Starting in the 1880s, public health nurses traveled to patients' homes, caring for the sick, teaching family members how to provide care in their absence, suggesting ways to improve health, and comforting the dying.  As the nurse's role in saving lives became more apparent, insurance companies started to offer visiting nurse services to their working- and middle-class policyholders faced with illness.  By 1916 these services were available to more than 10 million policyholders in the United States, creating the first nationwide system of insurance payment for home-based care.