s first social worker, and one of its first male employees.  He later served as Home Health Aide Manager, Director of Programs, Director of Corporate Services, Director of Human Resources, and most recently,       Director of Development.

2007 The Agency began to prepare in earnest for Medicare’s forthcoming “Pay For Performance” reimbursement system by focusing on measurable patient outcomes such as lengths of stay and reductions in acute care hospitalizations.  Initiatives also included a staffing structure change that created interdisciplinary care teams to improve clinical outcomes. A new performance appraisal process was implemented to encourage consistency and measurable results.

Mid-year, Medicare announced revisions to the existing prospective payment reimbursement system, including cuts totaling 11.8% over four (4) years.  Management work groups were developed to generate response strategies in the areas of finance, patient assessment, and supply management.

An additional threat to eliminate the annual inflation increase prompted an agency-wide   advocacy effort resulting in over 850 letters being sent to legislators.  Representative Brad Ellsworth responded by visiting the Agency to learn about home care and hospice and          VNA’s Flu Program staff provided his shot. Ultimately, the market basket increase for     2008 was retained, while other reductions were implemented.

Other visitors to the agency throughout the year included Evansville Mayor Jonathan Weinzapfel and best selling author and end-of-life advocate, Stephen Kiernan, who wrote          the book Last Rights.

Specialty services, such as Wound Care and Mental Health were the focus of Agency marketing efforts in promoting VNA’s competitive advantages.

In July, the Legacy Societies Donor Recognition Program was launched, with nine (9) levels of recognition tied to historical figures important in VNA’s history.  On October 16, over 200 Legacy Society donors were welcomed to the Agency for a recognition event, featuring donated gourmet food, wine, entertainment, and tours of the Charlier Hospice Center and Legacy Hall.

Under the theme of “A Quarter-Century of Caring”, VNP celebrated its 25^th anniversary with several events for employees, board members, customers, referral sources, the Solarbron community, vendors and more. A time capsule was also created with instructions to open it in the year 2032 during VNP’s 50^th anniversary.

2008 The year 2008 was marked by adaptation to industry and reimbursement change, and numerous challenges resulting from these changes.  Patient related revenue of $10,797,000 reached the lowest point in seven (7) years, due to the culmination of several factors including: shorter lengths of stay, more specific admission criteria, staff turnover, and community perceptions resulting from these changes.  In response to this revenue trend, two (2) rounds of staff reductions were implemented in May and July.  Additionally, management and support staff schedules were reduced to a seven-hour workday in July.  All offices remained “open” to the public until 4:30 p.m. through the implementation of a call-center at the Evansville office.

In August, a team from the Eldorado office planned the first ever “5 K for Compassionate Care” to raise money for VNA services in Illinois.  In addition to positive publicity, more than $5,000 was raised in support of the mission.

VNA’s Flu Program was scaled back by 40% in response to growing availability of flu vaccinations and market saturation.  Clinics were still held at VNA offices and offered at some public sites.

An intensified marketing outreach effort for The Charlier Hospice Center included an online virtual tour, DVD copies of this tour distributed to referral and community contacts, billboards, and a physician open-house to mark the five-year anniversary of the Center’s opening.

In November, VNA’s Telehealth program was launched with five (5) monitors in Gibson and Vanderburgh counties funded by grants from the Vanderburgh and Gibson Community Foundations, Alcoa, and AT&T.

Amidst severe economic woes facing the country as well as the Agency, a special year-end appeal to supporters of the Charlier Hospice Center was undertaken with more than $35,000 raised.

Due to financial constraints, the Annual Christmas Breakfast was not held for the first time since it began in the 1950’s.

With the purchase of Health Watch by Royal Philips Electronics, all VNP Health Watch personal emergency response units were replaced with Philips Lifeline Medical Alert Service units during a two-week transition period that affected approximately 375 customers.

VNP closed its on-site office at Solarbron–The Pointe in March of this year. Solarbron officials determined that by hiring their own personnel, they could provide the same type of non-medical and nursing services that VNP had offered residents since 2004. VNP continued to offer semi-monthly on-site foot clinics to Pointe residents.

Due to the low volume of private pay business–and the high costs of supplementing under-funded government services–Visiting Nurse Plus officials made the decision to discontinue services in Perry and Spencer Counties and to close the VNP Tell City office, effective October 31.

2009 Proposed health care reform dominated the political scene and resulted in ambiguity as to the impact on home health and hospice reimbursements.  After an initial “promise date” for legislation    for August, the date was later moved to October and still no definite plan emerged from Congress            by year-end.  In general, 2009 brought a huge shift in the national political environment.

Much of the early part of 2009 was spent in preparing for changes which occurred during             the last quarter of the year related to implementing electronic scheduling for the     visiting staff, Medicare’s revised Hospice Conditions of Participation, and patient       assessment       tools (OASIS-C).

A “just in time” patient supply delivery system to maximize efficiencies and control of supplies was also implemented in stages throughout the year with positive results and            savings of $34,844 in inventory costs realized by year-end.  The process and vendor for this service, Home Health Solutions, were tested during a severe ice storm in January   2009,   during which even the most rural patients received their supplies in a timely manner.

On May 1^st, VNA’s long-standing pension plan with Mutual of America was transitioned to a 401K plan.  This positive change resulted in increased opportunities for employees to save for their retirement years and allows potential employees an easier to recognize pension benefit during the recruitment process.

In July, a first-time fundraising event called, “The Art of Caring” was held at VNA’s main office in Evansville.  Artists featured in The Charlier Hospice Center were invited to showcase their artistry and meet patrons of the event.  Tours, dinner, a testimonial by a Hospice family, and an auction of donated artwork completed the event, with over 200 guests attending.  More than $35,000 in net proceeds was raised for funding of The Charlier Hospice Center.

The Teleheath program was expanded from the Princeton office to Eldorado and later       Tell City.  Eldorado’s program was funded with an employee-initiated appeal to area             businesses and donors which resulted in more than $6,000 raised.  The Tell City program was funded with successful grants to area businesses and community foundations.

This year also brought a worldwide pandemic from an H1N1 flu strain, resulting in a program to inoculate VNA staff and patients in specified tiers, according to health department criteria.  VNA held public seasonal flu clinics at only office-based sites.

Gloria Horton, VNP Executive Director, served on a task force comprised of members of the Indiana Association for Home and Hospice Care and the Indiana Home and Hospice Foundation to develop the Indiana Home Care Work Force Training Project. The project is designed to create career opportunities for direct care providers and to address Indiana’s future caregiver shortage by offering excellent and consistent training, career advancement, and recognition opportunities             throughout the State. The Caregiver Training Manual developed by the task force and published by Pearson Education, a Fortune 500 publishing company, was accepted by Ivy Tech Community College as its curriculum for training caregivers at its sites throughout Indiana.

VNP nurses assisted the Vanderburgh County Health Department with the administration of vaccines for the H1N1 virus, which was classified as having pandemic proportions by the World Health Organizations. Clinics were conducted by the Health Department at schools and various public sites.